Use of pre-packaged chloroquine for the home management of presumed malaria in Malagasy children

A cross-sectional investigation in two communities, in the hamlets and villages located close to carers, retailers, community-based service providers and primary health centres was carried out.Carers in the two districts were equally well aware of the use of pre-packaged chloroquine. Their first response to the onset of fever was to treat children with this antimalarial drug at home. The dose administered and treatment compliance were entirely satisfactory (100%) with pre-packaged chloroquine and rarely satisfactory (1.6% to 4.5%) with non pre-packaged chloroquine. In cases of treatment failure, the carers took patients to health centres. Chloroquine was supplied principally by private pharmacies and travelling salesmen selling unpackaged chloroquine tablets. Non pre-packaged chloroquine was the most common drug used at health centres. The frequency of positive rapid malaria tests (P = 0.01) was significantly higher in children treated with non pre-packaged chloroquine (38%) than in children treated with pre-packaged chloroquine (1.3%).Home malaria management should be improved in Madagascar. Efforts should focus on communication, the training of community-based service providers, access to pre-packaged drugs and the gradual withdrawal of pre-packaged chloroquine and its replacement by pre-packaged artemisinin-based combination therapies.Malaria, known locally as "tazo" or "tazomoka", is the leading cause of morbidity, mortality and hospital admission in Madagascar. Official data show a reported 2,114,400 cases of suspected malaria in 2003 (18.8% of all outpatient visits). About 740,000 of these cases occurred in children under the age of five years [1-3]. Limited physical access to public health facilities has been recognized to limit the provision of early treatment in developing countries, such as Madagascar. As a result of this limited access, communities resort to self-medication, through the unregulated private and informal sectors [4-6]. Thus, pharmacies, med