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Intensity of Malaria Transmission and the Spread of Plasmodium falciparum–Resistant Malaria: A Review of Epidemiologic Field Evidence

Malaria transmission intensity has been proposed, based on theoretical models, as an important factor for the spread of falciparum-resistant malaria, but the predictions obtained vary according to the assumptions inherent in the model used. We summarized the available field data on transmission intensity and the prevalence of malaria drug resistance. Resistance to chloroquine and sulphadoxine-pyrimethamine monotherapy was invariably higher where transmission was intense. Vector control interventions were associated with a better chloroquine and sulfadoxine-pyrimethamine efficacy. However, high resistance to chloroquine and also to combination therapy (chloroquine plus sulphadoxine-pyrimethamine and amodiaquine plus sulfadoxine-pyrimethamine) was also observed in very low transmission areas. Reducing transmission intensity is likely to slow the spread of drug resistance. Nevertheless, where transmission is extremely low, to limit the unnecessary use of antimalarials and a consequent paradoxical acceleration of the spread of resistance, patients should be treated only after laboratory confirmation of malaria.

Received August 21, 2006. Accepted for publication February 23, 2007.

Acknowledgments: We are grateful to Dr J. G. Breman for stimulating the idea for this review and to the very extensive comments from two anonymous reviewers.

Financial support: The authors received no specific funding for this article. However, Ambrose O. Talisuna is supported by the Medicines for Malaria Venture (MMV) in collaboration with the Institute of Tropical Medicine, Antwerp, Belgium.

^* Address correspondence to Ambrose O. Talisuna, Ministry of Health, Epidemiological Surveillance Division, PO Box 7272, Kampala, Uganda. E-mail atalisuna{at}afsat.com

Authors’ addresses: Ambrose O. Talisuna, Ministry of Health, Epidemiological Surveillance Division and East African Network for Monitoring Antimalarial Treatment (EANMAT). Paul Okello, PO Box 33861, Kampala, Uganda. Annette Erhart, Marc Coosemans, and Umberto D’Alessandro, Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium, Telephone: 32-3-247-63-11, Fax: 32-3-247-63-59.

Reprint requests: Ambrose O Talisuna, Ministry of Health Epidemiological Surveillance Division, PO Box, 7272 Kampala, Uganda, Telephone: 256-41-345-741, E-mail atalisuna{at}afsat.com.

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