Antimalarial drug resistance is a growing threat to malaria control, especially in regions like Africa and Southeast Asia. Recent studies have raised concerns about the effectiveness of artemisinin-based combination therapies (ACTs), the current standard treatment. The World Health Organisation (WHO) has reported increasing numbers of drug-resistant parasites.
Chloroquine, once widely used to treat malaria, was introduced in the 1940s, particularly in Southeast Asia. However, resistance to this drug emerged a few decades later as parasites adapted. Today, ACTs, which combine artemisinin with another antimalarial drug, are the main treatment of malaria. However, with signs of resistance to ACTs in Africa—the country with the highest malaria burden—there is an urgent need for new treatments or better management of resistant parasites.
To address this, the WHO emphasises effective malaria case management, including quick access to diagnostics and treatments. Their strategy focuses on reducing drug resistance by using multiple first-line therapies and improving surveillance systems.
In recognition of World Malaria Day on April 25, this article highlights the remarkable work being done at the Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), a partnership between Barwon Health and Deakin University’s Institute for Mental and Physical Health and Clinical Translation (IMPACT).
Dr Charles Narh, a Research Fellow at CIIDIR, works on developing diagnostics and using genomic surveillance for antimalarial resistance. His research is crucial for creating new tools to detect, track, and control the spread of malaria treatment resistance in affected regions.
Understanding the challenges and gaps
Developing affordable diagnostic tools to detect drug-resistant malaria parasites is a key challenge, particularly in Africa, where the disease burden is highest. These tools are vital for supporting malaria control programs by enabling early detection, proper treatment, and tracking of resistance patterns. However, there are several hurdles to overcome.
Diagnostic Testing:
Many current diagnostic technologies, like PCR and next-generation sequencing, are accurate but expensive and not widely available in low-resource areas. While rapid diagnostic tests (RDTs) have helped detect malaria, they cannot identify drug resistance. This limits the ability to monitor resistance effectively in real-time.
Surveillance:
Tracking drug resistance is essential but difficult due to fragmented surveillance systems and poor data sharing between countries. A more coordinated approach to collecting and sharing resistance data across regions would help guide treatment decisions and improve malaria control efforts.
Evolving parasites:
Malaria parasites continuously evolve, making drug resistance more complex. Diagnostic tools must keep up with these changes and be adaptable to different parasite strains and regions, adding another layer of difficulty to resistance detection.
Contributing to the global fight against malaria
Dr Narh is committed to developing effective diagnostic tools to detect drug-resistant malaria in Africa. Through strengthening antimalarial resistance genomic programs via both basic and translational research, as well as building capacity through workshops and student projects, Dr Narh aims to provide essential insights that will enhance malaria treatment across the continent.
What motivated you to pursue malaria research?
Dr Narh says, “While growing up in Ghana, I used to see a lot of people not getting better after taking chloroquine (a drug commonly used for malaria treatment in the 1900s) for malaria treatment. Later on, during my Honour’s degree, I got to know it was due to the malaria parasite’s resistance to the drug, and I have since being interested in studying how these resistant parasites spread” throughout the population.
Parasites are evolving gene mutations that indicate drug resistance
Malaria treatments in Ghana remain effective, but genomic analysis indicates that some parasites are evolving mutations that could lead to resistance against artemisinin combination therapies (ACTs), the last effective antimalarial treatment. Developing affordable diagnostic tools to detect drug-resistant malaria is crucial for the success of malaria control and elimination programs in Africa. By tackling challenges related to cost, accessibility, and surveillance, these tools can enable timely and targeted interventions, ultimately supporting the global effort to eliminate malaria.