The MARC SE-Africa dashboard: Joining forces to counteract emerging antimalarial resistance in South and East Africa.

Abstract

Regions within eastern and southern Africa (SE-Africa) carry some of the highest malaria burdens. Understanding the spatiotemporal dynamics of the emergence and spread of artemisinin (partial) resistance (ART-R) and how to mitigate ART-R is therefore of paramount importance in these areas. Here, we present a dashboard developed by the Mitigating Antimalarial Resistance Consortium for SE-Africa in collaboration with nineteen national control malaria programs (NCMPs) and their partners. The dashboard supports NCMPs' decision-making by providing curated information on the latest available antimalarial resistance data. We systematically reviewed, collated, and visualized antimalarial resistance information from therapeutic efficacy studies, molecular surveillance for Pfkelch13 ART-R genetic markers, current in-country malaria treatment policies, and reported malaria cases and deaths. We identified evidence gaps in therapeutic efficacy and molecular surveillance, particularly in southern Africa. Five countries, Angola, the Democratic Republic of Congo, Kenya, Tanzania and Uganda, reported artemether-lumefantrine treatment failures above the WHO threshold of 10% after correcting for reinfections. The A675V, R561H, P574L, and C469F Pfkelch13 markers were highly prevalent in cross-border regions of several East African countries, with the C469Y marker rapidly spreading across Uganda. The dashboard provides an interactive platform for sharing regional data. We discuss the implications of these findings for policy, practice, and research.