Scientists have warned that the fight against malaria in Africa may have got tougher after a new study found that a lifesaving drug was becoming less effective among children with serious infections. The study published in the Journal of the American Medical Association (JAMA) stated that children had developed resistance to artemisinin - a key malaria drug that rapidly eliminates most malaria parasites in the body. Artemisinin resistance was first identified in southeast Asia in the 2000s but it is the first time it has been identified specifically in children with severe malaria in Africa.

Malaria is caused by a parasite called Plasmodium falciparum, which spreads through the bite of a mosquito. The World Health Organization's (WHO) 'gold standard' treatment involves the use of a course of pills containing an artemisinin derivative combined with a 'partner' drug that circulates in the body for longer and kills the remaining parasites. These regimens are called artemisinin-based combination therapies (ACTs).

Study methodology

The study was conducted in Uganda, involving 100 children hospitalised with severe malaria. The test findings showed that 11 of these children had developed partial resistance to artemisinin -- meaning that the parasites were evolving to evade the 'gold standard' malaria treatment. All the children with resistant malaria carried genetic mutations linked to drug resistance.

"If this is verified by other studies, it could change guidelines for treatment of severe malaria in African children, and they are the biggest target group by far," Chandy John, a specialist in paediatric infectious diseases at Indiana University in Indianapolis and co-author of the study told Nature.

Notably, another group of ten children in the study had a malaria infection that recurred after their treatment concluded.

"What the recurrence suggests to us is that maybe that partner drug is not working as well as it should, because the parasites are coming back," said John, adding that recurrence might have been caused by resistance to lumefantrine, a partner drug administered orally during ACT.

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What does it mean?

As the resistance spreads, it could make treating malaria harder, especially in a region like Africa which accounted for 95 per cent of the 608,000 malaria-related deaths in 2022.

"The emergence of artemisinin partial resistance in Africa is a major threat to malaria control," he says. "We are now only starting to understand what's going on," said Philip Rosenthal, a malaria specialist at the University of California, San Francisco.

"Even if the drug still works, that slower action could make a difference and lead to higher levels of mortality," he added.