The effect of paracetamol on the parasitological diagnosis of Plasmodium falciparum malaria

Abstract

Up until the present time, malaria represents an immense public health problem worldwide with a significant morbidity and mortality rate in many developing countries including Sudan. The use of antipyretics and analgesics in the settings of malaria has been a matter of contention over a vast period of time. Now, it is widely believed among the public and some health professionals in Sudan that the antipyretic and analgesic paracetamol disturbs the accuracy of the parasitological diagnosis of malaria. This study investigates the magnitude and effects of that belief through a descriptive study and examines the actual effect of paracetamol on the parasitological diagnosis of falciparum malaria through a clinical trial. This is a conjoined study that includes a prospective and descriptive study and a randomized, placebo-controlled, double-blind, and parallel-group clinical trial. The descriptive study included 846 participants from various states in Sudan. The targeted study subjects were the public and health professionals and the study was conducted utilizing an online-based questionnaire. The clinical trial included 325 patients with uncomplicated falciparum attending two primary healthcare outpatient clinics in Gezira state, Sudan. The patients were randomly allocated to receive either placebo tablets or 500 mg of oral paracetamol after the first blood smear sample was taken. The second blood smear samples were taken 2 h after taking treatment. Parasite density estimation and other parasitological data were obtained from each sample before and after treatment. The majority of the public thinks that paracetamol affects the parasitological diagnosis of malaria (76.21%, n = 330/433). Personal experience and family and friends were the most dominant information sources for the public (31.20% and 28.01% respectively), while scholarly articles were the most common source of information for the health professional group (45.03%, n = 186/413). No significant differences between the parasitological findings acquired before and after taking the treatments among both the paracetamol group (P = 0.22) and the placebo group (P = 0.12). The parasite density mean for the paracetamol group differed by 16.31 P/μL after taking paracetamol, while the placebo group parasite density mean differed by 15.34 P/μL. The treatments did not inflict impacts on the advanced microscopic features of Plasmodium falciparum blood smears. Paracetamol does not affect the parasitological diagnosis of falciparum malaria.