Volume 99, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Genotyping of allelic variants of merozoite surface proteins 1 and 2 ( and ), and the glutamate-rich protein is the gold standard for distinguishing reinfections from recrudescences in antimalarial drug trials. We compared performance of the recently developed 24-single-nucleotide polymorphism (SNP) Barcoding Assay against and genotyping in a cluster-randomized effectiveness trial of artemether–lumefantrine and dihydroartemisinin–piperaquine in Malawi. Rates of recrudescence and reinfection estimated by the two methods did not differ significantly (Fisher’s exact test; = 0.887 and = 0.768, respectively). There was a strong agreement between the two methods in predicting treatment outcomes and resolving the genetic complexity of malaria infections in this setting. These results support the use of this SNP assay as an alternative method for correcting antimalarial efficacy/effectiveness data.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, 2008. Methods and Techniques for Clinical Trials on Antimalarial Drug Efficacy: Fenotyping to Identify Parasite Populations. Informal Consultation Organized by the Medicines for Malaria Venture and Cosponsored by the World Health Organization. May 29–31, 2007, Amsterdam, The Netherlands.
  2. Snounou G, Zhu X, Siripoon N, Jarra W, Thaithong S, Brown KN, Viriyakosol S, 1999. Biased distribution of msp1 and msp2 allelic variants in Plasmodium falciparum populations in Thailand. Trans R Soc Trop Med Hyg 93: 369374.
    [Google Scholar]
  3. Juliano JJ, Gadalla N, Sutherland CJ, Meshnick SR, 2010. The perils of PCR: can we accurately ‘correct’ antimalarial trials? Trends Parasitol 26: 119124.
    [Google Scholar]
  4. Greenhouse B, Myrick A, Dokomajilar C, Woo JM, Carlson EJ, Rosenthal PJ, Dorsey G, 2006. Validation of microsatellite markers for use in genotyping polyclonal Plasmodium falciparum infections. Am J Trop Med Hyg 75: 836842.
    [Google Scholar]
  5. Greenhouse B, Dokomajilar C, Hubbard A, Rosenthal PJ, Dorsey G, 2007. Impact of transmission intensity on the accuracy of genotyping to distinguish recrudescence from new infection in antimalarial clinical trials. Antimicrob Agents Chemother 51: 30963103.
    [Google Scholar]
  6. Mwangi JM, Omar SA, Ranford-Cartwright LC, 2006. Comparison of microsatellite and antigen-coding loci for differentiating recrudescing Plasmodium falciparum infections from reinfections in Kenya. Int J Parasitol 36: 329336.
    [Google Scholar]
  7. Daniels R et al., 2008. A general SNP-based molecular barcode for Plasmodium falciparum identification and tracking. Malar J 7: 223.
    [Google Scholar]
  8. Sisya TJ, Kamn’gona RM, Vareta JA, Fulakeza JM, Mukaka MF, Seydel KB, Laufer MK, Taylor TE, Nkhoma SC, 2015. Subtle changes in Plasmodium falciparum infection complexity following enhanced intervention in Malawi. Acta Trop 142: 108114.
    [Google Scholar]
  9. Arnaud-Haond S, Belkhir K, 2007. genclone: a computer program to analyse genotypic data, test for clonality and describe spatial clonal organization. Mol Ecol Notes 7: 1517.
    [Google Scholar]
  10. Ewing VL, Terlouw DJ, Kapinda A, Pace C, Richards E, Tolhurst R, Lalloo DG, 2015. Perceptions and utilization of the anti-malarials artemether-lumefantrine and dihydroartemisinin-piperaquine in young children in the Chikhwawa District of Malawi: a mixed methods study. Malar J 14: 13.
    [Google Scholar]
  11. Arinaitwe E et al., 2009. Artemether-lumefantrine versus dihydroartemisinin-piperaquine for falciparum malaria: a longitudinal, randomized trial in young Ugandan children. Clin Infect Dis 49: 16291637.
    [Google Scholar]
  12. Sawa P et al., 2013. Malaria transmission after artemether-lumefantrine and dihydroartemisinin-piperaquine: a randomized trial. J Infect Dis 207: 16371645.
    [Google Scholar]
  13. World Health Organization, 2015. Mass Drug Administration, Mass Screening and Treatment and Focal Screening and Treatment for Malaria. Geneva, Switzerland: WHO.
  14. Galinsky K et al., 2015. COIL: a methodology for evaluating malarial complexity of infection using likelihood from single nucleotide polymorphism data. Malar J 14: 4.
    [Google Scholar]

Data & Media loading...

Supplemental reference, figures, and tables

  • Received : 02 Jan 2018
  • Accepted : 18 Feb 2018
  • Published online : 21 May 2018
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error