The pathogenesis of post-malaria anaemia is multifactorial. Iron supplementation remains the
mainstay of management of moderate and severe anaemia; however the management of mild anaemia
(Hb 80-110g/l) is problematic as population supplementation studies of children in malaria
endemic areas demonstrate adverse effects in children with mild anaemia. We hypothesize that
the anti-inflammatory, anti-malarial and anti-macrophageal iron loading effects of
chloroquine could make it a useful drug in the management of mild post malaria anaemia. To
test this hypothesis, we plan to randomize children (aged 12 months to 6 years) with post
malaria anaemia (Hb 70-110g/l) to receive a standard anti-malarial treatment, co-artemether .
All children with parasitologic cure after three days on treatment will be randomised to
receive either weekly chloroquine or weekly placebo starting from day 10 till day 90. By
comparing the curve of haemoglobin change between day 3 and day 30 in the placebo arms of the
two groups, we will test the effect of chloroquine vs. ACT treatment on macrophageal iron
loading and release in acute clinical malaria. By comparing the haemoglobin change between
day 3 and day 90 between the weekly chloroquine arms and the weekly placebo arms we will test
the longer-term anti-inflammatory and anti- malarial effects of weekly chloroquine
prophylaxis. In addition to the primary endpoint, we plan to assess potential mechanisms of
action by determining parasite clearance, peripheral cytokine production and iron flux