The gene flow between these subpopulations might have driven the spread of artemisinin resistance over Cambodia.
This significant malaria reservoir in a mobile and illegal population with difficult access to a health care system raises the threat of artemisinin resistance and puts the population of the Guiana Shield at risk of new transmission foci while countries of the region aim at malaria elimination.
Adequate refresher training, monitoring, supervision, and regular reliable supply of RDTs and anti-malarials were needed for capacity strengthening of volunteers in MARC zones.
VMW/MMW job performance must be increased from 80 to 100 % in order to achieve elimination.
These findings indicate that inclusion of Cys in current formulations of ACT, or its use as adjunct therapy could improve the anti-plasmodial activity of artemisinin, decrease mortality in cerebral malaria patients, and prevent or delay the development and spread of artemisinin resistance.
The dominant k13 mutation observed in Upper Myanmar, F446I, appears to be associated with an intermediate rate of parasite clearance compared to other common mutations described elsewhere in the Greater Mekong Subregion.
Artemisinin resistance is potentially a more pressing concern than partner drug resistance due to the lack of viable alternatives.
Efforts should focus on correcting misconceptions about malaria transmission, prevention and universal use of ITN/LLINs.
Several factors affect PC 1/2 . As substantial heterogeneity in parasite clearance exists between locations, early detection of artemisinin resistance requires reference PC 1/2 data.
In SEA, clinical and epidemiological investigations are urgently needed to stop the further spread of artemisinin resistance, monitor the efficacy of ACTs where K13 mutations are prevalent, identify currently-available drug regimens that cure ACT failures, and rapidly advance new antimalarial compounds through preclinical studies and clinical trials.