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THE MORTALITY CONSEQUENCES OF THE CONTINUED USE OF CHLOROQUINE IN AFRICA: EXPERIENCE IN SIAYA, WESTERN KENYA

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  • 1 Malaria Section, Epidemiology Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta; Clinical Research Centre, Kenya Medical Research Institute, Nairobi, Kenya; Siaya District Hospital, Siaya, Kenya
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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.

Author Notes

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@health.nyc.gov
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