Some households spend over 10% of their annual net income with each episode of malaria (Konradsen et al., 1997). This can result in people having to borrow money or labour to look after their farms, and pay the direct costs of remedies or drugs, transport to the clinic, and private treatment. In Africa, the cost has been estimated at 21 days of output per case, or 1% of GDP in 1995 (Shepard et al., 1991).
Currently, both chloroquine and pyrimethamine-sulfadoxine (PSD) cost less than 20 cents per adult per course. However, for many poor people in rural areas, where a number of family members may be infected, even this amount may not be affordable. If the new call for a combination of existing antimalarials is adopted, while cost-effective in the long-run through reducing resistance in populations, the immediate cost to consumers will be more than ten times the cost of the above two drugs. A very real question presents itself - can resistance be controlled if people or countries cannot afford the combination therapy?.
Resistance, synergism and traditional medicines.
Medical science is beginning to recognise aspects of synergy, complexity and potentiation in malaria therapy.
At the same time, little significance is as yet being given to the obvious point that all of the major antimalarials have been derived from plants, often based on traditional knowledge about the effects of the plants against fever, or specifically, malaria. The call to combine antimalarials overlooks the fact that combination existed in the traditional formulations before the process of extraction took place. In view of this, it must be asked whether any pre-existing synergism, and hence challenge to the development of resistance, may have been lost in the process of extraction, isolation and synthesis of new molecules. For instance, the artemisinin drugs (artesunate, artemehter, dihydroartemisinin) are derived from artemisia annua, used in traditional Chinese medicine as an antipyretic.
