A total of 473 children were screened out of which 294 were positive for malaria parasite. One hundred and forty seven were assigned to each treatment group of Artemether Lumefantrine (Coartem) and sulfadoxine/pyrimethamine plus chloroquine (SP + CQ). One hundred and thirty one (131) completed the study in the Coartem group while 135 completed in the SP + CQ group. Coartem group had adequate clinical and parasitological response and high sensitivity while SP + CQ on the other hand had lower efficacy, high treatment failure and resistance.
Combination therapy using Artemether/Lumefantrine was found to be superior to that of sulfadoxine/pyrimethamine with chloroquine in the treatment of uncomplicated childhood malaria. Sulfadoxine/pyrimethamine + CQ clear symptoms faster especially on days 1 and 2 only in those that are sensitive to it. The decreased efficacy of Coartem noted in our preliminary observation mentioned earlier could be due to poor adherence to time of administration. The 8 hours and subsequent 12 hourly intervals after the first dose are not strictly observed in unsupervised patients; hence the minimum inhibitory concentration of the drug needed to clear the parasite may not be achieved.
1. Artemisinin based combination therapy as recommended by WHO and Federal Ministry of Health of Nigeria, should be the mainstay for the treatment of uncomplicated falciparum malaria.
2. Patients should be educated on the need to adhere strictly to the time and interval of drug administration.
3. All health centers should be monitored and discouraged from the use of Monotherapy in treatment of uncomplicated falciparum malaria, as this leads to development of resistant strains. Awareness should be created among medical practitioners and the general population.
4. The recommended antimalaria should be made available and at affordable rate to all patients for treatment of uncomplicated malaria.
5. Emphasis should be placed on simple Laboratory investigation for malaria parasite detection by provision of simple side room laboratories using microscopy in rural areas.
6. Further multi centred research is necessary to determine the sensitivity and resistance pattern to various cheap and affordable antimalarial agents.
7. Preventive measures against malaria infection such as the use of insecticide treated bed nets and/or window nets should be advocated in homes, schools and dormitories to curb the incidence of malaria.
REFERENCES
1. WHO. Global Antimalarial Drug programme data base: AFRO available at Http/mosquito.ho.int/amdp/amdp_afro.(accessed December 14, 2006).
2. Wernsdorfer WH. Coartemether (artemether and lumefantrine): an oral antimalarial drug. Expert Rev Anti infects Ther 2004:2:181-96.
3. RBM. United Nations decades to Roll Back Malaria 2001 – 2010: Malaria in Africa available at http/www.rollbackmalaria.org.
4. Hendrickse RG. Parasitic Diseases. In: Hendrickse RG. Editor. Pediatrics and Child Health in the Tropics. Oxford: Blackwell Scientific Publication, 1991:675- 710
5. World Health Organization. Management of severe malaria: A practical handbook 2nd edition Geneva: WHO 2006:69
6. Pitmang SL, Thatcher TD, Madaki JKA, Egah DZ, Fischer PR. Comparison of Sulfadoxine-pyrimethamine with and without Chloroquine for uncomplicated malaria in Nigeria. Am J Trop Med Hyg 2005; 72(3)263- 66.
7. The Nigeria Bulletin of Epidemiology 1999;1(3):1-2
8. Sowunmi A, Fateye BA. Plasmodium, falciparum gametocytaemia in Nigerian children before, during and after treatment with anti malaria drugs. Trop Med Int Health; 8:783-792.
10. WHO renew call for effective malaria treatment. News Med Net April 2004.
11. Research Highlights promising malaria treatment strategic (Health) UNDP April 2005:1-7.
12. Ogala WN. Malaria In: Azubuike JC, Nkangineme KEO. Editors. Paediarics and Child Health in a Tropical Region. Owerri; African Educational service 1999:426-37.
13. Marsh K. Malaria disasters in Africa. Lancet 1998; 352:294.
14. White NJ, Nosten F, Looagreesuwan S. Averting a malaria disaster. Lancet 1999; 353:1965-67.
15. Heico MM, Joost K, David WK, Tjip SV. Chloroquine and sulphadoxine-pyremethamine resistant falciparum malaria in vivo - a pilot study in rural Zambia. Trop Med Int Health 2000; 5(10):692-695.
16. Philip J, Radlofe PD, Wernsederfer W, Kremser PG. Follow up of the susceptibility of plasmodium falciparum to anti malaria in Gabon. Am J Trop Med Hyg 1998; 58(5):612-618.
17. UNICEF/WHO. Malaria prevention and treatment. The Prescriber 2000: 18-19.
18. Greenwood B. Malaria mortality and morbidity in Africa. Bull world Health Organ 1999; 77:617-8.
19. WHO News letters, Quarterly Bulletin of WHO Lagos Nigeria 2000; 15(2).
20. Federal Ministry of Health National anti malaria treatment policy. National malaria and vector control Division, Abuja Nigeria 2005:
21. Sowunmi A, Fateye BA. Gametocyte sex ratios in children with asymptomatic, recrudescent pyrimethamine-sulphadoxine-resistant plasmodium falciparum malaria. Am Trop Med Parasitol 2003; 97:671-82.
22. Molta NB, Oguche S, Pam SD, Omalu IC, Afolabi BM, Odujoko JB, et al.
Amodiaquine treatment of uncomplicated malaria in children in an area of chloroquine-resistant plasmodium falciparum in North-Central Nigeria. Am Trop Med Parasitology 2003, 97:663-9.
23. WHO. The Africa malaria report. Geneva: World Health Organization, 2003.
24. WHO Position of WHO; roll back malaria department of malaria treatment policy. Geneva: World Health Organization, 2003.
25. Seidlen LV, Bojang K, Jones P, Juffa S, Pinder M, Obaro SA. Randomized Control trial of artemether/Benflumetol A new antimalaria and pyrimethamine/suphadoxine in the treatment of uncomplicated falciparum malaria in African Children. Am J Trop Med Hyg 1998:638-644.
26. Piola P, Fogg C, Bajunirwe F, Biraro S, Gandesso S, Babigumira J, et al.
Supervised versus Unsupervised intake of six-dose artemether-Lumefantrin for treatment of acute uncomplicated plasmodium falciparum malaria in Mbarara Uganda: a randomized trial. Lancet 2005; 365:1467-73.
28. Stuedke SG, Mpimbaza A, Kamya MR, Nzzubara BK, Dorsey G, Rosenthal PJ, Combination treatment for uncomplicated falciparum malaria in Kampala, Uganda: randomized clinical trial. Lancet 2004; 364:1950-57.
29. White NJ. Preventing Antimalaria drug resistance through combination. Drug resistance up dates 1998;1:3-9.
30. Peter BB, Etling, Meek S. Combination therapy for malaria in Trica: hype or hope, Bulletin of the world Health Organization 2000; 78 (12):137-85.
31. Faroog U, Mahajan RC. Drug resistance in malaria. J vector Borne Disease 2004 Sep- Dec; 41(3-4):45-53.
32. Warhust D. New development (2001): Chloroquine in plasmodium falciparum.
Drug resistance updates 4:141.
33. Wellems TE, Plowe. Chloroquine-resistant malaria. J inf Dis 2001; 184:770.
34. Wongsrichanalai C, Pickard AL, Wernderter WH, Mesnick SR. Epidemiology of drug resistant malaria. Lancets infect Dis 2002;135:241-3.
35. Federal Ministry of Health of Nigeria RBM Baseline data for monitoring and evaluation 2001:30.
36. Goodman CA, Coleman PG, Mills AJ, The Cost effectiveness of antimalaria prevention in sub-Saharan Africa. Am J Trop Med Hyg 2001; 64 (1-2 Suppl):
45-46.
37. Malaria situation Analysis Document, Federal Ministry of Health of Nigeria 2000.
38. Federal Ministry of Health Nigeria. National Guidelines and strategies for malaria prevention and control during pregnancy. May 2004.
39. Burchard G, Houtsmann R, Werndarfer W, Detrich M. Plasmodium falciparum malaria: resistance to chloroquine but sensitive to mefloquine in Gabon. A prospective invitro study. Trop Med Parasitol 1998; 35:20-35.
40. WHO. The Africa malaria report. Geneva: World Health Organization, 2004:
2-4.
41. WHO. Position of WHO; roll back malaria, department of malaria treatment policy. Geneva: World Health Organisation, 2005: 6.
42. Guerin PJ Oliaro P, Nosten F. Malaria: current status of control, diagnosis, treatment, and a proposed agenda for research and development. Lancet infect Dis 2002; 2:264-573.
43. Marsh K, Makani J. Malaria. In: Parry E, Godfrey R, Mabey D, Gill G.
Editors. Principles of Medicine in Africa. 3rd Edition. Singapore. Cambridge University Press, 2004:284-86.
44. Finch RG, Moss P, Jeffries DJ, Anderson J. Infectious diseases, tropical medicine and sexually transmitted diseases. In: Kumar P, Clark M. Editors.
Clinical Medicine, 5th edition. Edinburgh. WB Saunders; 2003:98-99.
45. Artemisinin Available on http//www.en/wikepedia.org/wiki/Artemisinin
46. Petras JM, Kylc DE, Gettayacamin M, Young GD, Bauman RA, Webster HK, et al. Arteether: risk of two weeks adminsiration in Macaca Mulata. Am J trop Med Hyg. 1998; 56:390-396.
47. Acton N, Roth RJ. On the Conversion of dihydroartemisinic acid into artemisinin. J Org Chem 1998; 57:3610-3614.
48. Cumming JN, Ploypradith P, Posner GH. Antimalarial activity of artemisinin (ginghaosu) and related trioxanes: mechanism(s) of action. Advances in pharmacology 1998; 37:253 – 297.
49. White NJ. Preventing antimalaria drug resistance through combination. Drug resistance updates 1998;1:3-9
50. Prince RN. Effects of artemisinin derivatives on malaria transmissibility.
Lancet 1999; 347:1654-1658.
51. Vugt MV, Wilariatana P, Gemperdi B. Efficacy of six doses of artemether – Lumefantrine (Benflumetol) in multi drug-resistant plasmodium falciparum malaria. Am J Trop Med Hyg 60 (1999); 6:936-42.
52. Ro DK, Paradise EM. Production of the antimalarial drug precursor artemininic acid in engineered yeast. Nature 2006; 440:940-943.
53. Vikas D, Rao KV, Lakshmi NM. Current status of artemisinin and its derivatives as anti-malarial drugs. Life sciences 2000; 66(4):279-300
54. Basco LK, Bickil J, Ringwald P. In vitro activity of lumefantrine (Benflumetol) against clinical chemotherapy, Sept 1998;42(9):2347-51.
55. Drugs used in parasitic diseases. WHO model prescribing information 1998;
World Health Organization, Geneva; 32-38.
56. Martin SK, Oduola AM, Milhous WK. Reversal of chloroquine resistance in plasmodium falciparum by verapamil. Science 1999; 235:899-901.
57. Foote SJ, Kyle DE, Martin RK. Several alleles of multidrug resistance gene are closely linked to chloroquine resistance in plasmodium falciparum. Nature 1998; 345:255-8.
58. Okey CN, Ziba C, Kazemba P, Chitsulo L, Wirima JJ, Kumwenda N, et al.
Efficacy of sulfadoxine/pyrimethamine for plasmodium falciparum in Malawian children under five years of age. Trop Med Int Health 1998; 1 (2):231-235.
59. Grissen E, Ashruf G, Lamboo M, Kager PA. In vivo efficacy study pf amodiquine and sulfadoxine/pyrimethamine in Kibwezi, Kenya and Kigoma Tanzania. Trop Med Int Health 1999; 2(1):205-9.
60. Lell B, Lehman LG, Kremsner PG. Malaria chemotherapy trial at a minimal effective dose of mefloquine/sulfadoxine/pyremethamine compared with equivalent doses of sulfadoxine/pyrimthamine or mefloquine alone. Am J Trop Med Hyg 1998; 59(5):619.
61. Oguche S, Molta NB, Pam SD, Omalu ICJ, Afolabi BM, Odujoko JB, et al.
Comparative Assessment of the clinical performance of chloroquine and
infection in Plateau State. An open Randomized study of 109 children with acute uncomplicated malaria. Nig J Paed 2004; 31(3):87-92.
62. Delvon P, Mayombo J, Elisa N. Sulfadoxine-pyrimethamine for the treatment of Plasmodium Falciparum malaria in Gabonese children. Transactions of the Royal Society of Tropical Medicine and Hygiene 2000; 94(2):188-90.
63. Nzila AM, Mberu EK, Sulo J, Watkin WM. Towards an understanding of the mechanism of pyrimethamine-sulfadoxine resistance in plasmodium falciparum: genotyping of dihydrofolate reductase and dihytropetroate synthase of Kenyan parasites. Antimicrobial agents and chemotherapy 2000;
44(4):991-6.
64. Tinto H, Zoungrana EB, Coulibaly SO, Quedraoga JB, Traore M, Guiguemde TR, et al. Chloroquine and sulphadoxine-pyrimethamine efficacy for uncompleted malaria treatment and heamatological recovery in children in Bobo-Dioulasso, Burkina Faso during a 3-year period 1998-2000. Trop Med Int Health 2002;7(11):925-8.
65. Falade CO, Salako LA, Sowunmi A, Oduola AM, Larcier P. Comprative efficacy of halofantrine, chloroquine and sulfadoxine/pyrimethamine for treatment of acute uncomplicated falciparum malaria in Nigerian children.
Trans R Soc Trop Med Hyg 1998; 91(1):58-62.
66. Butcher GA. Artimalaria drugs and mosquito transmission of plasmodium. Int J Parasitol 2000; 27:975-987.
67. Buckling AG, Taylor LH, Carlton JMR, Read AF. Adaptive changes in plasmodium transmission strategies following chloroquine chemotherapy.
Parasitology 1999; 23:68-69.
68. Lines JD, wilkes JJ, Lysiomo EO. Human malaria infectiveness measured by age specific sporozoite rates in Anopheles gambiae in Tanzania. Parasitology 1998; 104:167-177.
69. Tipathi R, Puri SK, Dutta GP. Sodium B-Artelinate. A new potential Gametocide. Exp Parasitol 1999; 52:251-254.
70. Trape JF, Pison G, Preziosi MP, Enel C, Desgrees du Lou A, Delaunay V, et al. Impact of Chloroquine resistance on malaria mortality. CR Acad Sci III 1998; 321(8):689-79.
71. Getu OA, Steve B. Chloroquine resistance of Plasmodium falciparum in Ethiopia and Eritrea. Trop Med Int Health 1998;1(6):810-815.
72. Boyang KA, Schneidar G, Obaro SK Jaffer S, Pinder M. A trial of chloroquine or fansidar alone for the treatment of uncomplicated malaria in Gambian children. Trans R Soc Trop Med Hyg 1998;92(1):73-7
73. Rowland M, Durrani N, Hewitt S, Sondrop E. Resistance of falciparum malaria to chloroquine and sulfadoxine-pyrimethamine in Afghan refugee settlements in Western Pakistan: surveys by the general health services using simplified in vivo test. Trop Med Int Health 1998; 2(11):1049-1056.
74. Trape JF. The public health impact of chloroquine resistance in Africa. Am J Trop Med Hyg 2001;64(1,2):12-17.
75. Rukaria – Kaumbitho RM, Ojwang SB. Oyieke JB. Resistance to chloroquine therapy in pregnant women with malaria parasitemia. Int J Gynaecol Obstet 2001;53(3):235-41.
76. Mutabingwa TK, Anthony D, Heller A, Hallet R, Ahmed J, Drekeley C, Greenwood MB, Whitty JMC. Amodiaquine alone, amodiaquine + sulphadoxine – pyrimethamines amodiaquine + artesunate and artemether – lumefantrine for outpatient treatment of malria in Tanzanian children: a four-arm randomized effectiveness trial. Lancet 2005; 365:1474-1480.
77. Zongo I, Dorsey G, Rouamba N, Tinto H, Dokomajilar C, Guiguemde RT, Rosenthal PJ, Quedraogo JB. Arthemether-Lumfantrine versus amodiaquine plus sulfadoxine-pyrimethamine for uncomplicated falciparum malaria in Burkina Faso: a randomized non-inferiority trial. The Lancet 2007; 369:491-498.
78. Thomas C, Davis GB, Andrew MK, Frederick HM. The Artemisinin based Combination in the treatment of uncomplicated falciparum malaria in Colombia. Am J Trop Med Hyg 2003; 5(2):122- 4
79. Meek S. treatment of Falciparum malaria with Quinine and tetracycline or combined mefloquine/sulfadoxine/pyrimethamine on the Thai-Cambodian border. Am J Trop Med Hyg 1998;35;246-250.
80. Mc Intosh HM, Greenwood BM. Chloroquine or Amodiaquine combined with sulfadoxine-pyrimethamine as a treatment for uncomplicated malaria a system review Annals of Trop Med Parasitol, 1998;93:265-270.
81. White NJ. Assessment of the pharmacodynamic properties of antimalaria drugs in vivo Antimalarial agents and chemotherapy, 1999; 41:1413-1422.
82. Lorenx VS, Kalifa B, Peter J, Shabor J, Margaret P, Steven O, et al. A randomized controlled trial of artemether/Benflumetol, a new antimalaria and pryrimethamine/sulfadoxine in the treatment of uncompliated falciparum malaria in Africa Children. Am J Trop Med. Hyg 1998; 638-644.
83. Chessbrough M. Malaria Parasites. Medical Laboratory Manual for Tropical Countries, 2nd edition, Butterworth Heineman, Cambridge 1991; 221-251.
84. Meremikwu M, Alaribe A, Ejemot R, Oyo-ita A, Ekenjoku J, Nwachukwu C, et al. Artemether-Lumefantrine versus artesunate plus amodiaquine for treating uncomplicated childhood malaria in Nigeria: randomized controlled trial.
Malar J 2006; 5: 43
85. Ekanem OJ, Ezedinachi ENU, Molta NB, Watila JM, Chukwuani CM, Meremikwu MM, et al. Treatment of Malaria in North-Eastern and South Eastern Nigeria: A population study of Mefloquine, sulphadoxine, pyrimethamine combination (MSP) vs chloroquine. West Afr J Med 2001;
19:293-297.
86. Jakel FJ. Sample size, Randomization and Probability theory. In: Jekel FJ, Katz LD, Elmore GJ. Editors. Epidemiology, Biostatic and Preventive Medicine. 2nd Edition. Philadelphia. WB Sanders. 2001: 194-198.
87. Center for Disease Control. Atlanta, Georgia 2002; Epi info version 3.4.2.
88. WHO Anti-malarial drug combination therapy: Report of WHO technical consultation (Document WHO/CDS/RBM/2001/35) Geneva..
89. Flowe CV, Doumbo OK, Djimde A. Chloroquine treatment of uncomplicated plasmodium falciparum malaria in Mali.: parasitologic resistance versus therapeutic efficacy. Am J Trop Med Hyg 2001; 64:242
90. Depoortere E, Guttmann JP, Presse J. Efficacy and effectiveness of the combination of sulfadoxine-pyrimethamine and a 3 day-course of artesunate for the treatment of uncomplicated falciparum malaria in a refuge settlement in Zambia. Trop Med lnt Health 2005; 10:135-9.
91. Redd SC, Kazembe PN, Luby SP, Nwanyawu O, Hightower AW, Ziba C, et al.
Clinical algorithm for treatment of plasmodium falciparum malaria in children.
Lancet 1998; 342:223-227.
92. Mayxay M, Khanthavong M, Lindegardh N, Keola S, Barends M, Pongvonsa T, et al. Randomized Comparison of chloroquine plus sulfadoxine-pyrimethamine versus Artesunate plus mefloquine in Treatment of uncomplicated falciparum malaria in the Lao People’s Democratic Republic.
Clinical infectious diseases 2004; 39:1139-1142
93. Kathryn M, Michael M, Thomas N, Williams S. Falciparum malaria: current therapeutic challenges. Current opinion in infectious disease 2004; 17(5):405.
94. Alonso PL, Abacassamo F, Aponte JJ, Enosse S, Gomex FX, Thomson R.
Efficacy of chloroquine, antequine, sulphadoxine-pyrimethamine and combination therapy with artesunate in Mozambican children with non complicated malaria. Trop Med Int Health 2004 Feb; 9 (2):200-208.
95. Menard D. Madji N. Manirakiza A, Djalle D, Koula MR, Talarman A. Efficacy of chloroquine, amodiaquine, sulfadoxine-pyrimethamine, chloroquine sulfdoxine-pyrimethamine combination and amodiaquine sulfadoxine pyrimethamine combination in central African children with noncomplicated malaria. Am J Trop Med Hyg, May, 2005; 72(5):581-585.
96. Henry MC, Eggelte TA, Watson P, Bakker DA, Kluim J. Response of Childhood Malaria to chloroquine and fansidar in area of intermediate chloroquine resistance in Cote d’Ivoire. Trop Med Int Health 1998; 1(5):610-615.
97. Premji Z, Minjas JN, Schiff CJ. Chloroquine resistant plasmodium falciparum in central Tanzania. A Challenge to the continued strategy of village based chemotherapy for malaria control. Trop Med Parasitol 2000; 1:47-8.
98. Shretta R, Omunbo J, Rapuodu B, Snow RW. Using evidence to change antimalaria drug policy in Kenya. Trop Med Int Health 2000; 5:755-64.
99. Falade CO, Ogundele AO, Yusuf BO, Ademowo OG, Ladipo SM. High efficacy of two artemisinin-based combination (artemether-Lumefantrine and artesunate plus amodiaquine) for acute uncomplicated malaria in Ibadan, Nigeria. J Trop Med Int Health, May 2008; 13(5): 635-643.
100. Fidock DA, Nomura T, Talley AK. Mutation in P. Falciparum digestive vacoule transmembrane protein PFCRT and evidence for their role in chloroquine resistance. Mol Cell 2000; 6:861-71.
PLATEAU STATE SPECIALIST HOSPITAL JOS
APPENDIX I
APPENDIX II CONSENT FORM
We are conducting a research on the effectives of Artemether/Lumefantrine and comparing it with that of chloroquine with fansidar in treatment of uncomplicated malaria in children.
Your child/ward has been chosen to participate because he/she has been identified as having uncomplicated malaria.
If you agree that the child can participate we are going to do the following:- i. Examine your child routinely.
ii. Prick his/her finger after cleaning with spirit to take blood for malaria parasite to know what we are treating and know how much blood he/she has.
Please note that:-
i. Routine examination is not painful
ii. Finger prick is painful but will not harm your child.
iii. Some children react to artemether/lumefantrin or fansidar or chloroquine by either vomiting or body rashes or body itching. This condition can be treated but we will take necessary precaution to prevent it from happening. If it does we will treat it.
The laboratory test will be done free of charge
All drugs will also be given free of charge.
Your child participation in the study is strictly voluntary. You have the right to chose not to participate and it will not affect your future health care of other services to which you are entitled.
Do you have any question to ask about this study?
“I voluntarily accept that my child/ward will participate in this study”.
Name of subject:………..
Name of parent/guardian:………
Signature of parent/guardian:………..
APPENDIX III
Assessment form on comparison of artemether/lumefantrine and chloroquine with sulfadoxine/pyremethamine in uncomplicated malaria in children.
1. PERSONAL DATA
(a) Hospital Number……… (b) Date………
(c) Age……… (d) Sex……… (e) Weight………...
(f) Informant……… Group identity………
2. DAY ‘O’ ASSESSMENT
(a) Symptoms (b) Signs
(i) Fever (Yes/No) (i) Pallor……….
(ii) Diarrhoea (Yes/No) (ii) Hydration Status…………
(iii) Anorexia (Yes/No) (iii) Temperature………..
(iv) Vomiting (Yes/No) (iv) PR/HR………
(v) Cough (Yes/No) (v) Chest……….
(vi) Convulsion (Yes/No) (vi) Abdomen………..
(c) Laboratory Finding
(i) MP……… (ii) PCV………..
(iii) Level of Parasitaemia………..
3. DAY 1 ASSESSMENT
(a) Symptoms (b) Signs
(i) Fever (Yes/No) (i) Pallor……….
(ii) Diarrhoea (Yes/No) (ii) Hydration Status…………
(iii) Anorexia (Yes/No) (iii) Temperature………..
(iv) Vomiting (Yes/No) (iv) PR/HR………
(v) Cough (Yes/No) (v) Chest……….
(vi) Convulsion (Yes/No) (vi) Abdomen………..
4. DAY 2 ASSESSMENT
(a) Symptoms (b) Signs
(i) Fever (Yes/No) (i) Pallor……….
(ii) Diarrhoea (Yes/No) (ii) Hydration Status…………
(iii) Anorexia (Yes/No) (iii) Temperature………..
(iv) Vomiting (Yes/No) (iv) PR/HR………
(v) Cough (Yes/No) (v) Chest……….
(vi) Convulsion (Yes/No) (vi) Abdomen………..
5. DAY 3 ASSESSMENT
(a) Symptoms (b) Signs
(i) Fever (Yes/No) (i) Pallor……….
(ii) Diarrhoea (Yes/No) (ii) Hydration Status…………
(iii) Anorexia (Yes/No) (iii) Temperature………..
(iv) Vomiting (Yes/No) (iv) PR/HR………
(v) Cough (Yes/No) (v) Chest……….
(vi) Convulsion (Yes/No) (vi) Abdomen………..
(c) Laboratory Finding
(i) MP……… (ii) Level of Parasitaemia…….
(iii) % of Day ‘O’………...%
6. DAY 7 ASSESSMENT
(a) Symptoms (b) Signs
(i) Fever (Yes/No) (i) Pallor……….
(ii) Diarrhoea (Yes/No) (ii) Hydration Status…………
(iii) Anorexia (Yes/No) (iii) Temperature………..
(iv) Vomiting (Yes/No) (iv) PR/HR………
(v) Cough (Yes/No) (v) Chest……….
(vi) Convulsion (Yes/No) (vi) Abdomen………..
(c) Laboratory Finding