Five Years of Large-Scale dhfr and dhps Mutation Surveillance Following the Phased Implementation of Artesunate Plus Sulfadoxine-Pyrimethamine in Maputo Province, Southern Mozambique

The Question

Has widespread implementation of AS-SP (an ACT) as a malaria treatment slowed the evolution of antimalarial resistance in Maputo Province, Southern Mozambique over a five year period?

What we found

Evidence suggests that deploying artesunate plus SP (AS-SP) in Maputo Province has not slowed the spread of resistance to SP.  Several possible explanations are proposed.  Resistance may be the result of pre-existing parasitic mutations in the region, the use of SP monotherapy for pregnant women, and the systematic underdosing of SP for children under five.  The study suggests that the therapeutic lifespan for AS-SP is reduced by the trends in resistance.

Why it matters

Deployment of ACTs has been heralded as a means to fight resistance to antimalarial drugs, however evidence suggests that the strategy is not always effective at slowing the spread of resistance.  Employing effective antimalarials is essential to reduce disease mortality and morbidity and to support  other malaria interventions.