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In spite of increasing resistance, chloroquine remains the primary drug for treatment of malaria in most sub-Saharan African countries. We evaluated the effect of drug treatment policy on the case-fatality rates of children, adjusting for differing distributions of malaria and severe anemia. In 1991, 63% of children were treated with chloroquine while the remaining 37% were treated with a regimen that would eliminate and clear parasitemia. Case-fatality rates were 13% and 4.1%, respectively; the proportion of deaths attributable to chloroquine treatment was 69%. The trend in case-fatality rates for malaria decreased as an increasing proportion of children received an effective treatment regimen; adjusted malaria case-fatality rates were 5.1%, 3.6%, and 3.3% in 1992, 1993, and 1994, respectively, when 85% of children in 1992 and 97% of children in 1993–1994 received effective therapy. These 4 years of data provide strong evidence that continued use of chloroquine in areas with resistance is contributing to excess Plasmodium falciparum-related deaths.
Received October 12, 2000. Accepted for publication May 2, 2002.
Acknowledgments: This paper is published with the permission of the Director, Kenya Medical Research Institute. We thank Johnson Awino, Solomon Twala, and Lucy Otieno for their participation in this study.
Financial support: This work was partly supported by the World Health Organization (Global Programme on AIDS, Division of Diarrheal and Acute Respiratory Disease Control, and the Programme for Research and Training in Tropical Diseases).
Authors’ addresses: Jane R. Zucker, New York City Department of Health and Mental Hygiene, Immunization Program, 2 Lafayette Street, 19th Floor, New York, NY 10007; Trenton K. Ruebush II, Centers for Disease Control and Prevention, Division of Parasitic Diseases, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 34031; Charles Obonyo, Research Fellow, New England Medical Center, 750 Washington St., # 041, Boston, MA 02111; Juliana Otieno, Kisumu Provincial Hospital, PO Box 849, Kisumu, Kenya; Carlos C. Campbell, UNICEF–Health Section, 3 UN Plaza, New York, NY 10017.
Reprint requests: Dr. Jane R. Zucker, New York City Department of Health and Mental Hygiene, Immunization Program, 2 Lafayette Street, 19th Floor, New York, NY 10007, Telephone: 212-676-2248, Fax: 212-676-2258, E-mail: jzucker{at}health.nyc.gov
* Use of trade names is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services.
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