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SUSTAINED USE OF INSECTICIDE-TREATED CURTAINS IS NOT ASSOCIATED WITH GREATER CIRCULATION OF DRUG-RESISTANT MALARIA PARASITES, OR WITH HIGHER RISK OF TREATMENT FAILURE AMONG CHILDREN WITH UNCOMPLICATED MALARIA IN BURKINA FASO

The impact of vector control measures on the evolution of antimalarial drug resistance is an important issue for malaria control programs. We investigated whether the in vivo efficacy of chloroquine (CQ) in children aged 6–59 months with uncomplicated malaria differed in 9 villages that had benefited from long-term use of insecticide-treated curtains (ITCs) and in 9 nearby non-ITC villages. We also compared the prevalence of genetic markers of resistance to CQ and sulfadoxine-pyrimethamine (SP) between the two groups of villages. The study enrolled 1,035 children with uncomplicated malaria and 231 infected but asymptomatic children. After taking account of re-infections, the proportions of children who experienced clinical failure after treatment with CQ were 14% and 19% in ITC and non-ITC villages, respectively (OR = 0.68; 95% CI: 0.39, 1.18). Parasitologic failure was observed in 49% of children in ITC villages and 58% of children in non-ITC villages (OR = 0.71 95%CI: 0.44, 1.13). The proportion of symptomatic children who harbored parasites carrying the pfcrt-76T allele was 43% in ITC villages and 40% in non-ITC villages (OR = 1.09; 95%CI: 0.80, 1.50). The pfmdr1-86Y allele was detected in 31% and 29% of children in the two groups of villages (OR = 1.14; 95%CI: 0.75, 1.72). Triple mutations in the dhfr gene were observed in 12% of children in both groups. No double mutations in the dhps gene were observed. Similar results were observed in asymptomatic children. In this setting, ITC use was not associated with increased circulation of parasites resistant to standard antimalarial drugs, or with a greater risk of treatment failure among children less than 5 years of age.

Received February 1, 2006. Accepted for publication July 5, 2006.

Acknowledgments: The authors are most grateful to the population of the study villages and to the medical teams of Ziniaré, Boussé, Paul VI, secteur 30 and Kaya districts of the Ministry of Health of Burkina Faso. We are grateful to the Director of CNRFP, to the CNRFP staff, to the Gates Malaria Partnership staff, to Rachel Hallett and Anna Randall. The authors thank Andrew Thomson for his assistance in estimating the proportion of parasite strains carrying mutant alleles. This investigation received financial support from the Gates Malaria Partnership. ITC coverage was maintained from 1994–2002 thanks to the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), the European Commission (INCO-DC, Directorate General XII), the Danish Agency for International Development and the Ministry for University and Scientific Research of Italy. It formed part of a programme of activities run by CNRFP, under the bilateral co-operation agreement between Burkina Faso and the Italian Direzione Generale per la Cooperazione allo Sviluppo, Ministry of Foreign Affairs. The principal investigator received partial support from the Multilateral initiative on malaria/TDR.

Financial support: The study received financial support from the Gates Malaria Partnership, which is supported by the Bill and Melinda Gates Foundation. The principal investigator received financial support from Gates Malaria Partnership and the Multilateral Initiative on Malaria of UNDP/World Bank/WHO/TDR for his PhD training at the London School of Hygiene and Tropical Medicine, United Kingdom.

^* Address correspondence to Diadier Diallo, Centre National de Recherche et de Formation Sur Le Paludisme (CNRFP), Avenue de l’Oubritenga, 01 BP 2208 Ouagadougou 01, Burkina Faso. E-mail: ddiallo.cnlp{at}fasonet.bf

Authors’ addresses: Diadier A. Diallo, Issa Nebié, Amadou T. Konaté, and Edith Ilboudo-Sanogo, Centre National de Recherche et de Formation Sur Le Paludisme (CNRFP), Avenue de l’Oubritenga, 01 BP 2208 Ouagadougou 01, Burkina Faso, Telephone: +226 50 32 46 95, Fax +226 50 31 04 77, E-mails: ddiallo.cnlp{at}fasonet.bf, and issanebie.cnlp{at}fasonet.bf, and a.konate.cnlp{at}fasonet.bf. Colin Sutherland, Rosalynn Ord, Hirva Pota, Cally Roper, Brian M. Greenwood, and Simon N. Cousens, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London WC1E 7HT, United Kingdom, Telephone: +44 (0)20 7636 8636, Fax: +44 (0)20 7436 5389, E-mails: colin.sutherland{at}lshtm.ac.uk, rosalynn.ord{at}lshtm.ac.uk, hirva.pota{at}lshtm.ac.uk, cally.roper{at}lshtm.ac.uk, edith.cnlp{at}fasonet.bf, brian.greenwood{at}lshtm.ac.uk, and simon.cousens{at}lshtm.ac.uk.

Reprint requests: Diadier A. Diallo, Centre National de Recherche et de Formation Sur Le Paludisme (CNRFP), Avenue de l’Oubritenga, 01 BP 2208 Ouagadougou 01, Burkina Faso, Telephone: +226 50 32 46 95, Fax: +226 50 31 04 77, E-mail: ddiallo.cnlp{at}fasonet.bf.

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