for children under 5 years of age more than doubled. Throughout the period, about 5 percent of those children died (Khoromana et al., 1986). The spread of chloroquine resistance in Malawi during this time was well documented.

Tanzania. The mission hospitals in Tanzania recorded steep increases in the proportion of admissions for malaria from 1968 through 1985. In the 1970s, about 10 percent of admissions were for malaria, and by the mid-1980s, had risen to 23 percent (Kilama and Kihamia, 1991). This also coincides with the rapid increase in chloroquine-resistant malaria in Tanzania.

Congo. In the hospital that was the main referral center in Kinshasa, the proportion of overall pediatric admissions for malaria increased each year, from 29.5 percent in 1982, to 56.4 percent in 1986, and the proportion of deaths increased from 4.8 to 15.3 percent over the same period (Greenberg et al., 1989). Again, this was the period during which chloroquine resistance emerged and spread quickly in Kinshasa.

Malaria admissions and deaths at the four hospitals in Brazzaville were studied for the years 1983-1989, during which (in 1985) chloroquine resistance was first detected there. From 1983 through 1986, pediatric admissions for malaria increased from 22 to 54 percent of all pediatric admissions, and then remained stable. Deaths from cerebral malaria more than doubled from the first to the second half of the study period (Carme et al., 1992).

Nigeria. A similar pattern was seen in the pediatric emergency room of Calabar Hospital in Nigeria, where the number of cases of malaria-related convulsions doubled during the years 1986 through 1988. In 81 percent of these cases, chloroquine was ineffective (Asindi et al., 1993).

Various other studies, including one of trends in severe anemia in Kenya, and another of changes in hospital case fatality rates for malaria after a switch from chloroquine to SP, provide corroborating evidence that chloroquine resistance has led to increases in severe malaria and malaria deaths (Trape, 2001).

Front Matter (R1-R20)

Executive Summary (1-16)

Part 1: A Response to the Current Crisis1 Malaria Today (17-60)

2 The Cost and Cost-Effectiveness of Antimalarial Drugs (61-78)

3 The Case for a Global Subsidy of Antimalarial Drugs (79-111)

4 An International System for Procuring Anitmalarial Drugs (112-122)

Part 2: Malaria Basics5 A Brief History of Malaria (123-135)

6 The Parasite, the Mosquito, and the Disease (136-167)

7 The Human and Economic Burden of Malaria (168-196)

8 Malaria Control (197-251)

9 Antimalarial Drugs and Drug Resistance (252-298)

Part 3: Advancing Toward Better Malaria Control10 Research and Development for New Antimalarial Drugs (299-311)

11 Maximizing the Effective Use of Antimalarial Drugs (312-328)

Acronyms and Abbreviations (329-333)

Glossary (334-346)

Index (347-364)