A community perspective on the efficacy of malaria treatment options for children in Lundazi District, Zambia

In 1996, Zambia's Ministry of Health made sulfadoxine-pyrimethamine (SP) av ailable as a second-line antimalarial. SP differs from chloroquine (CQ) in ways that might affect parents' acceptance of the drug, resulting in possib le delays in seeking treatment if parents perceive SP as less efficacious. A multifaceted study consisting of a rapid community ethnographic assessmen t to examine local attitudes and perceptions toward malaria, a 14-day in vi vo drug efficacy study comparing clinical and parasitological efficacy of C Q, SP, and SP with paracetamol (PCM) in children under five, and a qualitat ive study examining caretakers' perceptions of drug efficacy helped to guid e implementation of the new drug policy. The rapid ethnographic study indic ated that the community was aware of malaria as an illness best treated wit h modern medicines, particularly CQ. The drug efficacy study demonstrated a 25% level of clinical failures compared to none with SP, and 30% of the ch ildren treated with CQ had either RIII or RII parasitological failures wher eas none occurred in children treated with SP Most parents perceived that t heir children were improving and that the drugs were working. Parents in th e SP groups were most pleased and readily accepted SP as a new drug. The ad dition of PCM did not improve perceptions of SP efficacy, contradicting con ventional wisdom regarding the need for direct antipyretic action for paren ts to perceive a drug as efficacious. The combined results reflected a comm unity that was in the beginning stages of evaluating a new malaria therapy mostly unknown to them. Perceptions of efficacy of CQ were beginning to shi ft, indicating a readiness for accepting anew drug based on its shown biolo gical efficacy Parasitological and clinical failure rates reinforced the ne ed to fully implement the changed national policy as soon as possible, and to consider a change in first-line therapy.