The challenge of managing malaria
Effective control and treatment of malaria presents enormous logistical challenges. Many at-risk populations live in extreme poverty in remote rural areas. Poor and rural families are the least likely to have access to preventative measures such as insecticide-treated nets13 that are fundamental to malaria control, and are less able to afford treatment once infection has occurred.13
Drug resistance and other barriers to malaria control
Another critical problem is the emergence and spread of resistance to conventional antimalarial treatments, which has led to a resurgence of infection and malaria deaths over the last decade. There is now serious resistance to previously effective therapies, notably chloroquine and sulphadoxine-pyrimethamine, in much of Africa and South-East Asia14-16. These agents have shown failure rates as high as 50% in some regions of Africa15,17 and resistance is already developing in East Africa to amodiaquine, rendering combination therapies that include amodiaquine less effective.15
In 2006, WHO called for manufacturers to stop selling monotherapy artemisinin treatments in an attempt to prevent malaria parasites developing resistance to the drug.18 Unfortunately, many companies are yet to comply, creating a further barrier to disease control. In addition, substandard drugs and counterfeits pose a major problem, with up to 35% of all antimalarial treatments sold in Africa being substandard.19
