title: Mitigating the threat of artemisinin resistance in Africa: improvement of drug-resistance surveillance and response systems.
abstract: Artemisinin-resistant Plasmodium falciparum malaria has emerged in western Cambodia and has been detected in western Thailand. The situation is ominously reminiscent of the emergence of resistance to chloroquine and to sulfadoxine-pyrimethamine several decades ago. Artemisinin resistance is a major threat to global public health, with the most severe potential effects in sub-Saharan Africa, where the disease burden is highest and systems for monitoring and containment of resistance are inadequate. The mechanisms that underlie artemisinin resistance are not fully understood. The main phenotypic trait associated with resistance is a substantial delay in parasite clearance, so far reported in southeast Asia but not in Africa. One of the pillars of the WHO global plan for artemisinin resistance containment is to increase monitoring and surveillance. In this Personal View, we propose strategies that should be adopted by malaria-endemic countries in Africa: resource mobilisation to reactivate regional surveillance networks, establishment of baseline parasite clearance profiles to serve as benchmarks to track emerging artemisinin resistance, improved data sharing to allow pooled analyses to identify rare events, modelling of risk factors for drug resistance, and development and validation of new approaches to monitor resistance.
authors.affiliation: Malaria Public Health and Epidemiology Group, University of Oxford and KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya. ambrose.talisuna@wwarn.org
authors.forename: Ambrose O
authors.initials: AO
authors.lastname: Talisuna
authors.forename: Corine
authors.initials: C
authors.lastname: Karema
authors.forename: Bernhards
authors.initials: B
authors.lastname: Ogutu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Juma
authors.forename: John
authors.initials: J
authors.lastname: Logedi
authors.forename: Andrew
authors.initials: A
authors.lastname: Nyandigisi
authors.forename: Modest
authors.initials: M
authors.lastname: Mulenga
authors.forename: Wilfred F
authors.initials: WF
authors.lastname: Mbacham
authors.forename: Cally
authors.initials: C
authors.lastname: Roper
authors.forename: Philippe J
authors.initials: PJ
authors.lastname: Guerin
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
mesh_terms: D000349:Africa / Q000453:epidemiology; D017954:Africa South of the Sahara; D000962:Antimalarials / Q000008:administration & dosage* / Q000494:pharmacology; D037621:Artemisinins / Q000008:administration & dosage* / Q000494:pharmacology; D003140:Communicable Disease Control / Q000379:methods; D004351:Drug Resistance; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology*; D010963:Plasmodium falciparum / Q000187:drug effects*; D018571:Sentinel Surveillance; D014944:World Health Organization
chemical_list: D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin