High Prevalence of Molecular Markers of Plasmodium falciparum Resistance to Sulphadoxine–Pyrimethamine in Parts of Ghana: A Threat to ITPTp-SP?

• Published in: Journal of tropical pediatrics (1980) Vol. 67; no. 1
• Main Authors: Afutu, Leslie L, Boampong, Johnson N, Quashie, Neils B
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 29-01-2021
• Subjects: Antimalarials - pharmacology; Antimalarials - therapeutic use; Drug Combinations; Drug Resistance - genetics; Female; Ghana - epidemiology; Humans; Malaria, Falciparum - drug therapy; Malaria, Falciparum - epidemiology; Plasmodium falciparum - genetics; Pregnancy; Prevalence; Pyrimethamine - pharmacology; Pyrimethamine - therapeutic use; Sulfadoxine - pharmacology; Sulfadoxine - therapeutic use; Ghana; mutation; prevalence; intermittent preventive treatment; sulphadoxine–pyrimethamine; pregnancy; genotype; Plasmodium falciparum
• ISSN: 0142-6338; 1465-3664
• DOI: 10.1093/tropej/fmaa120

Abstract

Malaria in pregnancy is a huge public health problem as it is the cause of maternal anaemia, still birth, premature delivery, low birth weight among others. To tackle this problem, WHO recommended the administration, during pregnancy, of intermittent preventive treatment with sulphadoxine–pyrimethamine (IPTp-SP). The introduction of this policy is likely to create SP drug pressure which may lead to the emergence of parasite strains resistant to the drug. This study investigated the prevalence of the molecular markers of SP resistance as pointers to potential failure of IPTp-SP among pregnant women attending antenatal clinic, women at the point of baby delivery and out patients department (OPD) attendees. The study was conducted in health facilities located in parts of Ghana. Prevalence of mutations in dhfr and dhps genes of Plasmodium falciparum was determined using the method described by Duraisingh et al. The outcome of the study indicated the presence of high prevalence of strains of P.falciparum with the resistant alleles of the dhfr or dhps genes in the three categories of participants. There was a high prevalence of triple mutations (IRN) in the dhfr gene of P.falciparum isolates: 71.4% in peripheral blood of antenatal attendees; 74.1% in placenta cord blood of delivering mothers and 71.1% in OPD attendees. Quintuple mutations were only found in 2 (0.5%) isolates from OPD attendees. This observation might have occurred due to the increased use of SP for IPTp among others. There is the need for an interventional measure in order to protect pregnant women and their unborn children.

Lay summary
When pregnant women get infected with the malaria parasites they are exposed to all manner of dangers including pre-term delivery, still birth, maternal anaemia and low birth weight. Taking sulphadoxine–pyrimethamine (SP) at predetermined periods during pregnancy, referred to as ‘intermittent preventive treatment with SP’ (IPTp-SP)’ helps to curtail these problems. However, the frequent taking of these drugs is likely to create SP drug pressure which may lead to the emergence of parasite strains that are not readily killed by the drugs. In order to ascertain this phenomenon and advice stakeholders, this study determined the prevalence of certain ‘materials’ certified as markers of parasite resistance to SP. Alarmingly, more than 5% of all the category of women recruited to participate in this study were found to harbour the parasites that causes malaria. The outcome, also suggest the existence of high levels of strains of the malaria parasite, carrying the materials that make them to become resistant to SP. Policy makers must pay attention to these observations and institute measures to avoid escalation of the situation.