In vitro phenotype of reduced susceptibility to artemisinin in Plasmodium falciparum isolates from western Cambodia

Abstract

Background: Malaria is one of the most common infectious diseases in the world with more than 40 percent of the world's population at risk and one of the greatest public health concerns especially in sub-Saharan Africa. In Bungoma South district, malaria is the leading cause of morbidity, accounting for 49 percent of the top ten diseases in the district. In 2006, Kenya implemented a new malaria treatment policy recommending the use of Artemether-Lumefantrine (AL) as the first line of treatment. National guidelines on the diagnosis, treatment and prevention and job aids were developed and disseminated to health workers alongside in-service training. The survey investigated if treatment of uncomplicated malaria conformed to national malaria treatment guidelines in Kenya.Methods: In September 2009, face to face interviews for 31 health workers routinely performing consultations at out-patient departments in 17 health facilities were conducted. Data on health facility inventory control practices and stock status was retrospectively collected from records available. Outcome measures: availability of antimalarial drugs on the survey day, stock-outs in past six months, presence of job aids, health worker's exposure to in-service training on AL and access to new national malaria treatment guidelines.Results: 35 percent of the health facilities had access to job aids and current treatment guidelines, 76 percent of the health workers had been trained on malaria case management. AL was almost universally available in all the health facilities. All facilities had recorded stock outs of AL six months prior to the survey and the duration of the stock outs was substantial lasting two months on average.Conclusion: Treatment practices in uncomplicated malaria after policy change, do not fully conform to the national malaria treatment guidelines. Targets set for key implementation indicators by the division of malaria control, in terms of availability of recommended drug and training of health workers, have not been fully achieved. If the government does not ensure uninterrupted supply of recommended treatment, high quality focused training and appropriate patient education, and if provider prescription practices do not fully conform to the recommended treatment guidelines, the major potential public health benefits of AL may not be realized.

Antimalarial Drug Predictions Using Molecular Descriptors and Machine Learning against Plasmodium Falciparum

“…Chloroquine (CQ) has long been the drug of choice for the treatment of malaria; however, CQ-resistant parasites are now present in most areas where malaria is endemic [ 10 , 11 ]. Moreover, recent alarming reports observed the emergence of artemisinin-resistant parasites in Southeast Asia [ 12 , 13 ], which could derail the current elimination/eradication efforts, and again foster an increase in malaria cases and deaths [ 14 , 15 , 16 ]. Observation of this study indicated the emergence of artemisinin resistance of Plasmodium falciparum not only in Southeast Asia but also in Sub-Saharan Africa, Tanzania being the case of study [ 17 ].…”

Screening and characterization of antimalarial resistance related genetic structural variations in P. falciparum

“…Despite being effective against a wide range of parasite developmental stages, Artemisinin resistance seem to be specific to early Ring stages, while the mature stages remained susceptible [69]. IDC morphology and transcriptional staging of Artemisinin resistant parasites exhibited prolonged Ring stages [74][75][76], as well as quiescence developmental state during treatment which would resume growth upon removal of Artemisinin exposure [77,78]. Population transcriptomics has also revealed upregulation of oxidative stress response and unfolded protein response in resistant parasites [79].…”