Volume 68, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 -related deaths.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, 1993. Implementation of the Global Malaria Control Strategy. Report of a WHO Study Group on the Implementation of the Global Plan of Action for Malaria Control 1993–2000. Technical Report Series no. 839. Geneva: World Health Organization.
  2. Bloland PB, Lackritz EM, Kazembe PN, Were JBO, Steketee R, Campbell CC, 1993. Beyond chloroquine: implications of drug resistance for evaluating malaria therapy efficacy and treatment policy in Africa. J Infect Dis 167 : 932–937. [Google Scholar]
  3. Greenwood BM, 1987. Asymptomatic malaria infections—do they matter? Parasitol Today 3 : 206–214. [Google Scholar]
  4. Zucker JR, Lackritz EM, Ruebush TK, Hightower AW, Adungosi JE, Were JBO, Metchock B, Patrick E, Campbell CC, 1996. Childhood mortality during and after hospitalization in western Kenya: effect of malaria treatment regimens. Am J Trop Med Hyg 55 : 655–660. [Google Scholar]
  5. Hennekens CH, Buring JE, 1987. Epidemiology in Medicine. Mayrent SL, ed. Boston: Little, Brown and Co., 66–73.
  6. Greenberg AE, Ntumbanzondo M, Ntula N, Mawa L, Howell J, Davachi F, 1989. Hospital-based surveillance of malaria-related paediatric morbidity and mortality in Kinshasa, Zaire. Bull World Health Organ 67 : 189–196. [Google Scholar]
  7. White NJ, Krishna S, 1989. Treatment of malaria: some considerations and limitations of the current methods of assessment. Trans R Soc Trop Med Hyg 83 : 767–777. [Google Scholar]
  8. World Health Organization, Division of Control of Tropical Diseases, 1994. Antimalarial drug policies: data requirements, treatment of uncomplicated malaria and management of malaria in pregnancy. Report of an informal consultation, Geneva, March 14–18, 1994. WHO/MAL/94.1070.
  9. World Health Organization, Division of Control of Tropical Diseases, 1996. Assessment of therapeutic efficacy of antimalarial drugs for uncomplicated falciparum malaria in areas of intense transmission. WHO/MAL/96.1077.
  10. Schapira A, Beales PF, Halloran ME, 1993. Malaria: living with drug resistance. Parasitol Today 9 : 168–173. [Google Scholar]
  11. Sudre P, Breman JG, McFarland D, Koplan JP, 1992. Treatment of chloroquine-resistant malaria in African children: a cost-effectiveness analysis. Int J Epidemiol 21 : 146–154. [Google Scholar]
  12. Campbell CC, 1991. Challenges facing antimalarial therapy in Africa. J Infect Dis 163 : 1207–1211. [Google Scholar]
  13. White NJ, Nosten F, Looareesuwan S, Watkins WM, Marsh K, Snow RW, Kokwaro G, Ouma J, Hien TT, Molyneux ME, Taylor TE, Newbold CI, Ruebush TK, Danis M, Greenwood BM, Anderson RM, Olliaro P, 1999. Averting a malaria disaster. Lancet 353 : 1965–1967. [Google Scholar]
  14. Hogh B, Gamage-Mendis A, Butcher GA, Thompson R, Begtrup K, Mendis C, Enosse SM, Dgedge M, Barreto J, Eling W, Sindin RE, 1998. The differing impact of chloroquine and pyrimethamine/sulfadoxine upon the infectivity of malaria species to the mosquito vector. Am J Trop Med Hyg 58 : 176–182. [Google Scholar]
  15. Brandts CH, Wernsdorfer WH, Kremsner PG, 2000. Decreasing chloroquine resistance in Plasmodium falciparum isolates from Gabon. Trans R Soc Trop Med Hyg 94 : 554–556. [Google Scholar]
  16. Greenberg AE, Lobel HO, 1990. Mortality from Plasmodium falciparum malaria in travelers from the United States, 1959 to 1987. Ann Intern Med 113 : 326–327. [Google Scholar]
  17. Marsh K, Forster D, Waruiru C, Mwangi I, Winstanley M, Marsh V, Newton C, Winstanley P, Warn P, Peshu N, Pasvol G, Snow R. 1995. Indicators of life-threatening malaria in African children. N Engl J Med 332 : 1399–1404. [Google Scholar]
  18. World Health Organization, 1990. Severe and complicated malaria. Warrell DA, Molyneux ME, Beales PF, eds. Trans R Soc Trop Med Hyg 84 (suppl. 2) : 1–65. [Google Scholar]
  19. Barutwanayo M, Bassalia D, Birabuza A, Delacollette C, Keita M, Madji N, Maiga AS, Maoude H, Ndihokubwayo H, Niangue J, Lemine SMOM, Yazipo ED, 1993. Malaria control in Africa: guidelines for the evaluation of national programs. U.S. Agency for International Development and U.S. Department of Health and Human Services, Atlanta, Publication No. 099-4243.
  20. Greenwood BM, Greenwood AM, Bradley AK, Tulloch S, Hayes R, Oldfield FSJ, 1987. Deaths in infancy and early childhood in a well-vaccinated, rural, East African population. Ann Trop Paediatr 7 : 91–99. [Google Scholar]
  21. Trape JF, Pison G, Preziosi MP, Enel C, Desgrées du Loû A, Delaunay V, Samb B, Lagarde E, Molez JF, Simondon F, 1998. Impact of chloroquine resistance on malaria mortality. C.R. Acad Sci Paris, Life Sciences 321 : 689–697. [Google Scholar]
  22. Marsh K, 1998. Malaria disaster in Africa. Lancet 352 : 924–925. [Google Scholar]
  23. Hogh B, Thompson R, Hetzel C, Fleck SL, Kruse NAA, Jones I, Dgedge M, Barreto J, Sinden RE, 1995. Specific and nonspecific responses to Plasmodium falciparum blood-stage parasites and observations on the gametocytemia in schoolchildren living in a malaria-endemic area of Mozambique. Am J Trop Med Hyg 52 : 50–59. [Google Scholar]
  24. Del Nero L, Nebie I, Soudouem G, Pietra V, 1994. Chloroquine and sulfadoxine/pyrimethamine sensitivity in Burkina Faso. In vivo sensitivity of Plasmodium falciparum to chloroquine and sulfadoxine/pyrimethamine in Burkina Faso. Trop Geogr Med 46 : 8–10. [Google Scholar]
  25. Kremsner PG, Winkler S, Brandts C, Neifer S, Bienzle U, Graninger W, 1994. Clindamycin in combination with chloroquine or quinine is an effective therapy for uncomplicated Plasmodium falciparum malaria in children from Gabon. J Infect Dis 169 : 467–470. [Google Scholar]
  26. Mharakurwa S, Mugochi T, 1994. Chloroquine-resistant falciparum malaria in an area of rising endemicity in Zimbabwe. J Trop Med Hyg 97 : 39–45. [Google Scholar]
  27. Premji Z, Minjas JN, Shiff CJ, 1994. Chloroquine-resistant Plasmodium falciparum in coastal Tanzania. A challenge to the continued strategy of village-based chemotherapy for malaria control. Trop Med Parasitol 45 : 47–48. [Google Scholar]
  28. Schreuder HW, Wolters FL, de Vries G, Wetsteyn JC, 1993. Prospective in-vivo study of chloroquine resistance of Plasmodium falciparum in Zambian under-fives. Trop Geogr Med 45 : 15–17. [Google Scholar]

Data & Media loading...

  • Received : 12 Oct 2000
  • Accepted : 02 May 2002

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error