DESCRIPTION OF HAEMATOLOGICAL TREND OF VIVAX MALARIA TREATED WITH CHLOROQUINE AND PRIMAQUINE IN EASTERN AFGHANISTAN LAGHMAN PROVINCE.

Background: Malaria is a major cause of morbidity and recognized as a heavy burden on health system in Afghanistan.,95% of confirmed cases are due to P. vivax which is challenging because of the non-specific nature of the signs and symptoms, relapses of the infection weeks to months after the initial attack for up to about 2 years and requires radical treatment but still not well-administered due to fear of hemolysis as according the literature the Mediterranean variant of G6PD is common in many ethnic groups in Afghanistan, Primary objective: To determine the normal hematological response, following P. vivax infection and treatment in malaria endemic population in Afghanistan. Secondary objectives: 1) To measure the hemoglobin difference before and after treatment. 2)To assess independent risk factors associated with anaemia. 3)To assess the time to recovery from anaemia after administration of chloroquine+primaquine and compare this with chloroquine alone 4) To assess the effect of primaquine mg/kg dose on hemoglobin reduction and time to anaemia recovery. 5) To describe evidence of hemolysis in patients receiving primaquine. 6) To estimate the prevalence of G6PD deficiency. Method: This was a single-arm observational cohort study for descriptive prospective analysis of clinical, Laboratory, and demographic data from outpatients with P. vivax malaria. Those who had parasitological confirmed Plasmodium vivax with thick blood smear examination who were meeting study inclusion criteria, gave consent and enrolled in the study, had their G6PD status, CBC including the WBC count, hemoglobin values, and platelets counts performed and after a careful clinical assessment the treatment prescribed according to the malaria treatment protocol (14). Results: Overall 221 patients have been recorded, however, the target were 250 patients but, 29 of them were recorded as defaulters. Adherence to 14 days PQ therapy in G6PD normal patients were excellent (100%), all patient in intervention group fully completed 14 days PQ therapy. Conclusion: Anti-relapse therapy is recommended for all confirmed PV cases. In the current situation, G6PD RDT can be used at lower health facilities. Acknowledgements: I as the author of this study, express my gratitude to my supervisors at Department of Public Health, Maulana AzadUniversity, Dr Latika Nath Sinha, Ms. Bhawana Sathi, Dr Abhishek Lohra, Dr Nitin Joshi and Dr Pr. Amila Vivek and all guest professors who taught the conduct of research and provided their valuable comments while writing up this paper. Likewise, I acknowledge the support of my co-supervisor, Dr. Ghulam Rahim Awab, MD, MPH Lecturer of Nangarhar university of Afghanistan for his support during complete course of MPH program, reviewing the report and valuable assistance.