MOLECULAR SURVEILLANCE OF CHLOROQUINE AND SULPHADOXINE PYRIMETHAMINE RESISTANCE ASSOCIATED MUTATIONS IN PLASMODIUM FALCIPARUM IN UNDER-FIVE CHILDREN IN SAGAMU LOCAL GOVERNMENT AREA OF OGUN STATE

Abstract

The World Health Organization (WHO) estimates that over 300 million new cases of
malaria occur yearly, with approximately two to three million deaths. Africa has 90% of
the global burden with pregnant women and children being the most affected. Drug
resistance has been identified as the major problem militating against global malaria
control programs. This study was set out to access the prevalence of resistance to
Chloroquine and Sulphadoxine/Pyrimethamine among children below the age of 5 years
from Sagamu by identifying the molecular markers of resistance to Chloroquine and
Sulphadoxine/Pyrimethamine after 6 years of change in National antimalarial policy in
favor of Artesunate combination therapy (ACT).
One hundred and thirty one children between the ages of 2 to 60 months were recruited
for the study. Questioners were administered to the parents/guardian of the children to
find out about their knowledge and use of insecticide treated net (ITN), chloroquine,
Sulphadoxine/Pyrimethamine and ACT. Blood samples were also collected from
participants to check for parasite density and molecular markers of resistance to both
chloroquine and Sulphadoxine/Pyrimethamine.
High rate of self medication with Chloroquine and Sulphadoxine/Pyrimethamine was
observed in this study, the rate of use was 35.1% and 66.4% respectively while only
20.6% used the currently recommended ACT. Participants have a good knowledge of
Insecticide treated net (96.9%) but the use of this modern malaria control measure was
very low (19.1%). There is still a high selection pressure which was confirmed by the
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high prevalence of SP and Chloroquine resistance genes observed among all patients
irrespective of frequency of use of both Chloroquine and Sulphadoxine/Pyrimethamine.
The prevalence of Pyrimethamine resistance genes S108N, C59R, N51I and the
S108N/C59R/N51I triple mutation was 88.2%, 76.5%, 64.7% and 56.3% respectively
while there was a 98.3% prevalence of Chloroquine resistant genes.
The implication of this is that as long as a significant number of Nigerians continue to
use Chloroquine and Sulphadoxine/Pyrimethamine the selection pressure will continue to
promote the circulation of resistant genes. This will defeat the purpose of the National
strategy to rest these drugs so as to reduce the selection pressure and thereby reduce
resistance, so that these drugs can be reintroduced in the future
It is therefore recommended that there is more advocacy and public enlightenment to
enlist the support of the public and also reduce the cost of Artesunate based combination
therapies which are about 10-20 times more expensive than chloroquine-based therapies
and prophylaxis by Sulphadoxine/pyremethamine.