Between 1998 and 2001, Kenya, Uganda, Tanzania, Zanzibar, Rwanda and Burundi changed
antimalarial drug policy, in the face of widespread
chloroquine resistance. The new first-line treatment is either
sulphadoxine-pyrimethamine (SP) monotherapy, or a combination of SP with either
chloroquine or
amodiaquine. Two national
malaria control programmes, Burundi and Zanzibar, have decided upon
amodiaquine-artesunate as their first-line treatment, although SP will continue to fill this role until the new policy can be implemented. Given the broad uniformity of parasite chemoresistance in the six countries, The East African Network for Monitoring
Antimalarial Treatment (EANMAT) has focused attention on, and worked towards, a sub-regional
antimalarial drug policy, where the evidence base would be the entire portfolio of network in vivo test results. Currently, there are several different
antimalarial drug policies within the EANMAT area: the intention is to eventually replace this plethora of policies with a single, sub-regional policy based upon combination
therapy. Currently, successful
malaria treatment depends primarily upon the efficacy of SP, and of
amodiaquine, which is either a component of first-line treatment, or the second line
drug. This report addresses the results of WHO in vivo tests on these two monotherapies within the network. Results are analysed to assess the evidence for change in parasite susceptibility over time; the range of susceptibility to each
drug within countries, and the implications of test results on policy.