By Steven Enatu.
A recent study from Uganda has revealed troubling news: some young children with severe malaria are starting to show partial resistance to artemisinin, the world’s strongest malaria drug. The findings were presented on November 14, 2024, at the Annual Meeting of the American Society of Tropical Medicine and Hygiene and published in the Journal of the American Medical Association (JAMA). For the first time, scientists have found evidence that young African children may not fully respond to artemisinin treatment, which is used to cure serious malaria infections. This resistance could be a warning sign for Uganda and other African countries heavily impacted by malaria.
Key Findings in Uganda
In the study, researchers observed that out of 100 Ugandan children with severe malaria, aged 6 months to 12 years, 11 showed partial resistance to artemisinin. This means their bodies took longer to clear the malaria parasite after treatment. Dr. Chandy John, from Indiana University, explained, “This is the first study from Africa showing that children with severe malaria are experiencing partial resistance to artemisinin.”

Moreover, ten of these children, who initially seemed cured, were reinfected with the same malaria strain within just 28 days, suggesting that the initial treatment did not completely clear the parasite. Dr. John noted, “It’s also the first study showing African children with severe malaria experiencing another malaria episode with the same strain so soon after standard treatment.”
Why This Matters
Artemisinin, introduced around 20 years ago, was a major breakthrough in malaria treatment because it worked quickly to eliminate the malaria parasite. However, in recent years, there have been signs of resistance in Southeast Asia, where some malaria patients now experience less effective treatment with artemisinin. This resistance has slowly spread into East Africa. The possibility of artemisinin losing its power is especially concerning for Uganda, which has one of the world’s highest malaria rates.
Uganda’s High Malaria Rates and the Risk of Drug Resistance
Uganda has the highest malaria incidence rate globally, with 478 cases per 1,000 people every year. Malaria is the top cause of illness and death in Uganda, responsible for about 40% of outpatient visits, 25% of hospital admissions, and 14% of hospital deaths. Each year, the malaria death toll in Uganda is estimated to be between 70,000 and 100,000, surpassing the toll from HIV/AIDS.

The study also found genetic mutations in the malaria parasite that are linked to resistance, similar to those found in Southeast Asia. Although these mutations have been seen before in Africa in mild malaria cases, this is the first time they have been observed in children with severe, life-threatening malaria in Uganda. Dr. John noted that children classified with partial resistance took more than five hours to clear 50% of the parasite burden, based on World Health Organization guidelines. Two children needed more than the standard three-day treatment with artesunate due to slower parasite clearance.
Treatment Concerns Moving Forward
The treatment given to these Ugandan children included an infusion of artesunate followed by oral medication with artemether-lumefantrine, a combination designed to make it harder for the parasite to resist artemisinin. Dr. John expressed concern that lumefantrine, the companion drug, may also be losing effectiveness. “We were surprised to find recurrent infections even when we thought the children were cured,” he said.
This study is part of ongoing research in Uganda to better understand severe malaria outcomes in children. However, researchers shifted their focus to drug resistance when they noticed that some children were slower to respond to the standard artemisinin-based treatment.
Future Implications
The study’s findings signal an urgent need to monitor drug resistance in Uganda closely. The American Society of Tropical Medicine and Hygiene, a global organization for experts in tropical diseases, emphasized that investments in research and new treatments are essential to protect communities like Uganda that are severely affected by malaria.