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

JANE R. ZUCKER 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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TRENTON K. RUEBUSH II 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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CHARLES OBONYO 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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JULIANA OTIENO 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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CARLOS C. CAMPBELL 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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