Resistance In Cambodia Research Articles

Identifikasi Mutasi Gen kelch 13 Penanda Resistensi Pada Plasmodium falciparum Dengan Pengobatan ACT Setelah 3 Hari Di Manokwari Papua Barat

Malaria is almost found all over the world, including Indonesia. WHO data on malaria case transmission in 2020, namely 241 million and 627,000 deaths. Female Anopheles mosquitoes are the main factor in the transmission of parasites, one of which is Plasmodium falciparum which is most dangerous to cause complications to death. Data from the Ministry of Health 2019 the highest transmission in Papua Province is 216,380 cases. The malaria elimination program uses ACT as a treatment therapy for malaria. The first appearance of ACT resistance in Cambodia was in 2008 to Plasmodium falciparum which was associated with the presence of a Kelch 13 gene mutation. The purpose of this study was to identify a mutation of the Kelch 13 gene markers of resistance in Plasmodium falciparum with ACT treatment after 3 days. This type of exploratory study used a population of all patients at the Amban Manokwari Health Center in West Papua, with a total sampling in August-September 2022. Of the 51 and 11 H3 samples met the inclusion criteria using RDT and Microscopic methods. The DNA isolated sample using Favorgen kit then amplified PCR and electrophoresis gel agarose. Then were 7 amplicons seen in the DNA band (±200bp) and confirmed results from PT. Science Genetics (±100bp), then 1 amplicon is continued for sequencing. The sequence results were analyzed using the Bioedit and Mega IX softwere with the alignment of the sequence results. Changes in nucleeid bases and amino acids were obtained so that the mutation of the Kelch 13 gene occurred, 3 mutation variants: substitution (transition & transversion), silent mutation (C3T codon 1 cysteine-cysteine), and missense mutation (T4A codon 2 tryptophan-serine). It can be concluded that the Plasmodium falciparum treatment ACT carriers the Kelch 13 gene mutation as one of the markers of resistance. Keywords: ACT, Plasmodium falciparum, Kelch 13 Gene Mutation.

Novel anti-malarial drug strategies to prevent artemisinin partner drug resistance: A model-based analysis.

Emergence of resistance to artemisinin and partner drugs in the Greater Mekong Subregion has made elimination of malaria from this region a global priority; it also complicates its achievement. Novel drug strategies such as triple artemisinin combination therapies (ACTs) and chemoprophylaxis have been proposed to help limit resistance and accelerate elimination. The objective of this study was to better understand the potential impacts of triple ACTs and chemoprophylaxis, using a mathematical model parameterized using data from Cambodia. We used a simple compartmental model to predict trends in malaria incidence and resistance in Cambodia from 2020-2025 assuming no changes in transmission since 2018. We assessed three scenarios: a status quo scenario with artesunate-mefloquine (ASMQ) as treatment; a triple ACT scenario with dihydroartemisinin-piperaquine (DP) plus mefloquine (MQ) as treatment; and a chemoprophylaxis scenario with ASMQ as treatment plus DP as chemoprophylaxis. We predicted MQ resistance to increase under the status quo scenario. Triple ACT treatment reversed the spread of MQ resistance, but had no impact on overall malaria incidence. Joint MQ-PPQ resistance declined under the status quo scenario for the baseline parameter set and most sensitivity analyses. Compared to the status quo, triple ACT treatment limited spread of MQ resistance but also slowed declines in PPQ resistance in some sensitivity analyses. The chemoprophylaxis scenario decreased malaria incidence, but increased the spread of strains resistant to both MQ and PPQ; both effects began to reverse after the intervention was removed. We conclude that triple ACTs may limit spread of MQ resistance in the Cambodia, but would have limited impact on malaria incidence and might slow declines in PPQ resistance. Chemoprophylaxis could have greater impact on incidence but also carries higher risks of resistance. Aggressive strategies to limit transmission the GMS are needed to achieve elimination goals, but any intervention should be accompanied by monitoring for drug resistance.

Resistance to Second-Line Anti-TB Drugs in Cambodia: A Phenotypic and Genetic Study

BackgroundDue to the emergence of Mycobacterium tuberculosis (M.tb) clinical isolates resistant to most potent first-line drugs (FLD), second-line drugs (SLD) are being prescribed more frequently. We explore the genetic characteristics and molecular mechanisms of M.tb isolates phenotypically resistant to SLD, including pre-extensively drug-resistant (pre-XDR) and extensively drug-resistant (XDR) isolates.MethodsDrug-resistant (DR) M.tb isolates collected from 2012 to 2017 were tested using sequencing and phenotypic drug susceptibility testing. Genotypes were determined to explore their links with SLD resistance patterns.ResultsOf the 272 DR M.tb isolates, 6 non-multidrug resistant (non-MDR) isolates were fluoroquinolones (FQ)-resistant, 3 were XDR and 16 were pre-XDR (14 resistant to FQ and 2 to second-line injectable drugs). The most frequent mutations in FQ-resistant and second-line injectable drugs resistant isolates were gyrA D94G (15/23) and rrs a1401g (3/5), respectively. Seventy-five percent of pre-XDR isolates and 100% of XDR isolates harbored mutations conferring resistance to pyrazinamide. All XDR isolates belonged to the Beijing genotype, of which one, named XDR+, was resistant to all drugs tested. One cluster including pre-XDR and XDR isolates was observed.ConclusionThis is the first description of SLD resistance in Cambodia. The data suggest that the proportion of XDR and pre-XDR isolates remains low but is on the rise compared to previous reports. The characterization of the XDR+ isolate in a patient who refused treatment underlines the risk of transmission in the population. In addition, genotypic results show, as expected, that the Beijing family is the main involved in pre-XDR and XDR isolates and that the spread of the Beijing pre-XDR strain is capable of evolving into XDR strain. This study strongly indicates the need for rapid interventions in terms of diagnostic and treatment to prevent the spread of the pre-XDR and XDR strains and the emergence of more resistant ones.

Public knowledge, attitudes and practices surrounding antibiotic use and resistance in Cambodia.

BackgroundWHO’s Global Action Plan on Antimicrobial Resistance includes as a priority to increase public education surrounding antibiotic use and resistance. Monitoring population-level antibiotic behaviours is crucial for informing intervention strategies, but data from a broad range of settings, particularly lower-resourced countries, are lacking.ObjectivesWe measured public knowledge, attitudes and practices regarding antibiotics and antibiotic resistance in Cambodia, providing baseline information against which to monitor the progress of future interventions.MethodsBetween September and October 2018, we conducted a household survey of knowledge, attitudes and practices related to antibiotic use in urban and rural populations of three Cambodian provinces: Phnom Penh, Siem Reap and Prey Veng. Response rates were respectively 79%, 86% and 86%.ResultsAmong the 2005 participants, we found high levels of awareness of terms relating to antibiotics (86.5%) and antibiotic resistance; most participants also recognized that antibiotic resistance is a problem (58.4%). However, few understood that antibiotics are effective only against bacterial infections (1.2%). We also found province-specific differences in participants’ sources of antibiotics and their sources of AMR-related information. In regression analyses, more favourable antibiotic practice scores were associated with higher knowledge (β = 0.18; 95% CI: 0.14–0.22) and attitude (β = 0.16; 95% CI: 0.11–0.22) scores, as well as trust in healthcare sources to obtain antibiotics and antibiotic information.ConclusionsThis study highlights the importance of interventions and public communication on antibiotic use and resistance that is effectively targeted to the local context through trusted healthcare providers.

Building capacity in surveillance of antimicrobial resistance in Cambodia

Building capacity in surveillance of antimicrobial resistance in Cambodia

Frequent unregulated use of antibiotics in rural Cambodian infants.

BackgroundDespite a high prevalence of antibiotic resistance in Cambodia, few studies have assessed health-seeking behaviour and the use of antibiotics by caregivers of young children in Cambodia.MethodsWe conducted a cross-sectional survey of infants <12 months of age and their caregivers, assessing the frequency of reported illness, common symptoms and associated health-seeking behaviour through structured questionnaires administered by trained fieldworkers at a home visit. In a subset of these participants, ages 4–8 months with no acute malnutrition, we conducted a 3-month surveillance with fortnightly home visits.ResultsOf 149 infants (ages 1–11 months, 54.4% male) enrolled in the cross-sectional study, 76 (51.4%) reported symptoms of diarrhoea, fever or cough in the previous 14 d, with associated use of antibiotics reported in 22 (14.8%) infants. In 47 infants enrolled in the longitudinal surveillance, there were 141 reported episodes of illness in 44 (94%) infants with 21 infants (45%) reported to have received antibiotics in 32/141 (22.7%) episodes. Amoxicillin was the most commonly reported antibiotic in both surveys (68% [40/59 episodes reporting the use of antibiotics]).ConclusionsAntibiotic usage is high in this population and appears to be occurring largely outside of the formal healthcare system.

Intensifying Political Geographies of Authoritarianism: Toward an Anti-geopolitics of Garment Worker Struggles in Neoliberal Cambodia

Cambodia’s recent crackdown on freedoms of expression, association, and assembly coincides with the wider geopolitical ascent of illiberal democracy. Scholarly and public discourse suggests that we are now witnessing a global authoritarian turn, possibly linked to the current conditions of late neoliberal capitalist development where deprivations linked to state rollback have engendered a corrective state rollout. The language of the global authoritarian turn, however, echoes earlier unhelpful and totalizing readings of neoliberal expansion as a process of top-down diffusion. To counter this, this article argues for a recentering of local geographies in understanding authoritarian neoliberalism and a renewed focus on the bottom-up dynamics of its articulation in specific contexts. Drawing from a detailed study of garment worker activism, this article unravels the two-way relationship that unfolds between the intensified experiences of capital and resistance in Cambodia and the intensifying political geography of authoritarianism that reverberates as a result. Forwarding an antigeopolitical reading of authoritarian neoliberalism in Cambodia, the article recasts the current crisis underway in Cambodia, disrupting the notion of an authoritarian turn. Rather than the top-down imposition of a new model of autocratic government, the crackdown is shown to represent an intensification of existing authoritarian neoliberalism provoked by geopolitics from below. Here, intensification reflects a demographic and spatial shift in the concentration of authoritarian strategies toward Cambodia’s garment workers. Key Words: anti-geopolitics, authoritarianism, Cambodia, neoliberalism, resistance.

Popular Resistance in Cambodia: The Rationale Behind Government Response

Popular Resistance in Cambodia: The Rationale Behind Government Response

The dark underbelly of land struggles: the instrumentalization of female activism and emotional resistance in Cambodia

ABSTRACTFacing land grabs and eviction in the name of development, women worldwide increasingly join land rights struggles despite often deeply engrained images of female domesticity and conventional gender norms. Yet, the literature on female agency in the context of land struggles has remained largely underexplored. Based on extensive ethnographic fieldwork, my findings suggest that land rights activism in Cambodia has undergone a gendered re-framing process. Reasoning that women use non-violent means of contestation and are less prone to violence from security personnel, non-governmental organizations (NGOs) push women affected by land grabs and eviction to the frontline of protests. Moreover, female activists are encouraged to publicly display emotions, such as the experienced pain behavior that sharply contrasts with Cambodian norms of feminine modesty. I critically question this women-to-the-front strategy and, drawing on Sara Ahmed’s politics of emotions approach, show the adverse risks for female activists. Furthermore, I demonstrate that the instrumentalization of female bodies and emotions in land rights protests perpetuate gender disparities instead of strengthening female agency in the Cambodian society and opening up political space for women.

Gametocyte Carriage, Antimalarial Use, and Drug Resistance in Cambodia, 2008-2014.

Gametocytes are the malaria parasite stages responsible for transmission from humans to mosquitoes. Gametocytemia often follows drug treatment, especially as therapies start to fail. We examined Plasmodium falciparum gametocyte carriage and drug resistance profiles among 824 persons with uncomplicated malaria in Cambodia to determine whether prevalent drug resistance and antimalarial use has led to a concentration of drug-resistant parasites among gametocyte carriers. Although report of prior antimalarial use increased from 2008 to 2014, the prevalence of study participants presenting with microscopic gametocyte carriage declined. Gametocytemia was more common in those reporting antimalarial use within the past year, and prior antimalarial use was correlated with higher IC50s to piperaquine and mefloquine, as well as to increased pfmdr1 copy number. However, there was no association between microscopic gametocyte carriage and parasite drug resistance. Thus, we found no evidence that the infectious reservoir, marked by those carrying gametocytes, is enriched with drug-resistant parasites.

Gametocyte Carriage, Antimalarial Use, and Drug Resistance in Cambodia, 2008-2014

Gametocyte Carriage, Antimalarial Use, and Drug Resistance in Cambodia, 2008-2014

Functional analysis of Plasmodium falciparum subpopulations associated with artemisinin resistance in Cambodia

BackgroundPlasmodium falciparum malaria is one of the most widespread parasitic infections in humans and remains a leading global health concern. Malaria elimination efforts are threatened by the emergence and spread of resistance to artemisinin-based combination therapy, the first-line treatment of malaria. Promising molecular markers and pathways associated with artemisinin drug resistance have been identified, but the underlying molecular mechanisms of resistance remains unknown. The genomic data from early period of emergence of artemisinin resistance (2008–2011) was evaluated, with aim to define k13 associated genetic background in Cambodia, the country identified as epicentre of anti-malarial drug resistance, through characterization of 167 parasite isolates using a panel of 21,257 SNPs.ResultsEight subpopulations were identified suggesting a process of acquisition of artemisinin resistance consistent with an emergence-selection-diffusion model, supported by the shifting balance theory. Identification of population specific mutations facilitated the characterization of a core set of 57 background genes associated with artemisinin resistance and associated pathways. The analysis indicates that the background of artemisinin resistance was not acquired after drug pressure, rather is the result of fixation followed by selection on the daughter subpopulations derived from the ancestral population.ConclusionsFunctional analysis of artemisinin resistance subpopulations illustrates the strong interplay between ubiquitination and cell division or differentiation in artemisinin resistant parasites. The relationship of these pathways with the P. falciparum resistant subpopulation and presence of drug resistance markers in addition to k13, highlights the major role of admixed parasite population in the diffusion of artemisinin resistant background. The diffusion of resistant genes in the Cambodian admixed population after selection resulted from mating of gametocytes of sensitive and resistant parasite populations.

Layer-Cake Figurations and Hide-and-Show Resistance in Cambodia

This article adds to previous research, by connecting the concept of resistance to practices of self-making and the embodying of various gendered images. In this article, I advance that women politicians, activists and NGO workers in Cambodia, who seem to repeat and maintain established gender discourses, actually use these discourses and the existence of a multilayered figuration as a ‘hiding place’. This can be understood as various gendered discourses and figurations being utilised as resistance. In order to further explore this pattern, the article introduces the concepts of hide-and-show resistance and layer-cake figurations. The notion of figurations, as situated and culturally differentiated, becomes an important starting point, displaying resistance that originates from the way we are constituted in a local–transnational, material and fast-changing world.

Measuring ex vivo drug susceptibility in Plasmodium vivax isolates from Cambodia

BackgroundWhile intensive Plasmodium falciparum multidrug resistance surveillance continues in Cambodia, relatively little is known about Plasmodium vivax drug resistance in Cambodia or elsewhere. To investigate P. vivax anti-malarial susceptibility in Cambodia, 76 fresh P. vivax isolates collected from Oddar Meanchey (northern Cambodia) in 2013–2015 were assessed for ex vivo drug susceptibility using the microscopy-based schizont maturation test (SMT) and a Plasmodium pan-species lactate dehydrogenase (pLDH) ELISA. P. vivax multidrug resistance gene 1 (pvmdr1) mutations, and copy number were analysed in a subset of isolates.ResultsEx vivo testing was interpretable in 80% of isolates using the pLDH-ELISA, but only 25% with the SMT. Plasmodium vivax drug susceptibility by pLDH-ELISA was directly compared with 58 P. falciparum isolates collected from the same locations in 2013–4, tested by histidine-rich protein-2 ELISA. Median pLDH-ELISA IC50 of P. vivax isolates was significantly lower for dihydroartemisinin (3.4 vs 6.3 nM), artesunate (3.2 vs 5.7 nM), and chloroquine (22.1 vs 103.8 nM) than P. falciparum but higher for mefloquine (92 vs 66 nM). There were not significant differences for lumefantrine or doxycycline. Both P. vivax and P. falciparum had comparable median piperaquine IC50 (106.5 vs 123.8 nM), but some P. falciparum isolates were able to grow in much higher concentrations above the normal standard range used, attaining up to 100-fold greater IC50s than P. vivax. A high percentage of P. vivax isolates had pvmdr1 Y976F (78%) and F1076L (83%) mutations but none had pvmdr1 amplification.ConclusionThe findings of high P. vivax IC50 to mefloquine and piperaquine, but not chloroquine, suggest significant drug pressure from drugs used to treat multidrug resistant P. falciparum in Cambodia. Plasmodium vivax isolates are frequently exposed to mefloquine and piperaquine due to mixed infections and the long elimination half-life of these drugs. Difficulty distinguishing infection due to relapsing hypnozoites versus blood-stage recrudescence complicates clinical detection of P. vivax resistance, while well-validated molecular markers of chloroquine resistance remain elusive. The pLDH assay may be a useful adjunctive tool for monitoring for emerging drug resistance, though more thorough validation is needed. Given high grade clinical chloroquine resistance observed recently in neighbouring countries, low chloroquine IC50 values seen here should not be interpreted as susceptibility in the absence of clinical data. Incorporating pLDH monitoring with therapeutic efficacy studies for individuals with P. vivax will help to further validate this field-expedient method.

Closing in on the reservoir while implementing passive case detection activities: pro-active case detection as a strategy to contribute to Plasmodium falciparum elimination in an area of multidrug resistance in Cambodia

This abstract corresponds with the following slides: https://f1000research.com/slides/6-711, presented at Medecins Sans Frontieres UK Scientific Days: Medical Research 2017. To watch the presentation click here: https://f1000research.com/videos/6-833. This abstract is part of an F1000Research gateway that includes posters, slides and videos from the MSF Scientific Day: Medical Research 2017. To see more please visit: https://f1000research.com/gateways/MSF/scidays

Closing in on the reservoir: pro-active case detection as a strategy to contribute to Plasmodium falciparum elimination in an area of multidrug resistance in Cambodia

Closing in on the reservoir: pro-active case detection as a strategy to contribute to Plasmodium falciparum elimination in an area of multidrug resistance in Cambodia

Molecular Epidemiology of Malaria in Cameroon and Côte d'Ivoire. XXXI. Kelch 13 Propeller Sequences in Plasmodium falciparum Isolates before and after Implementation of Artemisinin-Based Combination Therapy.

Artemisinin-resistant malaria has not been reported from Africa, but resistance can possibly spread from Asia or arise independently in Africa. The emergence of artemisinin resistance in Africa can be monitored by molecular assay of Kelch 13 (K13) propeller sequences. A total of 251 archived DNA samples of Plasmodium falciparum isolates collected in 2002, 2003, and 2006 in Yaounde, Cameroon, and 47 samples collected in 2006 and 2013 in Abidjan, Côte d'Ivoire, were analyzed for K13-propeller sequence polymorphism. Only one isolate carried a mutant K13-propeller allele (E602D). None of the isolates carried the key mutant alleles (Y493H, R539T, I543T, and C580Y) associated with artemisinin resistance in Cambodia. The presence of the mutant allele was not correlated with in vitro response to dihydroartemisinin determined by the classical hypoxanthine incorporation assay. There was no evidence of K13 mutations associated with artemisinin resistance before and soon after the introduction of artemisinin-based combination therapies in Cameroon and Côte d'Ivoire.

Local constraints to access appropriate malaria treatment in the context of parasite resistance in Cambodia: a qualitative study

BackgroundDespite emerging drug resistance in Cambodia, artemisinin-based combination therapy (ACT) is still the most efficacious therapy. ACT is available free of charge in the Cambodian public sector and at a subsidized rate in the private sector. However, un- and mistreated cases in combination with population movements may lead to the further spread of resistant parasites, stressing the importance of understanding how the perceived aetiology of malaria and associated health-seeking behaviour may delay access to appropriate treatment. A qualitative study explored these factors after an epidemiological survey confirmed parasite resistance in Preah Vihear province.ResultsIn Cambodian cosmology, illnesses can be inflicted by supernatural beings or originate from ‘natural’ causes because of disorder in the social, domestic or outdoor environment. Initial treatment options consist of cheap and accessible home-based care (manual therapy, herbs and biomedical medication) targeting single symptoms. If there is no steady recovery or if the condition quickly aggravates, care will be sought from ‘village doctors’, public health facilities, private pharmacies or, in case of suspicion of a supernatural cause, from a specialized indigenous healer. The choice of provider is mostly based on the family’s financial situation, access to and trust in the provider, and the congruence between the suspected aetiology of the illness and the treatment offered by the provider. Different treatment options are often combined during the same illness episode through a serial process of trial and error guided by the observable improvements in the patient’s condition.ConclusionsCambodian perceptions of illness that focus on single symptoms and their perceived severity may lead to the identification of one or multiple illnesses at the same time, rarely suspecting malaria from the start and implying different patterns of health seeking behaviour and treatment choice. However, decisions to self-diagnose and treat at home are also pragmatic and must be understood in the context of poverty, a major barrier to seeking prompt and appropriate care for malaria in an area characterized by parasite resistance.

A surrogate marker of piperaquine-resistant Plasmodium falciparum malaria: a phenotype–genotype association study

SummaryBackgroundWestern Cambodia is the epicentre of Plasmodium falciparum multidrug resistance and is facing high rates of dihydroartemisinin–piperaquine treatment failures. Genetic tools to detect the multidrug-resistant parasites are needed. Artemisinin resistance can be tracked using the K13 molecular marker, but no marker exists for piperaquine resistance. We aimed to identify genetic markers of piperaquine resistance and study their association with dihydroartemisinin–piperaquine treatment failures.MethodsWe obtained blood samples from Cambodian patients infected with P falciparum and treated with dihydroartemisinin–piperaquine. Patients were followed up for 42 days during the years 2009–15. We established in-vitro and ex-vivo susceptibility profiles for a subset using piperaquine survival assays. We determined whole-genome sequences by Illumina paired-reads sequencing, copy number variations by qPCR, RNA concentrations by qRT-PCR, and protein concentrations by immunoblotting. Fisher’s exact and non-parametric Wilcoxon rank-sum tests were used to identify significant differences in single-nucleotide polymorphisms or copy number variants, respectively, for differential distribution between piperaquine-resistant and piperaquine-sensitive parasite lines.FindingsWhole-genome exon sequence analysis of 31 culture-adapted parasite lines associated amplification of the plasmepsin 2–plasmepsin 3 gene cluster with in-vitro piperaquine resistance. Ex-vivo piperaquine survival assay profiles of 134 isolates correlated with plasmepsin 2 gene copy number. In 725 patients treated with dihydroartemisinin–piperaquine, multicopy plasmepsin 2 in the sample collected before treatment was associated with an adjusted hazard ratio (aHR) for treatment failure of 20·4 (95% CI 9·1–45·5, p<0·0001). Multicopy plasmepsin 2 predicted dihydroartemisinin–piperaquine failures with 0·94 (95% CI 0·88–0·98) sensitivity and 0·77 (0·74–0·81) specificity. Analysis of samples collected across the country from 2002 to 2015 showed that the geographical and temporal increase of the proportion of multicopy plasmepsin 2 parasites was highly correlated with increasing dihydroartemisinin–piperaquine treatment failure rates (r=0·89 [95% CI 0·77–0·95], p<0·0001, Spearman’s coefficient of rank correlation). Dihydroartemisinin–piperaquine efficacy at day 42 fell below 90% when the proportion of multicopy plasmepsin 2 parasites exceeded 22%.InterpretationPiperaquine resistance in Cambodia is strongly associated with amplification of plasmepsin 2–3, encoding haemoglobin-digesting proteases, regardless of the location. Multicopy plasmepsin 2 constitutes a surrogate molecular marker to track piperaquine resistance. A molecular toolkit combining plasmepsin 2 with K13 and mdr1 monitoring should provide timely information for antimalarial treatment and containment policies.FundingInstitut Pasteur in Cambodia, Institut Pasteur Paris, National Institutes of Health, WHO, Agence Nationale de la Recherche, Investissement d’Avenir programme, Laboratoire d’Excellence Integrative “Biology of Emerging Infectious Diseases”.

Plasmodium falciparum parasite population structure and gene flow associated to anti-malarial drugs resistance in Cambodia.

BackgroundWestern Cambodia is recognized as the epicentre of emergence of Plasmodium falciparum multi-drug resistance. The emergence of artemisinin resistance has been observed in this area since 2008–2009 and molecular signatures associated to artemisinin resistance have been characterized in k13 gene. At present, one of the major threats faced, is the possible spread of Asian artemisinin resistant parasites over the world threatening millions of people and jeopardizing malaria elimination programme efforts. To anticipate the diffusion of artemisinin resistance, the identification of the P. falciparum population structure and the gene flow among the parasite population in Cambodia are essential.MethodsTo this end, a mid-throughput PCR-LDR-FMA approach based on LUMINEX technology was developed to screen for genetic barcode in 533 blood samples collected in 2010–2011 from 16 health centres in malaria endemics areas in Cambodia.ResultsBased on successful typing of 282 samples, subpopulations were characterized along the borders of the country. Each 11-loci barcode provides evidence supporting allele distribution gradient related to subpopulations and gene flow. The 11-loci barcode successfully identifies recently emerging parasite subpopulations in western Cambodia that are associated with the C580Y dominant allele for artemisinin resistance in k13 gene. A subpopulation was identified in northern Cambodia that was associated to artemisinin (R539T resistant allele of k13 gene) and mefloquine resistance.ConclusionsThe gene flow between these subpopulations might have driven the spread of artemisinin resistance over Cambodia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1370-y) contains supplementary material, which is available to authorized users.