Current Status of Malaria and Anti-malarial Drug Resistance in Sri Lanka

Even though malaria continues to cause high morbidity and mortality in most of the malaria endemic countries in the world, it is currently not a major health problem in Sri Lanka. Despite the low malaria incidence, the development and spread of anti-malarial drug resistance, combined with a recent increase in the armed conflict hindering provision of effective health services will make it difficult to control malaria in Sri Lanka. Since chloroquine (CQ) resistant Plasmodium falciparum was first reported from Dambulla area in 1984, the number has increased to more than 50% observed in vivo from various endemic areas. In concordance with this, single nucleotide polymorphisms (SNPs) in genes of P. falciparum responsible for CQ resistance are present. A limited number of trials have investigated the efficacy of the second line drug, sulfadoxine/ pyrimethamine (SP) against P. falciparum and a few cases of resistance have been reported. Moreover, SNPs in P. falciparum genes responsible for SP resistance are present and may constitute a sign of evolving SP resistance development. For P. vivax, drug resistance is not yet recorded as a problem in Sri Lanka, however the prevalence of SP resistant SNPs in P. vivax populations seems high and may pose a risk despite that SP is not used directly against P. vivax infections. Continuous monitoring of drug efficacy in vivo, as well by measuring the prevalence of SNPs related to drug resistance are major issues to be addressed.