title: The mortality consequences of the continued use of chloroquine in Africa: experience in Siaya, western Kenya.
abstract: In spite of increasing resistance, chloroquine remains the primary drug for treatment of malaria in most sub-Saharan African countries. We evaluated the effect of drug treatment policy on the case-fatality rates of children, adjusting for differing distributions of malaria and severe anemia. In 1991, 63% of children were treated with chloroquine while the remaining 37% were treated with a regimen that would eliminate and clear parasitemia. Case-fatality rates were 13% and 4.1%, respectively; the proportion of deaths attributable to chloroquine treatment was 69%. The trend in case-fatality rates for malaria decreased as an increasing proportion of children received an effective treatment regimen; adjusted malaria case-fatality rates were 5.1%, 3.6%, and 3.3% in 1992, 1993, and 1994, respectively, when 85% of children in 1992 and 97% of children in 1993-1994 received effective therapy. These 4 years of data provide strong evidence that continued use of chloroquine in areas with resistance is contributing to excess Plasmodium falciparum-related deaths.
authors.affiliation: Malaria Section, Epidemiology Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 34031, USA. jzucker@health.nyc.gov
authors.forename: Jane R
authors.initials: JR
authors.lastname: Zucker
authors.forename: Trenton K
authors.initials: TK
authors.lastname: Ruebush
authors.forename: Charles
authors.initials: C
authors.lastname: Obonyo
authors.forename: Juliana
authors.initials: J
authors.lastname: Otieno
authors.forename: Carlos C
authors.initials: CC
authors.lastname: Campbell
mesh_terms: D000818:Animals; D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use*; D002675:Child, Preschool; D002738:Chloroquine / Q000494:pharmacology / Q000627:therapeutic use*; D004351:Drug Resistance; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000401:mortality*; D018512:Parasitemia / Q000188:drug therapy / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000187:drug effects*; D015995:Prevalence; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D002738:Chloroquine