THE IMPACT OF SELF-MEDICATION AND INCOMPLETE TREATMENT OF MALARIA ON DEVELOPMENT OF DRUG RESISTANCE: A NARRATIVE REVIEW

Abstract

Malaria remains a major infectious disease, particularly in sub-Saharan Africa, where it continues to pose a significant public health challenge. Although substantial progress has been made in malaria control, the emergence and spread of antimalarial drug resistance threaten efforts toward elimination. This review adopted a narrative literature review approach, examining available literature on the contribution of incomplete antimalarial treatment and self-medication to the development and transmission of drug-resistant Plasmodium parasites. It focused on factors contributing to poor treatment adherence, patterns of self-medication, and resistance mechanisms associated with commonly used antimalarial drugs. Poor adherence to prescribed treatment, premature discontinuation of therapy, economic difficulties, limited health literacy, adverse drug reactions, and restricted access to healthcare may result in inadequate drug exposure and selective pressure favouring resistant parasites. Self-medication further contributes through incorrect diagnosis, inappropriate drug selection, under-dosing, medication sharing, and the use of counterfeit or substandard medicines. The review discusses resistance mechanisms involving genetic mutations associated with chloroquine, sulfadoxine-pyrimethamine, and artemisinin. The consequences include treatment failure, increased morbidity and mortality, higher healthcare costs, and setbacks to malaria elimination. Effective control requires improved public health education, access to diagnostic and healthcare services, stronger pharmaceutical regulation, surveillance, adherence support, and continued research. Preserving the effectiveness of existing antimalarial medicines is essential for reducing malaria burden and achieving sustainable malaria control and elimination.