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The Rise of Drug-Resistant Malaria:


Malaria is a disease caused by Plasmodium parasites and is spread by mosquito bites. In November 2020, there had been 229 million cases of malaria and 409,000 related deaths worldwide. Specifically, the Sub-Saharan African region is most at risk of malaria, with 94% of all malaria cases in 2019 recorded there. Six countries in this region accounted for half of all malaria deaths: 23% in Nigeria, 11% in the Democratic Republic of the Congo, 5% in Tanzania, and 4% in Burkina Faso, Mozambique, and Niger respectively.

What is the problem?

A study published in the scientific journal, The Lancet, in April 2021, has confirmed that drug-resistant mutations of Plasmodium parasites are accounting for greater numbers of malaria cases in Rwanda. This is a significant risk to African populations, especially children, who make up two-thirds of malaria deaths.

Why is drug-resistant malaria a problem?

 Drug-resistant parasites can fight back against the most effective treatments currently in use. Artemisinin-based combination therapies (ACTs) were first introduced in Rwanda in 2006.  ACTs use a compound that clears most of the parasites from your body within 3 days of infection, alongside a longer-acting drug that removes the rest. ACTs were introduced to replace chloroquine, which was previously the main malaria treatment until the parasites developed resistance in the late twentieth century.

ACT-resistant malaria has been a concern for medical experts for a while, with studies in 2013, 2014, and 2018 showing mutations in the parasites. However, all previous studies have shown that ACTs were still over 90% effective in curing infections. The new study in The Lancet has now shown that 15% of the children studied still had high levels of parasites 3 days after treatment. The results of The Lancet’s study suggest that the effectiveness of ACTs has fallen to 85%, which is below the clinical threshold of efficacy for medications.

The rise of ACT-resistant malaria could lead to further increases in deaths in the years ahead until an alternative solution is provided. Malaria cases almost doubled in Nigeria from 2019 levels in 2020, owing to the public health crisis caused by COVID-19. Doctors without Borders have issued a plea for aid, to ensure populations have access to food, clean water, and vaccinations to prevent a humanitarian crisis. Preventing the further spread of malaria cases, particularly among vulnerable groups like children, is essential, and will be reliant on improving access to measures like mosquito nets.

What is being done?

 However, there is a glimmer of optimism. In May 2021, the Francis Crick Institute developed a ‘drug-like compound’ which blocks a step of the life cycle of Plasmodium parasites. It is currently being studied further, and the researchers hope to create a new malaria treatment that could help to offset the impact of ACT resistance.

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