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Treatment of paediatric malaria during a period of drug transition to artemether-lumefantrine in Zambia: cross sectional study

BMJ 2005; 331 doi: (Published 29 September 2005) Cite this as: BMJ 2005;331:734
  1. Dejan Zurovac, clinical research officer (dzurovac{at},
  2. Mickey Ndhlovu, clinical research officer2,
  3. Alexander K Rowe, medical epidemiologist3,
  4. Davidson H Hamer, associate professor4,
  5. Donald M Thea, professor4,
  6. Robert W Snow, professor5
  1. 1Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, KEMRI/Wellcome Trust Collaborative Programme, PO box 43640, 00100 GPO, Nairobi, Kenya
  2. 2Chainama Hills College Hospital of Health Sciences, Lusaka, Zambia
  3. 3Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA
  4. 4Center for International Health and Development, Boston University School of Public Health, Boston, MA 02118, USA
  5. 5Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, KEMRI/Wellcome Trust Collaborative Programme
  1. Correspondence to: D Zurovac
  • Accepted 18 August 2005


Objective To evaluate treatment practices for uncomplicated malaria after the policy change from chloroquine to sulfadoxine-pyrimethamine and to artemether-lumefantrine in Zambia.

Design Cross sectional survey.

Setting Outpatient departments of all government and mission facilities in four districts in Zambia.

Participants 944 children with uncomplicated malaria seen by 103 health workers at 94 health facilities.

Main outcome measures Antimalarial prescriptions in accordance with national guidelines and influence of factors on health workers' decision to prescribeartemether-lumefantrine.

Results Artemether-lumefantrine, sulfadoxine-pyrimethamine, and chloroquine were available, respectively, at 48 (51%), 94 (100%), and 71 (76%) of the 94 facilities. Of 944 children with uncomplicated malaria, only one child (0.1%) received chloroquine. Among children weighing less than 10 kg, sulfadoxine-pyrimethamine was commonly prescribed in accordance with guidelines (439/550, 79.8%). Among the children weighing 10 kg or more, sulfadoxine-pyrimethamine was commonly prescribed (266/394, 68%), whereas recommended artemether-lumefantrine was prescribed for only 42/394 (11%) children. Among children weighing 10 kg or more seen at facilities where artemether-lumefantrine was available, the same pattern was observed: artemether-lumefantrine was prescribed for only 42/192 (22%) children and sulfadoxine-pyrimethamine remained the drug of choice (103/192, 54%). Programmatic activities such as in-service training and provision of job aids did not seem to influence the prescribing of artemether with lumefantrine.

Conclusion Although the use of chloroquine for uncomplicated malaria was succesfully discontinued in Zambia, the change of drug policy towards artemether-lumefantrine does not necessarily translate into adequate use of this drug at the point of care.


  • Contributors DZ and MN coordinated the survey design, trained the survey staff, were responsible for the analysis and drafted and completed the manuscript. DMT and DHH participated in the data analysis and drafting of the manuscript. AKR and RWS participated in the study design, analysis, and finalisation of the manuscript. DZ is the guarantor.

  • Funding Zambian-Boston University Malaria Project (Association of Schools of Public Health and Centers for Disease Control and Prevention cooperation agreement S1954-21-21) and the Wellcome Trust, United Kingdom.

  • Competing interests DZ and RWS have received a fee for speaking at a meeting organised by Novartis Pharma, the manufacturer of artemether-lumefantrine.

  • Ethical approval This study was approved by the Boston University institutional review board (2003-412B) and research ethics committee of the University of Zambia (federal wide assurance No IRB00001131).

  • Accepted 18 August 2005
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