Antimalarial drug policy in Malawi

In the Shire Valley, southern Malawi, longitudinal malariometric data collected over 2 years (1993–1995) showed a high prevalence of severe anaemia in pregnant women and their infants. The prevalence of Plasmodium falciparum in primigravidae at first antenatal visit was 39%, and 30% of all primigravidae were severely anaemic (i.e. with <8 g haemoglobin/dl). In infants, anaemia had its onset at about 8 weeks of age. In the population studied, childhood deaths were frequently related to malaria and severe anaemia. A central aim of any malaria-control strategy in the area should be to reduce the prevalence of malaria-related anaemia. In this context, the criteria for the choice of a first-line therapeutic antimalarial drug in Malawi have been based on haematological and parasitological cure. A change in recommendation for first-line therapy in Malawi, from chloroquine to sulphadoxine-pyrimethamine, was influenced by poor haematological recovery and clinical response after chloroquine use, as well as a high l...