A SYSTEMATIC-APPROACH TO THE DEVELOPMENT OF A RATIONAL MALARIA TREATMENT POLICY IN ZAMBIA

Despite the spread of chloroquine-resistant Plasmodium falciparum thro ughout sub-Saharan Africa, chloroquine (CQ) remains the first-line tre atment for uncomplicated infection in most countries. To assess the ef ficacy of CQ and sulphadoxine-pyrimethamine (SP) in Zambia, studies us ing a standardized 14-day in vivo test were conducted at 6 geographica lly representative sites. Febrile children less than or equal to 5 yea rs of age were treated with standard doses of CQ or SP and monitored f or parasitological failure (using modified WHO criteria) and clinical failure (fever with parasitaemia after completion of therapy). RII/RII I (high to moderate level) parasitological failures were identified in 34% to 70% of CQ-treated children (total N = 300) at the 6 sites and clinical failures in 31% to 48%. SP testing at 2 sites identified RII/ RIII failures in 3% and 17% of children and only 1 clinical failure at each site. Because of the high levels of CQ resistance identified in these trials, the Ministry of Health of Zambia convened a national con sensus meeting which recommended that Zambia's national malaria treatm ent policy be modified to make SP available at ail health facilities f or use in persons who fail initial therapy with CQ. In addition, selec ted sites, staff, and the methodology from these studies were used to implement a sentinel surveillance system for antimalarial drug efficac y. This systematic approach to antimalarial drug efficacy testing coul d be easily replicated in other countries seeking to reassess their ma laria treatment policies.