Artemisinin Resistance Mechanisms and Surveillance Strategies in Plasmodium falciparum Malaria Control
Nassimbwa Kabanda D.
Faculty of Medicine Kampala International University Uganda
ABSTRACT
Artemisinin-based combination therapies represented the cornerstone of contemporary malaria treatment, yet emerging resistance in Plasmodium falciparum threatens global malaria control achievements. Artemisinin resistance manifested as delayed parasite clearance following treatment, driven primarily by mutations in the Kelch propeller domain of the K13 gene that confer survival advantages during the early ring stage of parasite development. This review examined the molecular mechanisms underlying artemisinin resistance in Plasmodium falciparum and evaluated current surveillance strategies for detecting and monitoring resistance emergence and spread. A comprehensive synthesis of peer-reviewed literature on K13 mutations, resistance phenotypes, molecular surveillance tools, and epidemiological monitoring approaches was conducted. Artemisinin resistance results from K13 mutations that alter protein homeostasis pathways, enhancing parasite capacity to withstand oxidative stress and maintain cellular quiescence during drug exposure. Validated resistance markers include C580Y and other nonsynonymous K13 mutations confirmed through clinical, in vitro, and genetic studies. Molecular surveillance utilizing polymerase chain reaction amplification and sequencing of K13 mutations enabled early detection, while therapeutic efficacy studies measuring parasite clearance kinetics provided functional resistance assessment. Geographic expansion of resistance from Southeast Asia to Africa necessitated intensified surveillance combining molecular marker detection, clinical outcome monitoring, and in vitro susceptibility testing. Surveillance gaps included limited capacity in resource-constrained settings, delayed reporting systems, and incomplete understanding of resistance mechanisms independent of K13 mutations. Integrated surveillance frameworks combining molecular diagnostics, clinical monitoring, and standardized reporting are essential for guiding treatment policy and containment strategies, though strengthening laboratory capacity and real-time data sharing remained critical priorities for effective artemisinin resistance management in malaria-endemic regions.
Keywords: Artemisinin resistance, Kelch 13, Plasmodium falciparum, Molecular surveillance, Parasite clearance.
CITE AS: Nassimbwa Kabanda D. (2026). Artemisinin Resistance Mechanisms and Surveillance Strategies in Plasmodium falciparum Malaria Control. IDOSR JOURNAL OF BIOCHEMISTRY, BIOTECHNOLOGY AND ALLIED FIELDS 11(1):107-115. https://doi.org/10.59298/IDOSR/JBBAF/2026/102107115