Malaria chemoprophylaxis in sickle cell disease

Abstract

Background: Malaria illness is associated with sickle cell crises. Health professionals often recommend life-long malaria chemoprophylaxis for people with sickle cell disease living in malaria endemic areas. It is therefore important we have good evidence of benefit.

Objectives: To assess the effects of routine malaria chemoprophylaxis in people with sickle cell disease.

Search strategy: We searched the Cochrane Infectious Diseases Group trials register (March 2003), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to March 2003), EMBASE (1988 to March 2003), and LILACS (2001, 39a Edition CD-ROM), and reference lists of articles. We contacted individual researchers working in sickle cell disease research to identify any unpublished trials.

Selection criteria: Randomized and quasi-randomized controlled trials comparing chemoprophylaxis with any antimalarial drug given for a minimum of 3 months compared to placebo or no intervention.

Data collection and analysis: Two reviewers independently applied the inclusion criteria.

Main results: One quasi-randomized controlled trial from Uganda gave antimalarial drugs and antibiotic prophylaxis together to 126 children with homozygous sickle cell disease. The authors reported the intervention group had fewer episodes of malaria, dactylitis, and higher mean haemoglobin values.

Reviewer's conclusions: There is very little direct evidence to support or refute giving routine chemoprophylaxis in sickle cell disease in areas where malaria is endemic.