Artemisinin Resistance Mechanisms and Surveillance Strategies in Southeast Asian Plasmodium Falciparum Malaria

Arionget Jemima

Department of Pharmacoepidemeology Kampala International University Uganda

Email: jemima.arionget@studwc.kiu.ac.ug

                                                                      ABSTRACT
Artemisinin-based combination therapies have remained the cornerstone of global malaria treatment for over two decades, achieving remarkable reductions in morbidity and mortality. However, the emergence and spread of artemisinin-resistant Plasmodium falciparum strains in Southeast Asia threatens to undermine these gains and poses substantial challenges to malaria elimination efforts worldwide. This review examined the molecular mechanisms underlying artemisinin resistance in Plasmodium falciparum, evaluated current surveillance strategies employed in Southeast Asia, and assessed the implications for treatment efficacy and public health responses. A comprehensive synthesis of peer-reviewed literature on artemisinin resistance mechanisms, genetic markers, clinical manifestations, and epidemiological surveillance approaches was conducted. Mutations in the Kelch propeller domain, particularly K13, constituted the primary genetic determinant of artemisinin resistance, mediating delayed parasite clearance through enhanced cellular stress responses and altered hemoglobin metabolism. Resistance had spread across the Greater Mekong Subregion with distinct geographical clustering patterns. Molecular surveillance utilizing polymerase chain reaction-based detection of resistance markers, coupled with therapeutic efficacy studies and in vitro susceptibility testing, provided essential data for treatment policy adaptation. The emergence of partner drug resistance threatened the efficacy of artemisinin-based combination therapy. Integrated molecular and clinical surveillance frameworks were essential for tracking resistance evolution, informing treatment guidelines, and supporting malaria elimination strategies in endemic regions.

Keywords: Artemisinin resistance, Plasmodium falciparum, K13 mutations, Molecular surveillance, Southeast Asia.

CITE AS: Arionget Jemima (2026). Artemisinin Resistance Mechanisms and Surveillance Strategies in Southeast Asian Plasmodium Falciparum Malaria. NEWPORT INTERNATIONAL JOURNAL OF BIOLOGICAL AND APPLIED SCIENCES 7(2):83-89.
https://doi.org/10.59298/NIJBAS/2026/7.2.8389