Are antimalarial drugs still effective?

Esther Ayuga knows all too well what to do when her four-year-old son Jeremy Otieno develops a fever: take him to the nearest health centre, Kaluo Health Centre immediately.

As a mother in the malaria-endemic Siaya county in Western Kenya, Esther takes the necessary precautions to keep her son safe from deadly mosquitoes - including ensuring he sleeps under an insecticide-treated mosquito bed net at night.

Whenever he is diagnosed with malaria, clinicians treat the boy with the medicine artemisinin, as per the guidelines in Kenya for his uncomplicated form of the disease.

A 2020 paper in the journal Nature, however, reported that researchers detected mutations associated with resistance to malaria parasites in another East African country Rwanda.

Another study in the New England Journal of Medicine confirmed that mutations are causing a drop in the ability of antimalarials, such as artemisinin, to treat people with the disease. The researchers found that it took longer than five hours for intravenous artesunate, a potent artemisinin derivative, to rid the body of more than half of the plasmodium falciparum, the malaria-causing parasite.

Less effective drugs

The declining effectiveness of these medicines could have catastrophic consequences if children like Jeremy do not get well after taking medication.

The latest World malaria report indicates that there were 241 million cases and 627,000 deaths of malaria in 2020. Ninety-five per cent of the cases and 96 per cent of deaths came from the World Health Organization Africa Region. Children under five years of age, like Jeremy, accounted for about 80 per cent of all malaria deaths in Africa.

According to Dr. George Githuka, the head of the Division of the National Malaria Control Programme (DNMP) at the Ministry of Health of Kenya, the country uses the medication Artemether-Lumefantrine (AL), an artemisinin derivative, for uncomplicated malaria. If the malaria were severe, the clinicians would administer the second-line Dihydroartemisinin-piperaquine (DHP) treatment.

Dr. Githuka says that these medications are still effective in Kenya. Yet, in Asia, scientists are raising the alarm about a 'super malaria' parasite that is resistant to the recommended first-line treatment for malaria, the artemisinins.

Malaria gets into the bloodstream through an infected mosquito bite and incubates there for about two weeks. Later, it multiplies and infects the body's red blood cells, causing fever and chills...