నైరూప్య

Antimalarial drug combination chemotherapy in malaria case management in Tanzania: how did it come about?

Stephen ED Nsimba

Malaria is a major public health and socioeconomic problem in sub-Saharan Africa including Tanzania. Every year about one million deaths result as a direct consequence of infection with Plasmodium falciparum. In Tanzania the malaria situation is worsening every year, as malaria-related morbidity and mortality is increasing. This situation has been worsened by the development and widespread of Plasmodium falciparum resistance to chloroquine (CQ) and followed by loss of efficacy due to development of resistance against sulfadoxine-pyrimethamine (SP). Hence, this has severely compromised effective treatment and malaria control programs in most sub-Saharan countries including Tanzania. The aim is to review various literatures using google, medline/PubMed search and publications on the drawbacks that have led to most sub-Saharan countries, including Tanzania, phasing out both CQ and SP, which were effective and cheap/affordable first-line drugs for clinical management of uncomplicated malaria. However, despite drawbacks of resistance to SP, the drug is still used for intermittent presumptive prophylactic treatment for pregnant women and infants, and CQ for patients with sickle cell anemia in mainland Tanzania. Thus, early recognition/diagnosis and prompt effective treatment with recommended first-line antimalarials including the use of long-lasting insecticide treated nets remains the mainstay of malaria control strategies in Sub-Saharan Africa. Furthermore, there is a strong need for improved understanding on optimizing malaria treatment policies so as to prevent/ minimize the development and spread of drug resistant malaria by improving compliance, drug quality, rational prescribing and rational use of antimalarial drugs in sub-Saharan countries.