In Southern Africa, parasitological failure of chloroquine treatment, previously the mainstay of malaria treatment in Africa, is frequent (45% in Mozambique, 60 % in KwaZulu Natal, 48% in Mpumalanga, 40% in Northern Province). 

Sulphadoxine / pyrimethamine (S/P) replaced Chloroquine as first line therapy in KwaZulu Natal in 1988, and in Mpumalanga in 1997.  Parasitological failure (including RI) of SP in KwaZulu Natal was 23.5% in 1996, 5% in Mpumalanga in 1997, and 5-10% in Mozambique in 1998. Preliminary results show that SP monotherapy resistance is currently approximately 50%in KwaZulu-Natal, while it is less than 10% in Mpumalanga. These levels are likely to rise exponentially.

The World Health Organisation recommends that first-line therapy be replaced once resistance exceeds 20-25%. 

Since the 1995 / 1996 malaria season the number of notified cases in KwaZulu Natal has increased from 10 266 to 38 442 in the 1999/2000 season ¹².  Since neighbouring malaria areas have not described such a dramatic increase in case numbers, concern has been expressed that increasing resistance and increased gametocyte carriage following SP treatment are potential causes of this escalating prevalence.

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