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Background  Artemisinin resistance, linked to polymorphisms in the Kelch gene on chromosome 13 of  Plasmodium falciparum  ( k13 ), has outpaced containment efforts in South East Asia. For national malaria control programmes in the region, it is important to establish a surveillance system which includes monitoring for  k13  polymorphisms associated with the clinical phenotype.    Methods  Between February and December 2013, parasite clearance was assessed in 35 patients with uncomplicated  P. falciparum  treated with artesunate monotherapy followed by 3-day ACT in an isolated area on the Myanmar–Thai border with relatively low artemisinin drug pressure. Molecular testing for  k13  mutations was performed on dry blood spots collected on admission.    Results  The proportion of  k13  mutations in these patients was 41.7%, and only 5 alleles were detected: C580Y, I205T, M476I, R561H, and F446I. Of these, F446I was the most common, and was associated with a longer parasite clearance half-life (median) 4.1 (min–max 2.3–6.7) hours compared to 2.5 (min–max 1.6–8.7) in wildtype (p = 0·01). The prevalence of  k13  mutant parasites was much lower than the proportion of  k13  mutants detected 200 km south in a much less remote setting where the prevalence of  k13  mutants was 84% with 15 distinct alleles in 2013 of which C580Y predominated.    Conclusions  This study provides evidence of artemisinin resistance in a remote part of eastern Myanmar. The prevalence of  k13  mutations as well as allele diversity varies considerably across short distances, presumably because of historical patterns of artemisinin use and population movements.    Electronic supplementary material  The online version of this article (10.1186/s12936-017-2128-x) contains supplementary material, which is available to authorized users.

Plasmodium falciparum Kelch 13 mutations and treatment response in patients in Hpa-Pun District, Northern Kayin State, Myanmar