According to the World Health Organization, malaria is a significant threat to public health in tropical countries. This deadly mosquito-borne disease was first discovered in the late 19th century. Among the five parasitic species that infect humans, Plasmodium falciparum affects most severely.
P. falciparum was found to be resistant to the most effective conventional anti-malarial drugs, namely, chloroquine and pyrimethamine/sulfadoxine. Since the middle of the year 2000, malaria infection is treated with the most promising combination of two drugs, artemisinin and piperaquine. This treatment is popularly known as an artemisinin-based combination therapy (ACT). Globally, deaths owing to malaria declined to 409,000 in 2019, compared to 585,000 in 2010. Further, several countries have entirely eradicated or are on the verge of eliminating the malarial infection.
Scientists believe that P. falciparum resistance to antimalarial drugs emerged first in the Greater Mekong subregion of Southeast Asia, including Thailand, Cambodia Vietnam, Laos, and Myanmar, subsequently dispersed to Africa.
In 2013, researchers reported some P. falciparum resistance to artemisinin derivatives in Southeast Asia. Even though ACT’s are still broadly effective, the scientists are worried that the weakened treatment procedures could bring about an increased spread of ACT resistance. Such incidence would lead to a complete loss of confidence in malarial treatment. Hence, the discovery of ACT resistant parasite has globally threatened all the measures developed to eradicate malaria from the world. It has also increased the fear of deadly infection that would drastically enhance the mortality rate in malaria-prone regions such as Africa.
Researchers in Rwanda have recently identified a strain of P. falciparum (Pfkelch13) that showed resistance to artemisinin drugs. This mutation is linked to the gene known as K13 that imparts resistance to artemisinin. While studying the P. falciparum parasite samples collected from patients infected with malaria in Rwanda, Didier Menard at the Pasteur Institute in Paris, Aline Uwimana at the Rwanda Biomedical Centre, Kigali, and their colleagues discovered the K13 mutation for the first time in Africa. A genetic study revealed that in this case, the malarial parasites with K13 mutation arose independently in Africa. They have published their findings in Nature.
There are several reasons for the emergence of a drug-resistant malarial parasite. The most common reasons are, a) the medical provider failing to prescribe a proper drug dose; b) the patient failing to complete the malarial treatment. For this reason, governments and global health programs are required to reinforce measures that promote effective, safe, and appropriate use of ACTs. For example, Management Sciences for Health is a global non-profit organization that assists in managing malaria in Madagascar, Benin, Nigeria, and Malawi. They provide training to health care providers on the use of ACTs following national malaria treatment guidelines.
Scientists believe that neighboring countries should work together to prevent the spread of the drug-resistant malarial parasite. As the resistant parasites are being found in Rwanda, proper actions should be taken to stop it from spreading to other African countries.