Emerging Resistance to Artemisinin-Based Combination Therapy Threatens Malaria Treatment Efficacy in Sub-Saharan Africa

Strategic Insights -

A recent study published in Malaria Journal has highlighted the growing threat of emerging artemisinin partial resistance to the treatment of uncomplicated malaria in sub-Saharan Africa. For over two decades, Artemisinin-based combination therapy (ACT) has been the first-line treatment for uncomplicated malaria in the region. However, researchers from Strathmore University have found that the increasing resistance to ACT could undermine the effectiveness of this treatment approach. The study highlights the need for alternative mitigation strategies, such as multiple first-line treatments (MFTs), to combat the spread of malaria in the region.

Key Takeaways:

  • Emerging artemisinin partial resistance threatens the efficacy of Artemisinin-based combination therapy (ACT) in sub-Saharan Africa.
  • Multiple first-line treatments (MFTs) represent a proposed mitigation strategy to combat the spread of malaria in the region.
  • A 2-year pilot study implemented adaptive cycling of four artemisinin-based combinations in western Kenya, involving 8 months of drug cycling on mainland and 12 months on Mfangano Island.
  • The study found that implementation involved 8 months of drug cycling on mainland and 12 months on Mfangano Island, while a control county continued to use Artemether-Lumefantrine (AL) throughout.
  • Health system challenges and facilitators associated with adaptive cycling deployment of MFTs for uncomplicated malaria remain unknown and require further exploration.
  • The study concluded that policy implications and regional cooperation potential warrant exploration in other sub-Saharan African countries with different deployment contexts.
  • Researchers from Strathmore University, including Andrew Cole, Timothy Chege, Rashid Aman, George Githuka, Richard Muga, Adam Aspinall, and Gilbert Kokwaro, contributed to the study.
  • The study highlighted the need for alternative treatment approaches, such as MFTs, to combat the spread of malaria in sub-Saharan Africa.

Statistics:

  • The study was conducted over a period of 2 years (June 2020-June 2022).
  • The pilot study involved 8 months of drug cycling on mainland and 12 months on Mfangano Island.
  • The research concluded that health system challenges and facilitators associated with adaptive cycling deployment of MFTs require further exploration.
  • The study found that implementation involved 8 months of drug cycling on mainland and 12 months on Mfangano Island, compared to a control county that continued to use Artemether-Lumefantrine (AL) throughout.

Sources:

  • "Health system challenges and facilitators associated with adaptive cycling deployment of multiple first-line treatment for uncomplicated malaria: a pilot study in a malaria-endemic region of Kenya." Malaria Journal, 2025;24(1):328.
  • Bmc, Campus, 4 Crinan St, London N1 9XW, England. (BioMed Central - www.biomedcentral.com/; Malaria Journal - www.malariajournal.com)
  • NewsRx. Findings on Malaria Detailed by Researchers at Strathmore University (Health system challenges and facilitators associated with adaptive cycling deployment of multiple first-line treatment for uncomplicated malaria: a pilot study in a ...). Malaria Weekly. October 20, 2025; p 284.