Malaria due to P. falciparum is the number one cause of morbidity and mortality in Uganda where it is highly endemic in 95% of the country. The use of efficacious and effective antimalarial medicines is one of the key strategies for malaria control. Until 2000, Chloroquine (CQ) was the first-line drug for treatment of uncomplicated malaria in Uganda. Due to progressive resistance to CQ and to a combination of CQ with Sulfadoxine-Pyrimethamine, Uganda in 2004 adopted the use of ACTs as first-line drug for treating uncomplicated malaria. A review of the drug policy change process and postimplementation reports highlight the importance of managing the policy change process, generating evidence for policy decisions and availability of adequate and predictable funding for effective policy roll-out. These and other lessons learnt can be used to guide countries that are considering anti-malarial drug change in future. 1. Introduction Malaria is the number one cause of morbidity and mortality in Uganda. It is highly endemic in 95% of the country, and the remaining 5% of the country is prone to malaria epidemics [1]. Over 95% of the malaria cases are due to plasmodium falciparum. Effective malaria case management, using efficacious and effective antimalarial medicines, is one of the recommended strategies for malaria control [2]. Until 2000, Chloroquine (CQ) was the first-line medicine for treatment of uncomplicated malaria in Uganda, and Sulfadoxine/Pyrimethamine (SP) or Amodiaquine (AQ) was the 2nd-line medicine while Quinine (Qn) was the reserve medicine. For severe malaria, Qn was the recommended medicine initially given intravenously until the patient is conscious and able to take medicines orally [3]. However, in the late 1990s, parasite resistance to CQ, at varying levels in the 8 East African Network for Monitoring Antimalarial Treatment (EANMAT) sentinel sites located in different parts of the country, was documented. By 2000, the parasitological resistance to CQ had increased significantly, ranging from <5% to >50% in different sites, and clinical failure following CQ treatment in Uganda had increased to about 38% [4], exceeding the WHO recommended threshold of clinical failure of 25%, beyond which policy change is recommended in the shortest time possible [5]. Uganda embarked on a malaria treatment policy change process as shown in Figure 1. After several technical discussions and considerations, the first-line antimalarial medicine for uncomplicated malaria was changed from CQ only, and a new interim policy with a combination of CQ and
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