Patterns of chloroquine use and resistance in sub-Saharan Africa: a systematic review of household survey and molecular data

Malaria Journal

Research

Anne EP Frosch¹  Miriam K Laufer²  Meera Venkatesan³ 

[1] Center for Infectious Disease and Microbiology Translational Research, Department of Medicine, University of Minnesota, McGuire Translational Research Facility, 6th Street SE, Minneapolis, MN, USA;Center for Vaccine Development, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD, USA;Howard Hughes Medical Institute, University of Maryland School of Medicine, MD, USA;WorldWide Antimalarial Resistance Network Molecular Module, University of Maryland School of Medicine, MD, USA;

关键词: Malaria;    Chloroquine;    Uncomplicated Malaria;    Amodiaquine;    Drug Pressure;   

DOI  :  10.1186/1475-2875-10-116

 received in 2010-12-15, accepted in 2011-05-09,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundAs a result of widespread chloroquine and sulphadoxine-pyrimethamine (SP) resistance, 90% of sub-Saharan African countries had adopted policies of artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria by 2007. In Malawi, cessation of chloroquine use was followed by the re-emergence of chloroquine-susceptible malaria. It was expected that introduction of ACT would lead to a return in chloroquine susceptibility throughout Africa, but this has not yet widely occurred. This observation suggests that there is continuing use of ineffective anti-malarials in Africa and that persistent chloroquine-resistant malaria is due to ongoing drug pressure despite national policy changes.MethodsTo estimate drug use on a national level, 2006-2007 Demographic Health Survey and Multiple Indicator Cluster Survey data from 21 African countries were analysed. Resistance data were compiled by systematic review of the published literature on the prevalence of the Plasmodium falciparum chloroquine resistance transporter polymorphism at codon 76, which causes chloroquine resistance.ResultsChloroquine was the most common anti-malarial used according to surveys from 14 of 21 countries analysed, predominantly in West Africa. SP was most commonly reported in two of 21 countries. Among eight countries with longitudinal molecular resistance data, the four countries where the highest proportion of children treated for fever received chloroquine (Uganda, Burkina Faso, Guinea Bissau, and Mali) also showed no significant declines in the prevalence of chloroquine-resistant infections. The three countries with low or decreasing chloroquine use among children who reported fever treatment (Malawi, Kenya, and Tanzania) had statistically significant declines in the prevalence of chloroquine resistance.ConclusionsThis study demonstrates that in 2006-2007, chloroquine and SP continued to be used at high rates in many African countries. In countries reporting sustained chloroquine use, chloroquine-resistant malaria persists. In contrast, a low level of estimated chloroquine use is associated with a declining prevalence of chloroquine resistance.

【 授权许可】

Unknown   
© Frosch et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.