For some time now, artemisinin, derived from a Chinese herb, has been the most powerful treatment available against malaria. To avoid the malaria parasite becoming resistant, the World Health Organization (WHO) strongly recommends combining artemisinin with another anti-malarial drug. But there are different formulations and derivatives, in different combinations, and with dosing schemes. Scientists from the Institute of Tropical Medicine (ITM) carried out a head-to-head comparison of four combination therapies in seven African countries. One combination appeared particularly promising for regions where the risk of re-infection is high. Malaria is caused by several related parasites, of which Plasmodium falciparum is the worst. The parasites have a complicated life cycle, partly in mosquitoes. When an infected mosquito bites a human, parasites are injected with the mosquito saliva into the blood, travel to the liver, where they change form, then infect red blood cells, where they further reproduce. After a few days (depending on the parasite species), the red blood cells burst to release a huge number of new parasites. These bursts cause intense fever, anaemia, and renal problems. Each year, approximately 800,000 people die of malaria. In recent years, the burden of malaria has declined substantially in several sub-Saharan African countries, due to large scale indoor residual spraying of insecticides, massive distribution of insecticide-treated bed nets, and the introduction of artemisinin-based combination treatments, ACTs for short. To treat patients with malaria, the WHO advises each region to choose an ACT based on the local level of resistance to non-artemisinin medicine in the combination. But data on that resistance are scarce.
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