Plasmodium falciparum non-synonymous Kelch13 mutations mediating artemisinin resistance in East Africa: A systematic review and meta-analysis: 2014–2024

What the report says

PLOS One published a systematic review and meta-analysis examining genetic markers linked to partial artemisinin resistance in Plasmodium falciparum malaria parasites in East Africa. The paper, by A. Kapesa and colleagues, reviewed studies with samples collected from 2014 to 2024 and focused on non-synonymous mutations in the Pf-Kelch13 gene, a molecular marker associated with delayed parasite clearance after artemisinin-based treatment.

According to the article, the authors searched Medline, CENTRAL, LILACS and EMBASE, registered the review protocol with PROSPERO, and included 24 eligible studies. Using a random-effects model, they estimated the pooled proportion of non-synonymous Pf-Kelch13 mutations at 5.0% across the region, with higher pooled estimates reported for Rwanda and Uganda, both at 10.0%. The review found high heterogeneity across included studies, meaning results varied substantially between study settings.

The most frequently identified mutation types were R561H and A675V, with pooled estimates of 9.0% and 7.0%, respectively. The authors also reported that patients infected with parasites carrying non-synonymous Pf-Kelch13 mutations were more likely to experience treatment failure than patients infected with wild-type P. falciparum parasites.

The findings matter because artemisinin-based combination therapies are central to malaria treatment in East Africa, adopted after earlier resistance to chloroquine and sulfadoxine-pyrimethamine. The article notes that partial artemisinin resistance has been reported in Rwanda, Uganda and Tanzania, and that East African Pf-Kelch13 mutations appear to have emerged locally rather than being imported from Southeast Asia. The authors call for continued molecular surveillance and regional coordination to limit spread.