Objective: To identify patient-related risk factors of chloroquine res
istance.Design: A case control study. Subjects: Plasmodium falciparum
infected school children were followed prospectively for 7 days for th
e detection of chloroquine resistance. Cases were 38 individuals with
chloroquine resistant infections. Controls were 125 individuals with c
hloroquine sensitive infections. Cases were compared with controls wit
h respect to previous or current study factor levels. Subjects were re
cruited from randomly selected schools which were stratified for area.
Study location was in North Guadalcanal, Solomon Islands. Outcome mea
sure: Treatment failure of chloroquine in standard dosage (25 mg/kg).
Follow-up period was 7 days. Results: Logistic regression resulted in
5 independent significant predictors of chloroquine resistance, obtain
ed simultaneously with the diagnosis of malarial infection: (i) Young
age (odds ratio (OR) for age <7 years: 7.1; 95% confidence interval (C
I): 2.5-25.0; OR per year increase after the age of 5 years: 0.8; 95%
CI: 0.6-0.9). (ii) High parasite density (OR for > 1000/mu l: 5.0; 95%
CI: 2.0-10.6; OR per 500 parasites/mu l increase: 1.3; 95% CI: 1.1-1.
7). (iii) Normal spleen size (OR: 4.0; 95% CI: 1.5-10.8). (iv) Malnutr
ition (OR: 4.9; 95% CI: 1.8-13.2). (v) Presence of gametocytes in the
thick smear (OR: 3.0; 95% CI: 1.1-8.0). Conclusion: The identified ris
k factors are easily measureable without special equipment. They may b
e useful for health workers in the Solomon Islands, even in remote are
as, to identify Plasmodium falciparum infected individuals at high ris
k for chloroquine resistance before a treatment decision is made.