Health Policy and Planning; 4(1): 17-28
© 1989
review-article |
Chloroquine resistant malaria in Africa: the challenge to health services
Takemi Programme in International Health, Harvard School of Public Health, Boston and Instituto Nacional de Saude Maputo, Mozambique
1Correspondence: Dr Allan Schapira, Sector de malaria, Instituto Nacional de Saude, C.P. 264, Maputo, Mozambique.
For years, malaria in Africa has been managed mainly by treatment of all fever cases with chloroquine. Resistance to this drug is now spreading rapidly over all of tropical Africa and in many areas of Eastern and Central Africa more than 50% of infections are resistant. This has important public health implications, although most infections can still be cured clinically with chloroquine. All the alternative drugs are very vulnerable to the development of resistance. Governments may choose between drug policies which are more or less restrictive and more or less demanding for the resources of the health care system. There are no economic barriers to relying much more on microscopy for guidance in malaria treatment than is presently the case, but at the same time it must be acknowledged that alternative drugs are becoming so cheap that economic mechanisms alone may not restrict their use.
Any policy aiming to reduce malaria mortality without the greater development of resistance must be based on a strengthening of all components of health services. It is necessary to create national units with reference laboratories for this purpose. Nationally and internationally, much more attention must be given to the case management of resistant malaria than has been the situation so far.