In Guinea-Bissau, CQ remained efficacious until replaced by AL. This is explained by the use of a unique well tolerated high dose treatment schedule 8-10. Since the introduction of AL in 2008, the number of children with malaria has increased manyfold in Bissau in contrast with other African countries. Our data suggests that this increase is due unavailability of AL, poorer than expected effectiveness of AL and to an increased use of the second-line drug quinine. Quinine is typically given for 3 instead of 7 days and has very poor efficacy when used thus11. To counter this Guinea-Bissau needs an alternative cheap and easily dosed 2nd line drug that can also be used when AL is not available or when funding for AL no longer exists.