A NEW study highlights partial resistance to artemisinin in Ugandan children with severe malaria, raising concerns about the efficacy of frontline treatments in sub-Saharan Africa. Conducted between 2021 and 2022 in Jinja, Uganda, the study evaluated children aged 6 months to 12 years who were hospitalized with complicated malaria. Resistance to artemisinin, a primary malaria treatment, could pose a severe public health threat if it compromises treatment outcomes for children in malaria-endemic areas.
Artemisinin-based therapies are the World Health Organization (WHO) standard for treating severe malaria, responsible for over 600,000 deaths annually. This study tested for variations in the Pfkelch13 gene, specifically A675V and C469Y, known markers of artemisinin partial resistance. Researchers found that 11 out of 100 study participants displayed partial resistance, with eight carrying the A675V mutation. This variation was associated with longer parasite clearance times, a critical metric in malaria treatment, averaging 4.9 hours versus 3.2 hours in non-variant carriers. Children with this mutation were 6.2 times more likely to experience delayed parasite clearance.
The study also reported a 10.3% 28-day malaria recrudescence rate among participants, indicating a potential for recurring infections despite initial parasite clearance. While not directly linked to the Pfkelch13 variations, this highlights a broader challenge in achieving long-term treatment efficacy.
With mounting evidence of drug resistance in high-burden regions, experts suggest that these findings necessitate a closer look at malaria treatment protocols in Africa. Revisions to current treatment guidelines may be needed to ensure effective management of severe malaria in young children at high risk.
Reference: Henrici RC et al. Artemisinin partial resistance in ugandan children with complicated malaria. JAMA. 2024. doi:10.1001/jama.2024.22343.
