Impactful maps and associated visualisations on antimalarial drug resistance for malaria programmes and policymakers

Kagoro, Frank

Impactful maps and associated visualisations on antimalarial drug resistance for malaria programmes and policymakers

Thesis / Dissertation

2025

Publisher

University of Cape Town

Department

Department of Medicine

Faculty

Faculty of Health Sciences

Abstract

The spread of antimalarial drug resistance threatens global, regional and national malaria elimination efforts. Despite being preventable and treatable, malaria still claims over half a million lives globally, with over 95% of malaria cases and deaths occurring in Africa. Antimalarial drug resistance threatens progress in malaria control and elimination, especially in less-resourced health systems in developing countries. Malaria control and elimination efforts are facing stagnation of funding and competing resources with other potential pandemic pathogens like COVID-19, HIV, tuberculosis and non-communicable diseases. Regrettably, the malaria programmes and policymakers who are at the forefront of confronting antimalarial drug resistance often lack timely monitoring tools for evidence-based decision-making. This thesis used an iterative, sequential, explanatory, mixed-methods design to strengthen evidence on Plasmodium falciparum antimalarial drug resistance in Asia and South Africa. Through four thesis chapters of peer-reviewed manuscripts, the thesis presents innovative approaches to developing impactful policymaker-friendly tools for detection, reporting and responding to antimalarial drug resistance. Through co-design techniques, the thesis addresses major data challenges and developed guidelines and tools to support near-real-time antimalarial resistance monitoring. The thesis also highlights important processes and pinch points in rolling out an early warning system for antimalarial drug resistance in a pre- elimination setting in South Africa. This research contributes to best practices in summarising evidence for antimalarial drug resistance for policymakers and decision-makers. Furthermore, this thesis provides insights on the process of establishing an early warning system in a pre-elimination malaria setting, a context reflective of where several Southern African countries and Island states are heading in this decade.