April 2019 digital edition

(RSA) concluded that survival rates of parasites in some
isolates were more than 10% higher. Similar rates have been
closely associated with delayed parasite clearance after
drug treatment and are considered to be a proxy for the
artemisinin-resistant phenotype.
Since India sits with Africa and SE Asia on either sides,
the spread of resistant strains of the parasite is somewhat an
imminent possibility. Already, sporadic cases of artemisinin
resistance have been reported from the eastern region of
India, the country’s malaria hotspot. A study conducted in
West Bengal in isolates from 136 patients with P. falciparum
infection obtained from April 2013 through March 2014 using
ex-vivo RSA observed increased parasite clearance half-lives in
14% of the patients.
Artemisinin resistance is defined as a delay in the
clearance of malaria parasites from the bloodstream following
ACT. The artemisinin combo is considered less effective if it
fails in clearing all parasites within a 3-day period.
The WHO, however, describes the delayed clearance of
the parasites as only “partial resistance” as the mechanisms
of resistance developed by the parasites against artemisinin
compounds affect only one stage of its cycle in humans, the
ring stage. Hence, it is more appropriate to call the delayed
clearance “partial resistance”, to highlight this time-limited and
cycle-specific feature.
Also, drug resistance, per se, did not contribute to the
rising numbers of cases in GMS and Africa. “Between 2012
and 2017, the reported number of malaria cases in GMS fell
by 75% despite confirmed partial artemisinin resistance in
5 countries and multidrug resistance in 4 countries. Malaria
deaths fell by 93% over the same period. In Africa, artemisinin
resistance has not yet been confirmed. The ACTs used as first
and second line treatments are highly efficacious in all African
countries,” says a spokesperson from RBM Partnership to End
Artemisinin is extracted from the plant Artemisia annua
‘High burden to
high impact’
strategy to bring
back malaria
control on track
Over 219 million new cases of malaria were
reported in 2017, 2 millions more from
217 million a year before. This was the second
consecutive year that the numbers went up,
reversing a trend marked by a steady series of
advances in the fight against malaria since the
turn of the century.
With more than 400,000 people projected
to die each year from the preventable and
treatable disease, the WHO has called for an
aggressive new approach to jumpstart progress
against the disease.
Without a major turnaround, we are very
unlikely to meet the targets set by the Global
Technical Strategy for Malaria 2016–2030
(GTS), which calls for reducing malaria cases
and deaths by at least 40% by 2020, at least
75% by 2025 and at least 90% by 2030.
The High Burden, High Impact approach
was launched in November 2018 in
Mozambique to infuse a fresh dose of vitality
to global efforts against malaria. “The launch
has provided momentum and has resulted in
a growing commitment from malaria-affected
countries, donor agencies and global health
organizations,” says a spokesperson from RBM
Partnership to End Malaria, which coordinates
with WHO on the initiative.
The RBM Partnership to End Malaria is
the largest global platform comprising over
500 partners - from community health worker
groups and researchers developing new tools
to malaria-affected and donor countries,
Malaria, which coordinates with the WHO in the ‘High Burden
to High Impact’ initiative launched in November 2018 to bring
malaria control on track. P. vivax resistance to artemisinin is yet
to be reported.
Asymptomatic malaria and POC detection
P. falciparum is the most prevalent malaria parasite in Africa,
accounting for 99.7% of the estimated cases in 2017, as it is
in South-East Asia (62.8%), the Eastern Mediterranean (69%)
and the Western Pacific (71.9%).
P. vivax is predominant in the Americas, representing
74.1% of malaria cases.
22 / FUTURE MEDICINE / April 2019