What are the effects of drug resistance on the global spread of malaria?
A systematic literature review
Abstract
Malaria remains one of the most significant global health
challenges, particularly in tropical and subtropical regions, with
sub-Saharan Africa bearing the highest burden. Advances in malaria
control, including insecticide-treated nets (ITNs), indoor residual
spraying, and artemisinin-based combination therapies (ACTs), have
reduced malaria cases and deaths. However, the emergence and spread of
antimalarial drug resistance, especially to artemisinin, present a
growing threat to malaria control and elimination efforts. Resistance to
ACTs, characterized by delayed parasite clearance due to kelch13
mutations, is most prevalent in Southeast Asia and is beginning to
emerge in Africa. This systematic literature review examines the global
impact of drug resistance on malaria transmission, treatment efficacy,
and control strategies. Findings reveal that drug resistance undermines
treatment effectiveness, increases transmission potential, and imposes
significant operational and economic challenges. Resistance hotspots in
Southeast Asia, sub-Saharan Africa, and South Asia are expanding, driven
by human migration and inadequate surveillance systems. The review
highlights the need for strengthened molecular surveillance, the
development of triple ACT therapies, and region-specific interventions
to address resistance patterns. Without coordinated global efforts, drug
resistance will continue to undermine progress toward malaria
elimination, exacerbating the disease’s global burden. This review
underscores the urgent need for innovative treatment strategies,
improved surveillance systems, and international collaboration to
contain the spread of drug-resistant malaria and ensure the
sustainability of malaria control programs worldwide.
