The increasing prevalence of Antimalarial Drugs Resistance (AMR) witnessed in recent years is raising alarm bells in the medical fraternity. Growing evidence indicates that malaria is showing resistance towards drugs like Artemisinin and Chloroquine, used either independently or in combination.
Understanding Drug Resistance
Drug resistance can be defined as the ability of disease-causing pathogens, such as bacteria or viruses, to continue multiplying despite the presence of drugs typically capable of eliminating them. This results in a reduction in the effectiveness of medication meant to treat a disease or condition. In the case of HIV (Human immunodeficiency virus), for instance, drug resistance arises from mutations in the virus’s genetic structure leading to modifications in certain HIV proteins and enzymes like the protease enzyme which assists HIV replication.
Factors Leading to Antimalarial Drug Resistance
The primary cause of antimalarial drug resistance has been identified as mutations. From 2010 to 2019, 1,044 global studies confirmed the partial resistance of the malarial parasite to artemisinin due to the PfK13 mutation. Other contributing factors include inadequate coverage of antimalarial drugs, improper diagnosis, misuse of drugs, and inefficient mosquito control programs. These failures result in increased exposure of the malaria parasites to drugs, thereby escalating the risk of drug resistance.
Growing Concerns
Chloroquine (CQ) is the most commonly prescribed drug for treating P Vivax parasite. A report by the World Health Organisation (WHO) highlighted the widespread resistance to chloroquine in all WHO regions, with 28 countries, including India, demonstrating this resistance. A scenario of widespread resistance could lead to an excess of 22 million treatment failures per year, 116,000 deaths, and costs including an estimated USD 130 million for changing treatment policy.
About Malaria
Malaria is a life-threatening blood disease transmitted through mosquito bites and caused by plasmodium parasites. It’s predominantly found in the tropical and subtropical areas of Africa, South America, and Asia. The disease spreads through the bites of infected female Anopheles mosquitoes, with the parasite entering the bloodstream and maturing in the liver. Symptoms include sweating, headache, nausea, vomiting, and abdominal pain.
Types of Malaria and the Indian Scenario
Humans can be infected by four types of Parasites: Plasmodium Vivax, P.ovale, P.malariae, and P.falciparum. India accounts for 2% of the global malaria case burden and deaths. It also bears 85.2% of the malaria burden in South East Asia and 47% of the global P.vivax malaria burden, making it strategically important for global malaria elimination. However, India has reported a 17.6% decline in 2019 as compared to 2018, being the only high-endemic country to have done so.
Initiatives to Eliminate Malaria
In an effort to eradicate malaria, several initiatives such as the National Strategic Plan for Malaria Elimination (2017-22) and National Framework for Malaria Elimination have been introduced.
The Way Forward
Malaria death toll stood at 405,000 with 218 million affected people in 2018. However, the fight against this deadly disease is becoming increasingly challenging due to the rising resistance against malarial drugs. Therefore, maintaining up-to-date, quality data on the effectiveness of recommended treatments is crucial. Implementing Molecular Malaria Surveillance to identify drug-resistant variants and taking timely corrective measures could be vital in averting disastrous consequences.
Last Modified: February 13, 2024