title: Trends in antimalarial drug use in Africa.
abstract: Resistance to chloroquine (CQ) and sulphadoxine-pyrimethamine (SP) led the World Health Organization (WHO) to recommend changes in national drug policies. The time between policy changes and their implementation profoundly affects program impact. We developed a model based on data on antimalarial treatments, extracted from household surveys and national antimalarial policy information from the literature. Drug use in each country during the time period 1999-2011 and the trend in reduction of CQ use after policy change were estimated. The SP use estimates were correlated with the prevalence of a molecular marker associated with SP resistance. There was no spatial pattern in the country-level rate of reduction of CQ use, after policy change. In East Africa SP drug use was strongly correlated to resistance. If artemisinin resistance spreads to, or emerges in, Africa this methodology will be a valuable tool to estimate actual drug use and its impact on changes in drug efficacy.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Flegg
authors.forename: Charlotte J E
authors.initials: CJE
authors.lastname: Metcalf
authors.forename: Myriam
authors.initials: M
authors.lastname: Gharbi
authors.forename: Meera
authors.initials: M
authors.lastname: Venkatesan
authors.forename: Tanya
authors.initials: T
authors.lastname: Shewchuk
authors.forename: Carol
authors.initials: C
authors.lastname: Hopkins Sibley
authors.forename: Philippe J
authors.initials: PJ
authors.lastname: Guerin
mesh_terms: D000349:Africa / Q000453:epidemiology; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D002738:Chloroquine / Q000627:therapeutic use*; D004338:Drug Combinations; D004351:Drug Resistance / Q000187:drug effects; D006306:Health Surveys; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D015233:Models, Statistical; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000502:physiology; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; C031327:artemisinin; D011739:Pyrimethamine
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