Strathmore experts warn malaria drug resistance rising

 Scientists raise concern over early mutations associated with reduced sensitivity to artemisinin-based combination therapies (ACTs) used in malaria treatment. [Courtesy]

A landmark study published in Nature: Scientific Reports, one of the world’s most cited scientific journals, has raised urgent concerns about the future of malaria treatment in Kenya. The research shows that resistance to commonly used antimalarial drugs is rapidly increasing in western Kenya, with evidence that the parasite may be evolving faster than current interventions can effectively control it.

The study was led by Dr Andrew Omandi Cole and Professor Gilbert Kokwaro of Strathmore University, in collaboration with the KEMRI-Wellcome Trust in Kilifi and the National Malaria Control Programme. It examined how Plasmodium falciparum is evolving under Multiple First-Line Therapy (MFT) strategies for uncomplicated malaria.

Conducted between September 2020 and January 2024, the research enrolled 310 patients across Homa Bay County (mainland), Migori County and Mfangano Island in Lake Victoria. It tracked genetic changes in the malaria parasite, focusing on spatiotemporal dynamics, treatment strategies and future policy directions.

The findings show that resistance is no longer confined to isolated areas but is now widespread across the region. Several genetic markers linked to resistance against older antimalarial drugs have reached near-total prevalence across all study sites, with some recorded at 100 per cent. In many cases, this indicates that previously effective treatments have been rendered largely ineffective. Of particular concern are early mutations associated with reduced sensitivity to artemisinin-based combination therapies (ACTs), the current frontline malaria treatment.

A key strength of the study is its spatiotemporal analysis, which tracked resistance patterns across both geography and time between 2020 and 2024. This approach revealed how sustained drug pressure and regional transmission dynamics are driving resistance across multiple locations, not just isolated hotspots.

The study, funded by Medicines for Malaria Venture (MMV), was conducted within a pilot programme testing Multiple First-Line Therapy (MFT), which rotates different antimalarial combinations to slow resistance development. However, findings show resistance patterns remained consistent across all sites regardless of treatment combinations, suggesting that broader factors such as transmission intensity and historical drug exposure may be more influential than drug rotation alone.

Researchers emphasise that there is still a window of opportunity to respond. They recommend strengthened molecular surveillance systems to track resistance in real time, increased investment in the development of new antimalarial drugs, and stronger regional coordination across East Africa to manage cross-border spread.

The study also highlights the need for data-driven policymaking, particularly in high-transmission areas. The rising drug resistance documented in this study threatens to undermine decades of progress in malaria control.

Published in a leading scientific journal, the findings position Strathmore University and its partners at the forefront of malaria research, offering both a warning and a roadmap for future action as scientists race to stay ahead of an evolving parasite.