Management of malaria in Zanzibar

Malaria remains to be a major cause of morbidity and mortality in most African countries. Chloroquine resistance is one of the major contributing factors in many parts of the continent. Besides plasmodia parasite mutation, improper management of malaria cases and the absence of standardised management guidelines for the treatment of malaria may play a role in increasing the existing drug resistance. In this retrospective study which involved 400 patients at the Mnazimmoja Hospital, Zanzibar, chloroquine was found to be the most popular anti-malarial drug prescribed to 369 (92.25%) of the patients. A full standard chloroquine regimen (25 mg-base/Kg) was provided to about 88.15% (238 out of 270) of all admitted patients treated with chloroquine alone or in combination with other drugs. Prescriptions of multiple antimalarials at a time were found in 97 (24.25%) of the cases. The duration of a prescribed chloroquine course was 3 days (WHO recommendation) in 289 (78.32%), less than 3 days in 49 (13.28%) and more than 3 days in 31 (8.40%) of the patients. The possible roles of under-dosage and incomplete courses of physician and self-prescribed chloroquine regimens in increasing chloroquine resistance are discussed.