Emerging drug resistance in eastern Africa hinders fight against malaria

Most of the countries in Africa are not on track to achieving the goal of eliminating malaria in the continent by 2030

By Madhumita Paul
Published: Wednesday 11 October 2023
Representative photo: iStock

The treatment of malaria in eastern Africa is encountering a significant challenge as the parasites have started developing resistance to artemisinin, the core component used for treating the disease, according to a new study.

Artemisinin-based combination therapy (ACT) has been a highly effective treatment for non-severe cases since the early 2000s.

While the clinical effectiveness of ACT remains generally robust in the continent, the recent emergence of partial artemisinin resistance in the eastern African countries of Rwanda, Uganda and Eritrea has raised significant concerns.

Plasmodium falciparum, the parasite responsible for malaria’s most dangerous form, is transmitted to humans via female Anopheles mosquitoes. The treatment of this parasite primarily relies on the administration of artemisinin-based medications in combination with a complementary anti-malarial drug.

ACT reduces the number of parasites during the first three days of treatment, while the role of the partner drug is to eliminate the remaining parasites and cure the infection.

In the study’s findings published in the New England Journal of Medicine, researchers from Columbia University used data from drug-efficacy studies conducted between 2016 and 2019. While evaluating the efficacy of three-day courses of ACT for non-severe cases in Eritrea, they found that the effectiveness of the drug therapy declined during the study period.

The drugs failed to clear parasites in 0.4 per cent of patients in 2016, rising to 4.2 per cent in 2019. Mutations in the P. falciparum parasite gene Pfkelch13 is the reason behind the growing drug resistance, according to them.

The study witnessed a substantial rise in the percentage of parasites carrying the Pfkelch13 R622I mutation (to 21 per cent in 2019 from 8.6 per cent in 2016).

Most of the countries in Africa are not on track to achieving the goal of eliminating malaria in the continent by 2030, according to the African Union Malaria Progress Report 2022.

The failure of ACT in the Horn of Africa is a severe concern for global health, as the spread of drug-resistant strains could make it much more difficult to control the disease, noted the study

However, efforts are underway to develop new drugs and treatment strategies to combat artemisinin-resistant strains of the malaria parasite. On November 18, 2022, the World Health Organization launched a new strategy to respond to anti-malarial drug resistance in Africa.

The researchers pointed out it is critical to continue using ACT in combination with other drugs and monitoring the spread of drug-resistant strains. Moreover, measures such as insecticide-treated bed nets and indoor residual spraying are key to controlling the disease.

Besides Africa, on a global scale, parasite resistance to artemisinin has been identified in the Greater Mekong sub-region.

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