Molecular surveillance for drug-resistant Plasmodium falciparum malaria in Malawi

We assessed the presence of point mutations associated with resistance to chloroquine (CQ) and sulphadoxine-pyrimethamine (SP) in 178 Plasmodium falciparum infections from three geographically distinct sites in Malawi. We confirm that CQ-resistance mutations are now rare in Malawi, being detectable at very low frequencies (2–4%) in infections from two of the three study sites. We also show that over 90% of infections from each of the three study sites carry a set of three dihydrofolate reductase (dhfr) and two dihydropteroate synthase (dhps) mutations strongly associated with SP treatment failure. In this short communication, we present these molecular data and discuss their implications for Malawiʹs first-line antimalarial treatment policy.