CHLOROQUINE-RESISTANT FALCIPARUM-MALARIA IN AN AREA OF RISING ENDEMICITY IN ZIMBABWE

Response of Plasmodium falciparum to chloroquine treatment was assesse d in vivo in 219 malaria cases from eight villages in a formerly hypoe ndemic area of Zimbabwe experiencing a malaria outbreak. Seven (3%) of the cases were fully sensitive to chloroquine while 182 (83%) exhibit ed chloroquine-resistant responses. Of the 182 chloroquine-resistant c ases 74 (41%) showed RT resistance while 108 (59%) exhibited RII-RIII resistance. In-vivo follow-up was not completed to Day 28 in the remai ning 30 (14%) of the malaria cases, which were therefore either fully sensitive or RI resistant. In 23 (11%) of the malaria cases pyrexia an d increasing parasitaemia occurred between Day 3 and Day 7 after treat ment. Mean parasite clearance time was 5.8 days (s.d. 2.89 days) in pa tients who were cleared of asexual parasitaemia. In all but 1 (0.5%) o f the chloroquine-resistant infections, asexual parasites were cleared by Day 7 following treatment with the sulphadoxine/pyrimethamine comb ination (Fansidar). This study showed an acute problem of chloroquine resistance in an area of Zimbabwe. It is recommended that the drug pol icy be modified to allow distribution of limited stocks of Fansidar to the local clinics for restricted use on documented chloroquine treatm ent failures within 7 days.