Currently Observed Trend in the Resistance of Malaria to Artemisinin Based Combination Therapy in Nigeria – A Report of 5 Cases

Malaria is a life threatening disease caused by parasites transmitted through the bite of an infected female mosquito. About 3.2 million (about half of the world’s population) are at risk of malaria; it affects all age group from young to old. Between 2002 – 2015, Sub-Saharan Africa was home to 88% of malaria cases and 90% of malaria deaths most of which were under-five years old. Plasmodium falciparum – transmitted by female Anopleles mosquito (one of the five parasites that cause malaria in humans) is the most prevalent malaria parasite in the African continent and is responsible for most malaria-related deaths globally [1].

Artemisinin-based combination therapy (ACT) resistance is rare in Sub-Saharan Africa. The World Health Organization (WHO) identifies monitoring and surveillance using day – 3 parasitaemia post treatment as the standard test for identifying suspected artemisinin resistance [2]. Early treatment failure due to possible ACT resistant Plasmodium falciparum has been identified in 5 cases across different age group, race, sex and gender. All cases managed showed significant clinical and parasitological responses to further treatment with combined Artesunate (intravenous) and Arthemeter (intramuscular), Arthemeter only (IM) or Artesunate tablets.

This study seeks to emphasize the need for a re-evaluation of the malaria treatment protocol and to throw more light on the increasing resistance of Plasmodium falciparum to the commonly used Artemisinin – based combination therapy agents in Nigeria.