RESEARCH The diminishing returns o d

Full list of author information is available at the end of the articleBackground Efforts are underway to eliminate Plasmodium falcip-arum malaria in many malaria-endemic countries [1]. A major threat to these efforts is the recent identification of artemisinin resistance in Cambodia [2], Thailand [3], Myanmar [4], and Vietnam [5]. Artemisinin combination therapy (ACT) is first-line treatment for malaria world-wide and thus an important component of strategies for malaria elimination. Mathematical modelling predicts that by using ACT at high coverage, as part of a combined strategy, artemisinin-resistant malaria can be eliminated. To do so would re-quire elimination of all malaria in an area as the last few infections to be cleared are most likely to be resistant [6]. Atovaquone-proguanil (A-P) has been proposed as an alternative anti-malarial to ACT to reduce selectiv