Mapping the prevalence of molecular markers of Plasmodium falciparum artemisinin partial resistance in Africa: a systematic review and spatiotemporal modelling study.
Neeva Wernsman Young, Cécile P G Meier-Scherling, Gina Cuomo-Dannenburg et al.
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In 30 seconds
This systematic review and spatiotemporal modelling study integrated published and unpublished surveys with public molecular databases to map Plasmodium falciparum resistance markers across Africa. The final dataset covered 578 studies, 3,848 surveys and 47 countries. Models identified distinct emergences and regional expansion of artemisinin partial-resistance-associated kelch13 mutations in east Africa. The highest predicted prevalence in 2024 was in Rwanda’s Northern Province: 62·2% (95% credible interval 3·9-98·6), compared with 0·2% (0·0-0·7) in 2012. The authors also found that crt K76T remained prevalent in the Horn of Africa.
Key findings
- Predicted kelch13 mutation prevalence in Rwanda’s Northern Province reached 62·2% (95% credible interval 3·9-98·6) in 2024, up from 0·2% (0·0-0·7) in 2012.
- Models indicated distinct kelch13 mutation emergences in Rwanda, Uganda, Ethiopia and Eritrea, followed by expansion into regional hotspots.
- The mdr1 N86Y marker was fading, whereas crt K76T remained prevalent in the Horn of Africa.
Why it matters
The mapped expansion of artemisinin partial-resistance markers, alongside markers of reduced susceptibility to partner drugs, raises concern about the continued efficacy of artemisinin-based combination therapies in affected areas. The study’s high-resolution estimates and uncertainty intervals can help identify locations where surveillance and therapeutic efficacy studies may be most informative.
What to keep in mind
The estimates are modelled from heterogeneous surveys with sparse surveillance in some locations; the wide credible interval for the highest 2024 estimate reflects substantial uncertainty.