NAIROBI, Kenya, Aug 13 – A new study led by researchers from the KEMRI-Wellcome Trust Research Programme has found that artesunate, the standard first-line treatment for severe malaria, remains effective in children despite growing concerns over drug-resistant malaria parasites in Africa.
The study found that artesunate remained effective in children infected with malaria parasites carrying PfK13 mutations, which are linked to artemisinin resistance, where malaria parasites develop a delayed response to artemisinin-based treatments.
The findings are based on the SMAART-CHARISMA clinical study conducted in northern and eastern Uganda between December 2022 and October 2024.
Researchers studied 465 hospitalised children aged between three months and 15 years, including 360 with severe malaria and 105 with less severe illnesses who were included for comparison.
The children received standard malaria treatment consisting of at least three doses of intravenous artesunate followed by a three-day course of oral artemether-lumefantrine.
Researchers used genetic testing to identify PfK13 mutations and compared treatment outcomes between children infected with parasites carrying the mutations and those with normal parasites.
About half of the children carried PfK13 mutations. While the parasites took longer to clear in children with the mutations, this did not negatively affect their treatment outcomes.
Death rates were low and did not differ significantly between the two groups.
The study also found no meaningful differences in hospital stay, need for blood transfusion, time taken to clear lactic acid, malaria recurrence or hospital readmission.
The findings come amid growing concerns over artemisinin resistance, with PfK13 mutations becoming more common in Plasmodium falciparum, the parasite that causes malaria.
In 2025, the World Health Organization recommended adding quinine to artesunate for treating severe malaria in areas with established artemisinin resistance.
Professor Kath Maitland of the KEMRI-Wellcome Trust Research Programme, who led the study, said the findings suggest that adding quinine may not be necessary.
“Artesunate remains highly effective at treating severe malaria in children in real-world clinical settings, so WHO recommendations to add quinine to the treatment protocol would be unnecessary, complex and costly,” Maitland said.
She, however, called for further research to monitor how PfK13 mutations respond to artesunate in larger groups of patients and in other African countries where the mutations are emerging.
KEMRI Director General Prof. Elijah Songok said the findings underscore the importance of evidence-based policy decisions and continued investment in locally led research to protect gains made in malaria control across Africa.
