Resistance of Plasmodium falciparum malaria to chloroquine is widespread in eastern Afghanistan

After two decades of war and conflict in Afghanistan, the public-health sys tem is in disarray and malaria has re-emerged as a major disease, with Plas modium falciparum malaria becoming increasingly common. The limited healthc are services that are available are mainly delivered by non-governmental or ganizations in collaboration with the Ministry of Health. Although chloroqu ine (CQ) remains the official first-line treatment against P. falciparum ma laria, there is little information on the severity or distribution of resis tance to this drug in Afghanistan. In-vivo surveys, co-ordinated by the Mal aria Reference Centre in Jalalabad, were therefore performed to determine t he frequency and grades of CQ resistance in the three eastern provinces of Kunar, Nangarhar and Laghman. Of the 142 cases enrolled in the study, only 47 (33%) were sensitive. Most of the cases (55%) showed RI resistance but R II/RIII resistance was not uncommon (11%). The prevalence of resistance app eared similar in children and adults, in males and females, and in each of the three provinces investigated. Gametocyte carriage post-treatment was el evated in the resistant cases, iis in neighbouring Pakistan, the resurgence of P. falciparum in Afghanistan is probably associated with the transmissi on and spread of chloroquine-resistant strains. The first-line therapy used against P. falciparum malaria must be changed in order to reverse this tre nd.