Sickle-cell disease (SCD) patients are at high risk of
developing malaria which is a major contributor to morbidity
and mortality in this disease. In Senegal, malaria transmission is
high during rainy season, between July and October, and it was
noted that sickle-cell crisis are frequent during this period. Then
we carried out a double-blind randomized controlled trial to
compare the impact of monthly sulfadoxine-pyrimethamine
(SP) during the high-transmission season versus placebo on
malaria incidence and morbidity of sickle-cell anemia. Sixty
(60) SCD patients were randomized either to receive three
intermittent preventive treatment (ITP) with SP or placebo
using the random permutation table with nine elements. The
drug was administrated as follows: sulfadoxine 25 mg/kg and
pyrimethamine 1.25 mg/kg and this treatment was given once
during the following months: September, October, and November.
Overall four episodes of malaria disease were
diagnosed, all these cases in the placebo arm. Thus, overall
prevalence was 6.6% and there was no other case of malaria in
the SP arm during the study period. Parasitological diagnosis
confirmed the presence of Plasmodium falciparum in all four
cases. No patient death was encountered during the study. SP
treatment was well tolerated as only one patient (1.6%) in the
SP arm reported pruritis. A significant reduction of patients'
complaints (p=002) and blood requirements (p=0.001) was
noted in the SP group; whereas, no impact was observed on
vaso-occlusive crisis and hospitalization occurrence. Malaria
prophylaxis by monthly intake of SP during the transmission
period of the parasite reduced the prevalence of malaria and
was safe in SCD patients leaving in malaria endemic area.