Artemisinin-based combination therapies (ACTs) are the first-line treatment of uncomplicated malaria. The public health benefit and safety of repeated administration of a given ACT are poorly studied. We conducted a randomized trial comparing artemether-lumefantrine, artesunate plus amodiaquine (AS+AQ) and artesunate plus sulfadoxine-pyrimethamine (AS+SP) in patients 6 months of age and older with uncomplicated malaria in Mali from July 2005 to July 2007. The patient received the same initial treatment of each subsequent uncomplicated malaria episode except for treatment failures where quinine was used. Overall, 780 patients were included. Patients in the AS+AQ and AS+SP arms had significantly less risk of having malaria episodes; risk ratio (RR) = 0.84 (P = 0.002) and RR = 0.80 (P = 0.001), respectively. The treatment efficacy was similar and above 95% in all arms. Although all drugs were highly efficacious and well tolerated, AS+AQ and AS+SP were associated with less episodes of malaria.

Plasmodium falciparum CQR transporter point mutation (PfCRT76T) is known to be the key determinant of CQR. Molecular detection of PfCRT76T in field samples may be used for the surveillance of CQR in the malaria endemic countries. The genotype-resistance index (GRI) which is obtained as the ratio of the prevalence of PfCRT 76T to the incidence of CQR in a clinical trial was proposed as a simple andpractical molecular-based addition to the tools currently available for monitoring CQR in the field. In order to validate the GRI model across populations, time, and resistance patterns, we compiled data from the literature and generated new data from a dozen of sites across Mali. We found a mean PfCRT76T mutation prevalence of 84.5% (range 60.9%–95.1%) across all sites. CQR rates predicted from the GRI model was extrapolated onto a map of Mali to show the patterns of resistance throughout the participating regions. We present a comprehensive map of CQR in Mali, which strongly supports recent changes in drug policy away from chloroquine.