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Food fortified with folic acid has been available for consumption in North America for over a decade. This strategy has led to an increase in folate levels in the general population and, more importantly, a significant decrease in the incidence of neural tube defects. However, this increase in folate intake has been associated with a greater risk of cancer disease. Many African countries are now embracing this concept; however, because folate promotes malaria parasite division, as it does in cancer cells, there is a possibility of malaria exacerbation if folate intake is increased. A precedent for such a concern is the now compelling evidence showing that an increase in iron intake can lead to a higher malaria risk; as a result, mass administration of iron in malaria-endemic areas is not recommended. In this article, we review work on the effect of folate on malaria parasites. Although this topic has received little research attention, the available data suggest that the increase in folate concentration could be associated with an increase in malaria infection. Thus, the introduction of food fortification with folic acid in malaria-endemic areas should be attended by precautionary programs to monitor the risk of malaria. [ABSTRACT FROM AUTHOR]

The emergence and spread of antimalarial resistance remain burgeoning issues. Any strategy to slow down or overcome these problems requires an understanding of the genetic changes underlying this resistance. Quinine, the first antimalarial, has been central in the treatment of severe malaria, and has been proposed as second line treatment for uncomplicated malaria in many African countries. Some reports have indicated the emergence of quinine resistance in South East Asia and in Africa, however doubts have been raised about this quinine resistance in Africa. New and interesting data are emerging on the mechanism of quinine reduced susceptibility. In this report, we have reviewed work on the in vivo efficacy and in vitro activity of quinine, and discussed recent data on genetic markers of resistance to this drug. Overall, quinine still remains efficacious in Africa, and pfnhe, the sodium hydrogen exchanger, may be one of the genetic markers underlying quinine in vitro resistance., (Copyright © 2011 Elsevier B.V. All rights reserved.)