title: Assessing the potential impact of artemisinin and partner drug resistance in sub-Saharan Africa.
abstract: BACKGROUND
  Artemisinin and partner drug resistant malaria parasites have emerged in Southeast Asia. If resistance were to emerge in Africa it could have a devastating impact on malaria-related morbidity and mortality. This study estimates the potential impact of artemisinin and partner drug resistance on disease burden in Africa if it were to emerge.
  
  
  METHODS
  Using data from Asia and Africa, five possible artemisinin and partner drug resistance scenarios are characterized. An individual-based malaria transmission model is used to estimate the impact of each resistance scenario on clinical incidence and parasite prevalence across Africa. Artemisinin resistance is characterized by slow parasite clearance and partner drug resistance is associated with late clinical failure or late parasitological failure.
  
  
  RESULTS
  Scenarios with high levels of recrudescent infections resulted in far greater increases in clinical incidence compared to scenarios with high levels of slow parasite clearance. Across Africa, it is estimated that artemisinin and partner drug resistance at levels similar to those observed in Oddar Meanchey province in Cambodia could result in an additional 78 million cases over a 5 year period, a 7% increase in cases compared to a scenario with no resistance. A scenario with high levels of slow clearance but no recrudescence resulted in an additional 10 million additional cases over the same period.
  
  
  CONCLUSIONS
  Artemisinin resistance is potentially a more pressing concern than partner drug resistance due to the lack of viable alternatives. However, it is predicted that a failing partner drug will result in greater increases in malaria cases and morbidity than would be observed from artemisinin resistance only.
authors.affiliation: Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis and Modelling, Imperial College London, London, W2 1PG, UK. hannah.slater@imperial.ac.uk.
authors.forename: Hannah C
authors.initials: HC
authors.lastname: Slater
authors.affiliation: Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis and Modelling, Imperial College London, London, W2 1PG, UK. jamie.griffin@imperial.ac.uk.
authors.forename: Jamie T
authors.initials: JT
authors.lastname: Griffin
authors.affiliation: Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis and Modelling, Imperial College London, London, W2 1PG, UK. a.ghani@imperial.ac.uk.
authors.forename: Azra C
authors.initials: AC
authors.lastname: Ghani
authors.affiliation: Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis and Modelling, Imperial College London, London, W2 1PG, UK. l.okell@imperial.ac.uk.
authors.forename: Lucy C
authors.initials: LC
authors.lastname: Okell
mesh_terms: D000349:Africa; D017954:Africa South of the Sahara; D000962:Antimalarials / Q000627:therapeutic use; D037621:Artemisinins; D001208:Asia; D004351:Drug Resistance; D006801:Humans; D008288:Malaria / Q000188:drug therapy*
chemical_list: D000962:Antimalarials; D037621:Artemisinins