Seasonal malaria chemoprevention in a context of high presumed sulfadoxine-pyrimethamine resistance: malaria morbidity and molecular drug resistance profiles in South Sudan.
Haplotype mutations
SMC
South Sudan
Sulfadoxine-pyrimethamine plus amodiaquine
Journal
Malaria journal
ISSN: 1475-2875
Titre abrégé: Malar J
Pays: England
ID NLM: 101139802
Informations de publication
Date de publication:
10 Nov 2023
10 Nov 2023
Historique:
received:
30
01
2023
accepted:
03
10
2023
medline:
13
11
2023
pubmed:
11
11
2023
entrez:
11
11
2023
Statut:
epublish
Résumé
Seasonal malaria chemoprevention (SMC) using sulfadoxine-pyrimethamine plus amodiaquine (SP-AQ), is a community-based malaria preventive strategy commonly used in the Sahel region of sub-Saharan Africa. However, to date it has not been implemented in East Africa due to high SP resistance levels. This paper is a report on the implementation of SMC outside of the Sahel in an environment with a high level of presumed SP-resistance: five cycles of SMC using SPAQ were administered to children 3-59 months during a period of high malaria transmission (July-December 2019) in 21 villages in South Sudan. A population-based SMC coverage survey was combined with a longitudinal time series analysis of health facility and community health data measured after each SMC cycle. SMC campaign effectiveness was assessed by Poisson model. SPAQ molecular resistance markers were additionally analysed from dried blood spots from malaria confirmed patients. Incidence of uncomplicated malaria was reduced from 6.6 per 100 to an average of 3.2 per 100 after SMC administration (mean reduction: 53%) and incidence of severe malaria showed a reduction from 21 per 10,000 before SMC campaign to a mean of 3.3 per 10,000 after each cycle (mean reduction: 84%) in the target group when compared to before the SMC campaign. The most prevalent molecular haplotype associated with SP resistance was the IRNGE haplotype (quintuple mutant, with 51I/59R/108N mutation in pfdhfr + 437G/540E in pfdhps). In contrast, there was a low frequency of AQ resistance markers and haplotypes resistant to both drugs combined (< 2%). The SMC campaign was effective and could be used as an additional preventive tool in seasonal malaria settings outside of the Sahel, especially in areas where access to health care is unstable. Malaria case load reduction was observed despite the high level of resistance to SP.
Sections du résumé
BACKGROUND
BACKGROUND
Seasonal malaria chemoprevention (SMC) using sulfadoxine-pyrimethamine plus amodiaquine (SP-AQ), is a community-based malaria preventive strategy commonly used in the Sahel region of sub-Saharan Africa. However, to date it has not been implemented in East Africa due to high SP resistance levels. This paper is a report on the implementation of SMC outside of the Sahel in an environment with a high level of presumed SP-resistance: five cycles of SMC using SPAQ were administered to children 3-59 months during a period of high malaria transmission (July-December 2019) in 21 villages in South Sudan.
METHODS
METHODS
A population-based SMC coverage survey was combined with a longitudinal time series analysis of health facility and community health data measured after each SMC cycle. SMC campaign effectiveness was assessed by Poisson model. SPAQ molecular resistance markers were additionally analysed from dried blood spots from malaria confirmed patients.
RESULTS
RESULTS
Incidence of uncomplicated malaria was reduced from 6.6 per 100 to an average of 3.2 per 100 after SMC administration (mean reduction: 53%) and incidence of severe malaria showed a reduction from 21 per 10,000 before SMC campaign to a mean of 3.3 per 10,000 after each cycle (mean reduction: 84%) in the target group when compared to before the SMC campaign. The most prevalent molecular haplotype associated with SP resistance was the IRNGE haplotype (quintuple mutant, with 51I/59R/108N mutation in pfdhfr + 437G/540E in pfdhps). In contrast, there was a low frequency of AQ resistance markers and haplotypes resistant to both drugs combined (< 2%).
CONCLUSIONS
CONCLUSIONS
The SMC campaign was effective and could be used as an additional preventive tool in seasonal malaria settings outside of the Sahel, especially in areas where access to health care is unstable. Malaria case load reduction was observed despite the high level of resistance to SP.
Identifiants
pubmed: 37950227
doi: 10.1186/s12936-023-04740-x
pii: 10.1186/s12936-023-04740-x
pmc: PMC10637007
doi:
Substances chimiques
fanasil, pyrimethamine drug combination
37338-39-9
Antimalarials
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
345Informations de copyright
© 2023. The Author(s).
Références
Malar J. 2021 Nov 18;20(1):440
pubmed: 34794431
PLoS One. 2020 Aug 20;15(8):e0235401
pubmed: 32817665
Malar J. 2022 Mar 24;21(1):104
pubmed: 35331231
J Infect Dis. 2018 Aug 14;218(6):946-955
pubmed: 29718283
Malar J. 2014 Feb 03;13:45
pubmed: 24490895
Lancet Infect Dis. 2019 May;19(5):546-556
pubmed: 30922818
Malar J. 2022 Feb 19;21(1):56
pubmed: 35183185
Malar J. 2022 Feb 23;21(1):65
pubmed: 35197053
Asian Pac J Trop Med. 2017 Mar;10(3):299-304
pubmed: 28442114
PLoS One. 2019 May 17;14(5):e0216486
pubmed: 31100072
Int J Environ Res Public Health. 2020 Sep 11;17(18):
pubmed: 32932990
BMJ Glob Health. 2020 Nov;5(11):
pubmed: 33214174
JMIR Res Protoc. 2021 Sep 15;10(9):e27855
pubmed: 34524109
Antimicrob Agents Chemother. 2019 Feb 26;63(3):
pubmed: 30559133
Lancet. 2020 Dec 5;396(10265):1829-1840
pubmed: 33278936
Lancet Infect Dis. 2021 Nov;21(11):1499
pubmed: 34717809
J Infect Dis. 2021 Mar 29;223(6):985-994
pubmed: 33146722
Sci Rep. 2022 Jan 26;12(1):1402
pubmed: 35082312
Trends Parasitol. 2013 Oct;29(10):505-15
pubmed: 24028889
Malar J. 2021 Dec 14;20(1):463
pubmed: 34906159
BMC Public Health. 2022 Mar 5;22(1):442
pubmed: 35247990
Lancet Glob Health. 2021 Feb;9(2):e199-e208
pubmed: 33482140
Malar J. 2022 Feb 8;21(1):39
pubmed: 35135546
Am J Trop Med Hyg. 1995 Jun;52(6):565-8
pubmed: 7611566
Antimicrob Agents Chemother. 2003 Apr;47(4):1347-54
pubmed: 12654669
Lancet Microbe. 2020 Sep;1(5):e209-e217
pubmed: 33089222
Malar J. 2020 Apr 6;19(1):137
pubmed: 32252774
Malar J. 2022 Dec 6;21(1):375
pubmed: 36474264
Antimicrob Agents Chemother. 2022 Apr 19;66(4):e0194521
pubmed: 35266823