Despite international efforts to ‘roll back malaria’ the 2008 World Malaria
Report revealed the disease still affects approximately 3 billion people in 109 countries; 45
within the WHO African region. The latest report however does provide some ‘cautious
optimism’; more than one third of malarious countries have documented greater than 50%
reductions in malaria cases in 2008 compared to 2000. The goal of the Member States at
the World Health Assembly and ‘Roll Back Malaria’ (RBM) partnership is to reduce the
numbers of malaria cases and deaths recorded in 2000 by 50% or more by the end of 2010.
Although malaria is preventable it is most prevalent in poorer countries where prevention is
difficult and prophylaxis is generally not an option. The burden of disease has increased by
the emergence of multi drug resistant (MDR) parasites which threatens the use of
established and cost effective antimalarial agents. After a major change in treatment
policies, artemisinins are now the frontline treatment to aid rapid clearance of parasitaemia
and quick resolution of symptoms. Since artemisinin and its derivatives are eliminated
rapidly, artemisinin combination therapies (ACT’s) are now recommended to delay
resistance mechanisms. In spite of these precautionary measures reduced susceptibility of
parasites to the artemisinin-based component of ACT’s has developed at the Thai-
Cambodian border, a historical ‘hot spot’ for MDR parasite evolution and emergence. This
development raises serious concerns for the future of the artemsinins and this is not helped
by controversy related to the mode of action. Although a number of potential targets have
been proposed the actual mechanism of action remains ambiguous