Malaria
remains a global public health burden with growing concerns of resistance to
antimalarials. The disease claims almost half a million lives, and infects over
200 million people yearly. Most of the cases (90%) and deaths (91%) occur in
Africa (World Health Organization, 2017). Children below the age of 5
are most vulnerable. And with an increase in the number of cases by a whopping
5 million recorded in 2016 (216 million) as compared to the cases recorded in
2015 (211million) (World Health Organization, 2017), the disease remains a threat
to humanity. Global efforts to eliminate the disease have worked in some
countries, continue to work in others (E-2020 countries) (World Health Organization, 2017) while under threat elsewhere.
The failure of these strategies in some malaria endemic regions is largely due
to resistance mounted by the malaria parasites Plasmodium spp to chloroquine and other monotherapies and
artemisinin-based combination (ACT) therapy in South East Asia (Centers for Disease Control and Prevention, 2015).
But
how has research in chloroquine and artemisinin resistance fared since emergence
of resistance in the 1950s and 1960s? In a bid to eyeball the progress of
research in these fields over time, I used NCBI's E-Utilities/EDirect tool to
search and retrieve counts of all publications on "chloroquine
resistance" and "artemisinin resistance" from 1950 to 2017 in
the PubMed database. A graph of the research trend in the two fields (above)
shows a consistent relative level of research. Chloroquine resistance emerged
first, and received a lot of attention between the 1980s and 1996, 2000 and
2007, and between 2010 and 2014. The general increase in both research areas
has in no doubt been enhanced by recent cutting edge technology. The upsurge of
chloroquine resistance research at different 'spacetimes', may be suggestive of
emergence of resistance at different times in different regions. Research in
artemisinin resistance started long after chloroquine resistance research and
has increasingly been on the rise. The continuous rise in research on
artemisinin resistance may be consistent with surveillance systems put in place
to screen for genetic markers of resistance in all malaria endemic regions. And
for the past few years, artemisinin resistance has received more attention, and
rightly so because ACTs are currently the first line of action against malaria
and are under serious threat.
However,
both plots show decrease in research in both fields between 2015 and 2017. This
is an interesting correlation with the malaria cases recorded in 2016, which
saw an increase. It is probable that many more articles published between 2016
and 2017 have not been integrated into PubMed, and therefore the reason for the
decrease in research publications. However, if these decreases genuinely
reflect the status of research in this time period, it could be a major cause
for concern. As we relax our strategies and quest for knowledge, the parasite
takes advantage of this ‘window of freedom’ to impart great damage on our race.
We
cannot also underestimate the impact of crises in conflict zones on the world malaria
burden. It is possible that crises around the world contributed hugely to the
overall increase in malaria cases in 2016. Of particular importance are the;
Boko Haram crisis in Nigeria, crises in Yemen, South Sudan, Bolivarian Republic
of Venezuela and the Democratic Republic of Congo (World Health Organization, 2017). These conflict zones pose a
great barrier to malaria intervention strategies.
Therefore,
we must continue to work to probe the weaknesses of the parasites, and equally
the strengths of the human system against the parasite in order to develop
effective intervention strategies that would not only achieve the 2030 targets
of the WHO Sustainable Development Goals, but the 2020 Elimination target (WHO, 2017).
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