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Resistance to chloroquine (CQ) and sulphadoxine-pyrimethamine (SP) led the World Health Organization (WHO) to recommend changes in national drug policies. The time between policy changes and their implementation profoundly affects program impact. We developed a model based on data on antimalarial treatments, extracted from household surveys and national antimalarial policy information from the literature. Drug use in each country during the time period 1999-2011 and the trend in reduction of CQ use after policy change were estimated. The SP use estimates were correlated with the prevalence of a molecular marker associated with SP resistance. There was no spatial pattern in the country-level rate of reduction of CQ use, after policy change. In East Africa SP drug use was strongly correlated to resistance. If artemisinin resistance spreads to, or emerges in, Africa this methodology will be a valuable tool to estimate actual drug use and its impact on changes in drug efficacy.

Original publication

DOI

10.4269/ajtmh.13-0129

Type

Journal article

Journal

Am J Trop Med Hyg

Publication Date

11/2013

Volume

89

Pages

857 - 865

Keywords

Africa, Antimalarials, Artemisinins, Chloroquine, Drug Combinations, Drug Resistance, Health Surveys, Humans, Malaria, Falciparum, Models, Statistical, Plasmodium falciparum, Pyrimethamine, Sulfadoxine, Time Factors