**5. Discovering and tackling adaptive drug resistance in plasmodium: recommendations**

Evolution of resistance to drugs is a survival mechanism influenced by many factors that produce mutation in the parasites. Common among causes of resistance is exposure to non-lethal doses of anti-malaria drugs [15]. Malaria parasites have unique ability to evolving mechanisms for evading the immune response in humans [43] and they are actively evolving resistance to anti-plasmodia drugs [44]. But there is a dearth of information are to the effect of plasmodia resistance to drug, especially adaptive resistance, which though is temporal, could influence the development of novel plasmodium stains not targeted by currently available anti-malaria drug. This development is a threat to malaria elimination agenda and should not be encouraged.

A host of resistance gene markers in plasmodium for drug resistance is an active field of malaria research [16, 18, 19, 45, 46], and still counting, but not much is written about the role or influence of adaptive resistance on these markers this is a conspicuous research gap in malaria biology and genetics requiring urgent attention. Selective sweep resulting in sudden change in an advantageous gene under strong positive selection [47] has been reported as product of evolution of resistance to drug. It is possible to scanning the genome for signature of selective sweeps, to identify genes undergoing adaptive evolution [48]. Similar studies revealed the mutations in presently known markers used in the study of malaria drug resistance [49–52], but none is focused on adaptive resistance. This kind of studies leverage of the NEXT GENERATION sequencing technology which is very limited and still very expensive in developing countries, especially in countries with no direct funding of research by government, where malaria is endemic.

### **6. Pertinent questions and suggestions for the way forward**

Is adaptive resistance in malaria parasites a challenge? Does it have a significant influence on combating and elimination of malaria particularly in malaria endemic regions in Africa? Understanding the effects of adaptive malaria drug resistance, in plasmodium, the vector and the human host will greatly contribute to malaria elimination agenda and reposition the malaria elimination programmes across the world with focus on sub-Saharan Africa as the hub. In addition, different populations respond differently to the same drugs. These differential responses are influenced by genetic variability in different ethnic groups within a population, which in turn can be associated with variation in resistance to given drugs. Identification of genes and gene pathways involved in adaptive resistance is also vital for developing markers for prediction and diagnosis and should be pursued.

Kim and Schneider [48] observed that, "by examining selective sweeps in many endemic areas with different demographic and epidemiologic characteristics" it would be possible to identify factors associated with adaptive resistance to malaria drugs and track epidemiological variables [53–56] for transmission

*Adaptive Drug Resistance in Malaria Parasite: A Threat to Malaria Elimination Agenda? DOI: http://dx.doi.org/10.5772/intechopen.98323*

and development of treatment regimes, accurate drug prescription and be able to determine costs of resistance. Understanding the implication and consequences of adaptive resistance alongside other forms of drug resistances will play significant role in policy formulation and implementation for disease control, give vivid picture of how to manage malaria control and modelling of disease transmission.
