How to cite:

Edward Nangoy, Corry Novita Mahama, Angelina Stevany Regina Masengi (2024) Narrative

Review: Current Updates in The Treatment of Malaria, (06) 10

E-ISSN:

2684-883X

[email protected]

Abstract

Malaria is an infectious disease caused by the Plasmodium parasite and transmitted

through the bite of female Anopheles mosquitoes. Although global efforts to control the

disease have increased, malaria remains a major health threat, especially in developing

countries. This study aims to identify recent developments in malaria treatment

methods. This study uses a narrative review method. Data collection was carried out

through a literature review by searching for relevant research articles, reports, and books

from various scientific databases. The collected data were then analyzed in three stages,

Keywords: Current treatment, Treatment, Malaria.

INTRODUCTION

Malaria is a disease caused by protozoa from the Plasmodium parasite and is one

of the leading causes of death and morbidity in many developing countries. It is

estimated that around 3.3 billion people worldwide are at risk of contracting this

disease. Malaria is also a significant health problem in tropical and subtropical regions

(Kendie et al., 2021). Globally, there are 247 million positive cases of malaria reported

in 84 malaria-endemic countries. Indonesia is one of the malaria-endemic countries with

a total of 443,530 cases, of which 89% of positive cases come from Papua Province

community elements. First, the implementation of comprehensive policies, including

increasing detection, case finding, and diagnostics. Second, strengthening surveillance.

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Syntax Idea, Vol. 6, No. 10, Oktober 2024 6509

Third, providing treatment. Fourth, controlling risk factors. Fifth, empowering the role

of the private sector and society (Indonesia, 2020).

malaria parasite before it enters the human liver, where it can multiply rapidly. The

most advanced vaccine candidate is R21, which has completed Phase 3 clinical trials. In

addition, there are other vaccines that focus on preventing parasite transmission, as well

as vaccines specifically designed to protect women during pregnancy (WHO, 2023).

Previous research by (Hanboonkunupakarn & White, 2022) showed that targeted

malaria eradication using focal mass treatment with dihydroartemisinin-piperaquine has

been proven to be a safe and effective malaria elimination accelerator, but overall

progress towards malaria elimination has been slow. Since 2015, the number of malaria

cases globally has increased. Since new drugs will not be widely available in the near

future, active measures to conserve current antimalarials should be the highest priority.

case management at the population level. This study aims to identify the latest

developments in malaria treatment methods.

RESEARCH METHOD

This study uses a narrative review method. Narrative is a research method in

social sciences that functions to describe or explain an event, incident, or series of

events that are chronologically interconnected (Yusri, 2020). Data collection was

carried out through a literature review by searching for relevant research articles,

reports, and books from various scientific databases. Data collection was carried out

through a literature review by searching for relevant research articles, reports, and books

Edward Nangoy, Corry Novita Mahama, Angelina Stevany Regina Masengi

6510 Syntax Idea, Vol. 6, No. 10, Oktober 2024

RESULT AND DISCUSSION

The disease mechanism of malaria occurs through the relationship between two

especially because the disease is widespread in countries and regions experiencing

poverty, hindering social and economic development in the area (Lukwa, Mawoyo,

Zablon, Siya, & Alaba, 2019). In addition to infecting humans, malaria parasites can

also infect other animals, such as reptiles, birds and mammals. To date, more than 200

Plasmodium species have been formally identified, with each species having a different

host (Nandal et al., 2024).

However, despite malaria being a major challenge, developments in medical

research and technology have brought advances in the management and treatment of the

disease. In recent decades, malaria treatment development programs have progressed

through partnerships in pharmaceutical development, aiming to find more effective and

to the problem of drug resistance, particularly to Plasmodium falciparum. This parasite

has now become highly resistant to most of the antimalarial drugs that were once

effective, so the medical world's attention is focused on developing new drugs. This

approach aims to combat parasite resistance more effectively and prevent the return of

malaria outbreaks in tropical regions (Nandal et al., 2024). Given the complexity of

malaria and the growing challenge of drug resistance, treatment renewal efforts are

urgently needed. More innovative and diverse approaches need to be implemented to

address the problem of drug resistance, including by introducing new antimalarials that

are more effective and resistant to mutated parasites (Monroe, Williams, Ogoma,

Karema, & Okumu, 2022).

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better protected from long-term health impacts. Thus, continuously updating and

improving treatment methods are steps towards a more achievable malaria elimination.

especially when combined with vector control interventions. This strategy has

significantly reduced the burden of malaria caused by Plasmodium falciparum

worldwide (Bhatt et al., 2015).

ACTs remain the only widely used treatment for uncomplicated falciparum

malaria. This is even true in regions such as the Greater Mekong Subregion (GMS),

where artemisinin resistance (ART-R) is widespread. Currently, there are five ACT

combinations recommended by WHO for the treatment of malaria, namely artemether-

lumefantrine, artesunate-mefloquine (ASMQ), dihydroartemisinin-piperaquine,

artesunate-amodiaquine, and artesunate-sulphadoxine-pyrimethamine (WHO, 2015).

These combinations rely on fast-acting artemisinin derivatives, combined with slower-

that may persist after artemisinin clears most of the parasites in the body. Treatment of

malaria with artemisinin can reduce the parasite load by 10,000-fold every 48 hours, or

one parasite life cycle. After a three-day course of ACT treatment, the remaining

parasites are then cleared by the partner drug (Dhorda, Amaratunga, & Dondorp, 2021).

However, in some areas, resistance to ACTs has begun to emerge. Malaria

parasites, such as Plasmodium falciparum, show the ability to mutate and survive

despite appropriate treatment. This resistance refers to the ability of the parasite to

survive or multiply despite being given a dose of a drug that is normally effective

(Alaithan, Kumar, Islam, Liappis, & Nava, 2023). This phenomenon has encouraged

researchers to develop new drugs that aim to overcome the increasing drug resistance.

imidazolopiperazine that works at different stages of the parasite life cycle. Despite

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6512 Syntax Idea, Vol. 6, No. 10, Oktober 2024

these new drugs, there are other compounds, such as 4-aminoquinoline ferroquine,

which are not a new class of compounds. Currently, these new drugs are undergoing

mechanism of action of this drug is not yet known, ZY-19489 showed potent

antimalarial activity against asexual blood stages of Plasmodium falciparum, both in in

vitro assays and in mouse models. However, it did not show significant activity against

the form of the parasite present in the liver or its sexual phase.

Results from the first phase 1 trial in healthy volunteers showed that the drug has

good efficacy and safety. No resistance was detected in cases of relapse, indicating that

the problem was due to insufficient exposure to the drug rather than the presence of a

genetic mutation. Therefore, further studies are needed to explore the potential of ZY-

19489 in combination with partner drugs, to treat the liver stage and sexual phase of the

parasite and prevent infection recurrence and resistance (Barber et al., 2022). In this

R21/MM, are available and are being evaluated for their performance in the field

(González-Sanz, Berzosa, & Norman, 2023).

The RTS,S/AS01 vaccine is a recombinant protein-based vaccine that uses T

epitope repeats of the P. falciparum sporozoite surface antigen. The vaccine also

contains hepatitis B surface antigen (HBsAg) and proprietary adjuvant AS01. In phase

III trials, the RTS, S/AS01 vaccine demonstrated partial protection against clinical

malaria in children aged 5 to 17 months who received three doses, plus a booster given

at 20 months of age. The efficacy of this vaccine was recorded at 36% (95% CI 32-40),

providing new hope in malaria prevention efforts among children (González-Sanz et al.,

2023).

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Syntax Idea, Vol. 6, No. 10, Oktober 2024 6513

case detection, bed net use, SMC (comprehensive management strategy), and indoor

residual spraying (Butler & Stricker, 2019).

sporozoite vaccine known as PfSPZ (Butler & Stricker, 2019). In addition, there are also

protein-based vaccines designed to target other stages in the parasite's life cycle, such as

Rh5, Pfs35, and Pfs230 (Minassian et al., 2021). In addition, research is also exploring

DNA- and mRNA-based vaccines (Mallory et al., 2021).

Furthermore, malaria treatment updates are also increasingly personalized with

the arrival of a rapid and accurate diagnostic test, the Rapid Diagnostic Test (RDT).

RDT for malaria is an examination method that measures a patient's antibodies against

specific antigens from one or more plasmodium species. According to Aryani (2023),

RDTs have become an important tool in efficiently detecting malaria infections.

The World Health Organization (WHO) recommends increasing the use of RDTs

responsive to individual needs.

Following on from the prevention approach, there has also been a renewal of the

direct community engagement approach. Globally, malaria control programs have

adopted a community-based approach known as community engagement (ACE) to

design and implement malaria interventions. According to Awasthi et al. (2024), this

approach emphasizes the importance of working with communities in the design and

implementation of culturally appropriate interventions. In this way, wider acceptance

and participation among at-risk groups is expected, while also developing a sense of

local ownership to improve the sustainability of malaria prevention efforts.

Increasing public awareness is one of the main focuses through health campaigns,

strengthening surveillance.

Edward Nangoy, Corry Novita Mahama, Angelina Stevany Regina Masengi

6514 Syntax Idea, Vol. 6, No. 10, Oktober 2024

Furthermore, community involvement in the malaria elimination program is

emphasized. Communities are encouraged to actively report malaria cases and follow

main challenges is access to treatment. In some areas, especially in remote or less

developed areas, access to quality malaria medicines is still very limited. In addition, the

cost of malaria treatment is also a burden for communities, especially in developing

countries. Low-income communities often struggle to afford treatment, even for

treatment that is necessary to save lives. Further complicating the challenge is climate

change. Climate change can expand the distribution areas of Anopheles mosquitoes,

which are the main vectors of malaria. As temperatures rise and rainfall patterns change,

new areas that were previously unaffected can become breeding grounds for these

mosquitoes. Thus, efforts must be made to overcome these challenges so that malaria

treatment reforms can be effective. To ensure the effectiveness of malaria treatment

the issues that need to be addressed. Therefore, close collaboration between

governments, health institutions, researchers and communities is necessary to achieve

the goal of reform in malaria treatment and to effectively achieve elimination of the

disease.

CONCLUSSION

Therefore, this research provides a compelling story of what leaders have done

and how they have enacted COVID-19 and its impacts on organisations through the lens

of adaptive leadership. In light of the adaptive leadership theory by DeRue, our results

depict the dynamic nature of leadership actions and environment—especially work

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Syntax Idea, Vol. 6, No. 10, Oktober 2024 6515

leadership. The most effective leaders are those who can change their style to meet the

needs of their followers and the demands of the situation."

organizational capacity and effectiveness in the post-COVID-19 era. The case can

therefore be made that by changing their leadership styles to suit the new environment,

leaders can effectively manage the complexities of the post-pandemic team

environment. Hybrid, collaborative, and inclusive leadership is a new era in leadership

concept and practice that The results show that updates in malaria treatment include the

development of new drugs as well as combination therapies, prevention efforts through

vaccines, more individualized treatment approaches, and community involvement in

treatment programs. The findings show that there have been advances in malaria

treatment, which include the development of new drugs and more effective combination

reporting and active participation in prevention efforts through the use of long-lasting

insecticide-treated nets (LLINs) and indoor residual spraying (IRS) activities. However,

despite significant progress, challenges such as limited access to treatment, the high cost

of treatment, and the impact of climate change expanding the distribution areas of

Anopheles mosquitoes remain a major barrier. Therefore, based on these findings,

further collaboration between governments, health organizations, researchers and

communities is needed to overcome these challenges and achieve sustainable malaria

elimination.

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