CHLOROQUINE IN AFRICA - CRITICAL-ASSESSMENT AND RECOMMENDATIONS FOR MONITORING AND EVALUATING CHLOROQUINE THERAPY EFFICACY IN SUB-SAHARAN AFRICA

Chloroquine-resistant malaria is a major public health threat in sub-S aharan Africa. While a few countries have already replaced chloroquine as the first-line therapy for uncomplicated malaria or are in the pro cess of doing so, other countries are faced with the complicated task of assessing the current status of drug resistance, making national po licy-level decisions about whether to replace chloroquine or not, and initiating a monitoring system to track changes in the efficacy of mal aria therapy. There is currently no standardized approach for collecti ng and interpreting data on therapy efficacy. There is also no agreeme nt as to how much chloroquine resistance or treatment failure is accep table and how much warrants a change in treatment policy. Using data c ollected in 10 sites in eastern and southern Africa between 1990 and 1 996, we have assessed the therapeutic response to chloroquine and inve stigated predictors of clinical successor failure. Based on these expe riences and analyses, a standardized protocol for in vivo studies of t he efficacy of malaria therapy and for approaches to designing monitor ing systems are proposed. The process of making policy-level decisions based on data collected by these systems is also discussed.