Knight S.E., Anyachebelu E.J., Geddes R., Maharaj R.
Department of Public Health Medicine, University KwaZulu-Natal, Private bag 7, Congella, Durban 4013, South Africa; Malaria Research Programme, Medical Research Council, Durban, South Africa
Knight, S.E., Department of Public Health Medicine, University KwaZulu-Natal, Private bag 7, Congella, Durban 4013, South Africa; Anyachebelu, E.J., Department of Public Health Medicine, University KwaZulu-Natal, Private bag 7, Congella, Durban 4013, South Africa; Geddes, R., Department of Public Health Medicine, University KwaZulu-Natal, Private bag 7, Congella, Durban 4013, South Africa; Maharaj, R., Malaria Research Programme, Medical Research Council, Durban, South Africa
Objective To investigate how delayed introduction of sulfadoxine- pyrimethamine(Fansidar®) and arthemeter-lumefantrine (Coartem®) as first-line drugs for malaria in KwaZulu-Natal contributed to the reported epidemics of 1985-1988 and 1997-2001. Methods Ecological study assessing the association between malaria incidence and the emergence and degree of resistance to chloroquine from 1982 to 1988 and to sulfadoxine-pyrimethamine from 1991 to 2001, when each was the first-line malaria treatment. Results The relative risk for malaria infection after the level of drug resistance reached 10% was 4.5 (95% CI: 4.0-5.2) in the chloroquine period and 5.9 (95% CI: 5.7-6.1) in the sulfadoxine-pyrimethamine period. In the chloroquine period, the relative risk of death from malaria was tenfold (95% CI: 1.3-78.1) and the case fatality doubled after drug resistance had reached 10%. The risk of death during the sulfadoxine-pyrimethamine period was 10.8 (95% CI: 5.9-19.2) and case fatality 1.8 times higher after drug resistance had reached 10%, than before. Conclusion Malaria epidemics in KwaZulu-Natal, South Africa have been exacerbated by failing drug regimens. The establishment of sentinel sites for monitoring drug failure and the prompt adoption of guidelines based on World Health Organization standards in drug resistance should improve malaria control. © 2009 Blackwell Publishing Ltd.
artemether plus benflumetol; chloroquine; fansidar; disease control; disease incidence; disease treatment; drug resistance; epidemiology; health risk; malaria; mortality; article; confidence interval; disease control; drug fatality; female; human; incidence; major clinical study; malaria; male; South Africa; Adolescent; Adult; Antimalarials; Artemisinins; Child; Child, Preschool; Drug Combinations; Drug Resistance, Multiple; Ethanolamines; Fluorenes; Guideline Adherence; Humans; Infant; Infant, Newborn; Malaria; Practice Guidelines as Topic; Pyrimethamine; South Africa; Sulfadoxine; Young Adult; Africa; KwaZulu-Natal; South Africa; Southern Africa; Sub-Saharan Africa