TITLE:
The Role of Oral Chloroquine Treatment in the Home-Based Management of Childhood Malaria in Jos, Nigeria: Biochemical, Hematological, Nutritional, and Co-Infection Perspectives
AUTHORS:
Segun Afolabi Olomu, Samuel Yusuf Gazuwa, Titilayo Johnson, Selina Nnuaku Okolo
KEYWORDS:
Plasmodium falciparum, Oral Chloroquine, Co-Morbidity, Parasitemia, Hematological Markers, Biochemical Indices
JOURNAL NAME:
Advances in Infectious Diseases,
Vol.14 No.4,
December
19,
2024
ABSTRACT: Research Background: Malaria, predominantly caused by Plasmodium falciparum, continues to be a leading cause of morbidity and mortality among children under five years of age in sub-Saharan Africa. Malaria remains a significant public health challenge in Nigeria, particularly in regions where access to healthcare facilities is limited. Home-based management of malaria has emerged as a critical strategy to reduce disease burden, enabling timely treatment at the community level. Chloroquine, once the cornerstone of malaria treatment, is still utilized in some settings due to its affordability, availability, oral administration, and historical effectiveness against Plasmodium species. However, the widespread emergence of chloroquine-resistant strains of Plasmodium falciparum has necessitated a reevaluation of its role in malaria management. This study investigates the therapeutic effectiveness of oral chloroquine in home-based management, focusing on its ability to reduce parasitemia and alleviate clinical symptoms. Additionally, the study assessed the influence of protein nutritional status and bacterial/viral co-infections on malaria outcomes among children under five years in Jos, Nigeria, providing insights into its current relevance in resource-limited settings. Research Objective: Given the historical use of chloroquine and emerging reports of chloroquine-sensitive strains, this research aims to evaluate the therapeutic effectiveness of oral chloroquine in the home-based management of childhood malaria in Jos, Nigeria, by assessing its impact on parasitemia, symptom alleviation, biochemical and hematological profiles, nutritional status, and interactions with co-infections while providing evidence-based insights to inform policy, community health practices, and contemporary malaria control strategies. Methods: This cross-sectional and analytical study evaluated the role of oral chloroquine in the home-based management of childhood malaria in Jos, Nigeria. A total of 93 children under five years of age, presenting with fever and confirmed Plasmodium falciparum parasitemia, were recruited from two hospitals in Jos. Participants were stratified into three groups: children treated with chloroquine at home prior to hospital presentation, untreated children with uncomplicated malaria, and untreated children with severe malaria. Caregivers were surveyed to assess the use of chloroquine as a first-line home treatment, including dosage and timing of administration. Ethical approval was obtained from the Jos University Teaching Hospital (JUTH) Ethical Committee, and informed consent was secured from caregivers before sample collection and interviews. Parasitemia levels were measured to correlate parasite density with clinical outcomes. Comprehensive assessments included biochemical analysis of serum creatinine, liver enzymes, and protein levels to evaluate organ function and metabolic status. Hematological parameters, including hemoglobin concentration and red blood cell (RBC) count, were measured to assess malaria severity and anemia. Nutritional status was evaluated through anthropometric measurements and serum protein analyses. Co-infections with bacterial and viral pathogens were identified using microscopic examination of blood samples. Statistical analyses were performed to identify significant associations between chloroquine treatment, clinical outcomes, and biochemical indicators. Results: Children treated with chloroquine demonstrated significantly lower parasitemia levels (18.13%) compared to untreated children with uncomplicated malaria (34.35%) and those with severe malaria (43.57%). Hemoglobin levels were notably higher in the chloroquine-treated group (9.60 g/dL) compared to the untreated groups, indicating a reduced burden of malaria-induced anemia. Body temperatures were significantly lower among chloroquine-treated children, underscoring its efficacy in fever reduction. Bacterial co-infections were identified in 54.35% of malaria cases, emphasizing their role in exacerbating disease severity. Liver and kidney function tests revealed no significant differences between the groups, indicating that chloroquine treatment did not result in hepatic or renal toxicity. Additionally, all participants exhibited adequate nutritional status, with no evidence of protein-energy malnutrition. Conclusion: The findings of this study highlight the significant role of oral chloroquine in the home-based management of childhood malaria in Jos, Nigeria. Children treated with chloroquine exhibited substantially lower parasitemia levels and higher hemoglobin concentrations compared to untreated children, demonstrating its effectiveness in reducing parasite burden and mitigating malaria-induced anemia. Additionally, chloroquine treatment was associated with lower body temperatures, reflecting its efficacy in fever control. Bacterial co-infections were present in over half of the malaria cases (54.35%), underscoring their potential contribution to disease severity and the need for integrated management strategies. Importantly, liver and kidney function tests showed no significant differences among the groups, indicating that chloroquine use did not lead to hepatic or renal toxicity. Furthermore, all participants maintained adequate nutritional status, with no signs of protein-energy malnutrition. These results support the continued use of chloroquine as a viable option in the home-based management of uncomplicated malaria while highlighting the importance of addressing co-infections to improve clinical outcomes.