ANTIMALARIAL DRUG POLICY IN MALAWI

In the Shire Valley, southern Malawi, longitudinal malariometric data collected over 2 years (1993-1995) showed a high prevalence of severe anaemia in pregnant women and their infants. The prevalence of Plasmod ium falciparum in primigravidae at first antenatal visit was 39%, and 30% of all primigravidae were severely anaemic (i.e. with < 8 g haemog lobin/dl). In infants, anaemia had its onset at about 8 weeks of age. In the population studied, childhood deaths were frequently related to malaria and severe anaemia. A central aim of any malaria-control stra tegy in the area should be to reduce the prevalence of malaria-related anaemia. In this context, the criteria for the choice of a first-line therapeutic antimalarial drug in Malawi have been based on haematolog ical and parasitological cure. A change in recommendation for first-li ne therapy in Malawi, from chloroquine to sulphadoxine-pyrimethamine, was influenced by poor haematological recovery and clinical response a fter chloroquine use, as well as a high level of parasitological resis tance to chloroquine in vivo. The criteria for changing drug choice ar e not well established and, if haematological criteria are to be used, nutritional anaemias and deficiency in glucose-6-phosphate dehydrogen ase might influence interpretation. Effective antimalarial drug policy should be based on internationally agreed criteria and should be tail ored to local needs.