Abstract

PIP: Chloroquine resistance is spreading across Africa. Trape et al. examined mortality patterns in 3 areas of Senegal over a period of 11 years, during which chloroquine resistance first emerged there. There has been a considerable increase in malaria-specific mortality in all 3 areas, areas which differ in levels of malaria endemicity and health care provision. In each case, the increase began when chloroquine resistance was first noted. The risk of death from malaria in 2 of the areas more than doubled, while in the 3rd area, Mlomp, a moderate transmission area with unusually good health care, the risk of malaria mortality among children under age 5 years rose 8-fold. Trape et al. attribute these increases in mortality exclusively to chloroquine resistance. These data demonstrate that chloroquine resistance is already a problem in West Africa, while other epidemiologists believe that malaria mortality is also on the rise in East Africa. Guidelines are needed on the levels of resistance at which countries should consider a switch to alternate first-line drugs. The data also indicate that case treatment is central to controlling malaria in Africa. Effective, affordable drugs capable of delaying the onset of resistance need to be used particularly where the core of the problem is, in rural communities with minimum access to health facilities.