The impact of malaria chemoprophylaxis in Africa with special reference to Madagascar, Cameroon, and Senegal.

Some past and present experiences in the use of antimalarial drugs, particularly for chemoprophylaxis, are reviewed. The failure in the long term of mass chemoprophylaxis with weekly chloroquine in children in Madagascar, Cameroon, and Senegal is discussed, the reasons for failure being an increasing lack of resources to ensure regular drug distribution and lack of supervision of dosage.The increasing number of reports confirming chloroquine resistance from East Africa over the last decade poses a serious threat to the future usefulness of chloroquine as an antimalarial agent in Africa. There is now an urgent need for extensive drug sensitivity tests, which should also include alternative antimalarial drugs. To rely on mass chemoprophylaxis as the main method of controlling malaria would appear to be no longer tenable.