Recent studies in Guyana and Suriname revealed diminished efficacy of artemisinin derivatives based on day-3 parasitaemia. Data on malaria medicine quality and pharmaceutical management, generated in the context of the Amazon Malaria Initiative, were reviewed and discussed. Numerous substandard artemisinin-containing malaria medicines were identified in both countries, particularly in Guyana. The quality of malaria medicines and the availability and use of non-recommended treatments could have played a role in the diminished efficacy of artemisinin derivatives described in Guyana and Suriname.

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