Abstract

Estimates for the annual mortality from malaria range from 0·5 to 2·5 million deaths. The burden of this enormous toll, and the concomitant morbidity, is borne by the world's poorest countries. Malaria morbidity and mortality have been held in check by the widespread availability of cheap and effective antimalarial drugs. The loss of these drugs to resistance may represent the single most important threat to the health of people in tropical countries. Chloroquine has been the mainstay of antimalarial drug treatment for the past 40 years, but resistance is now widespread and few countries are unaffected. 1 Bloland PB Lackritz EM Kazembe PN Were JB Steketee R Campbell CC Beyond chloroquine: implications of drug resistance for evaluating malaria therapy efficacy and treatment policy in Africa. J Infect Dis. 1993; 167: 932-937 Crossref PubMed Scopus (271) Google Scholar Pyrimethamine-sulphadoxine (PSD) is usually deployed as a successor to chloroquine. Both these antimalarials cost less than US$0·20 per adult treatment course, but the drugs required to treat multidrug-resistant falciparum malaria (quinine, mefloquine, halofantrine) are over ten times more expensive and cannot be afforded by most tropical countries—especially those in Africa, where it is estimated that more than 90% of the world's malaria deaths occur. Resistance to chloroquine is widespread across Africa and resistance to PSD is increasing. 2 Ronn A Msangeni HA Mhina J Wernsdorfer WH Bygbjerg IC High level of resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine in children in Tanzania. Trans R Soc Trop Med Hyg. 1996; 90: 179-181 Summary Full Text PDF PubMed Scopus (132) Google Scholar A health calamity looms within the next few years. 3 Marsh K Malaria disaster in Africa. Lancet. 1998; 352: 924-925 Summary Full Text Full Text PDF PubMed Scopus (164) Google Scholar As treatments lose their effectiveness, morbidity and mortality from malaria will inevitably continue to rise. Can this disaster be prevented? Can we really “roll back malaria”, as the new Director-General of WHO has demanded? 4 Harlem Brundtland G Speech to the fifty-first World Health Assembly. 13 May, Geneva1998 Google Scholar