Malaria with other antimalarials (known as artemisinin-combination therapy, or ACT), which decreases resistance to any single drug component. These additional antimalarials include: amodiaquine, lumefantrine, mefloquine or sulfadoxine/pyrimethamine. Another recommended combination is dihydroartemisinin and piperaquine. ACT is about 90% effective when used to treat uncomplicated malaria. To treat malaria during pregnancy, the WHO recommends the use of quinine plus clindamycin early in the pregnancy (1st trimester), and ACT in later stages (2nd and 3rd trimesters). In the 2000s (decade), malaria with partial resistance to artemisins emerged in Southeast Asia. Infection with "P. vivax", "P. ovale" or "P. malariae" usually do not require
Human genetic resistance to malaria as in other diseases, innate immunity leads into, and stimulates, adaptive immunity. Mutations may have detrimental as well as beneficial effects, and any single mutation may have both. Infectiousness of malaria depends on specific proteins present in the cell walls and elsewhere in red blood cells. Protective mutations alter these proteins in ways that make them inaccessible to malaria organisms. However, these changes also alter the functioning and form of red blood cells that may have visible effects, either overtly, or by microscopic examination of red blood cells. These changes may impair the function of red blood cells in various