Quinine makes a comeback

Press, 12 April 1984, Page 31

Quinine makes a comeback

By ALASTAIR MATHESON Nairobi, Kenya As African countries step up their efforts to halt the present alarming spread of malaria, medical researchers have discovered that a long-discarded cure — quinine — is proving more effective than modern drugs such as chloroquine, because of the latter’s resistance to new strains of malaria.

Rejected as obsolete in the 19505, quinine is making a comeback because new strains of malaria have not developed any resistance to it.

The problem of drug-re-sistant strains of malaria surfaced on the African continent only four or five years ago, although it had become serious in Latin America and East Asia for more than a decade, especially in countries such as Thailand and Vietnam. In East Africa it was not until 1980 that patients in Tanzania first complained that chloroquine-based drugs were giving ineffective protection against malaria. The illness was recurring within a week or two of treatment. In Kenya the phenomenon was first noted in 1982 along the Indian Ocean coastline to the north and south of Mombasa.

Since this area is the country’s most important

tourist destination, urgent investigations were begun and they revealed that about one quarter of the local population there showed some resistance to chloroquine-based drugs. East Africa and neighbouring countries have suffered from another related problem, only recently overcome. This has been the gradual rundown of field research into malaria and other insect-bome tropical diseases over the last 20 years.

The considerable research done in the pre-independ-ence era continued for some time under the wing of the East African Community, with several prestigious research stations including Amani, in Tanzania, latterly dealing with malaria, and others specialising in sleeping sickness carried by the tsetse fly or bilharzia, (“snail fever.”) When the regional organisation began to run down in the 19705, many expatriate medical experts began to leave East Africa. At the time there was a dearth of qualified local doctors and experienced researchers to take their places. Now, with a steady steam of graduates in medicine from African and foreign universities coming forward, the gap has been filled. But it has not been possible to make up for the

near-stagnation in this research in the latter half of the 19705.

It was also during this decade that the World Health Organisation reluctantly abandoned its global campaign to wipe out malaria, substituting in its place a malaria control programme as being more practicable in view of the impossibility of preventing persons carrying malaria from crossing most African frontiers undetected.

Medical opinion remains divided as to whether resistance to chloroquine has been caused by people taking too much of it for too long as a protection against malaria, instead of simply taking it to cure malaria once it is contracted.

The general opinion in the medical world seems to be that chloroquine-based drugs should be continued as a low-cost, non-toxic but effective protection for at least 75 per cent of the population, but that other drugs should be used for the remainder who fail to respond. These include amodiaquine and pyrimethaninesulfadiozone, and also quinine.

In the long term, all hopes rest on perfection of a vaccine against malaria, but researchers think this is at least ten years away. Copyright, London Observer Service.