Abstract
Malaria burden has severe impact on the world. Several arsenals, including the use of antimalarials, are in place to curb the malaria burden. However, the application of these antimalarials has two extremes, limited access to drug and drug pressure, which may have similar impact on malaria control, leading to treatment failure through divergent mechanisms. Limited access to drugs ensures that patients do not get the right doses of the antimalarials in order to have an effective plasma concentration to kill the malaria parasites, which leads to treatment failure and overall reduction in malaria control via increased transmission rate. On the other hand, drug pressure can lead to the selection of drug resistance phenotypes in a subpopulation of the malaria parasites as they mutate in order to adapt. This also leads to a reduction in malaria control. Addressing these extremes in antimalarial application can be essential in maintaining the relevance of the conventional antimalarials in winning the war against malaria.
Highlights
The control of malaria has stalled in the last five years [1,2]
Atovaquone/proguanil and sulfadoxine/pyrimethamine are among the antimalarials that can be used in chemoprevention of malaria (Table 1) [14,15]
Malaria control is hanging in the balance with the use of available tools of control, especially from the antimalarials
Summary
The control of malaria has stalled in the last five years [1,2]. There is need for a continuous review of the control strategies. Antimalarials remain one of the formidable tools in malaria control Both reduced access to antimalarials by the populace and pressure from these drugs on malaria parasites are important factors that play different roles in the overall malaria control. While reduced access to drugs negatively impact malaria control via increased spread/transmission, drug pressure facilitates the generation of resistant Plasmodium which results in treatment failures, respectively. Some antimalarials such as chloroquine (CQ) have lost their place in malaria control due to resistance development, and this fate befalls several other antimalarials [3,4]. This review seeks to assess the impact of these contrasting factors, limited access to drug and drug pressure, on the overall malaria treatment failure vis-à-vis its control
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