In her Special Report, Udani Samarasekera describes the development of artemisinin resistance at the Thai-Cambodian border, which could soon also affect sub-Saharan Africa. What can be done to avoid a repetition of the tragic history of chloroquine resistance?Obviously, the rollout of arte-misinin-based combination therapy (ACT) needs to be accelerated in sub-Saharan Africa. But access to and quality of malaria treatment are also an issue. Taking Burkina Faso as an example, the government has recently made available subsidised artesunate-amodiaquine to all public health services, but only as separate blister packs which are cheaper than fixed-dose ACT. In our experience, since amodiaquine is associated with unpleasant side-effects, patients frequently take only the (white) artesunate tablets and discard the (yellow) amodiaquine ones, resulting in artemisinin monotherapy.
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