Volume 98, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Data on prevalence of antimalarial molecular resistance markers in pregnant women in Ghana is scarce. Prevalence of single nucleotide polymorphisms/haplotypes in the , , , and genes was assessed in a cross-sectional study involving 200 pregnant women. Almost 90% of infections were wild type at the gene whereas the NFD mutant haplotype occurred in 43% of samples. Prevalence of quadruple mutation was 92.6% whereas quintuple mutation with K540E was not observed. The study provides important updates of antimalarial resistance markers in Ghanaian pregnant women and suggests increased tolerance to one of the first-line treatment options in Ghana: artemether–lumefantrine. The data support the view that sulfadoxine–pyrimethamine is still efficacious for intermittent preventive treatment in Ghana, but the impact of increased doses on selection of mutations needs to be assessed. Continuing the surveillance of resistance markers is important to inform changes in antimalarial drug policy in pregnancy.


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  1. Falade CO, Tongo OO, Ogunkole OO, Orimadegun AE, , 2010. Effects of malaria in pregnancy on newborn anthropometry. J Infect Dev Ctries 4: 448453. [Google Scholar]
  2. World Health Organization, 2017. World Malaria Report, 2017. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/malaria/publications/world-malaria-report-2017/en. Accessed August 16, 2017.
  3. Desai M, 2016. Impact of sulfadoxine-pyrimethamine resistance on effectiveness of intermittent preventive therapy for malaria in pregnancy at clearing infections and preventing low birth weight. Clin Infect Dis 62: 323333. [Google Scholar]
  4. Peterson DS, Walliker D, Wellems TE, , 1988. Evidence that a point mutation in dihydrofolate reductase-thymidylate synthase confers resistance to pyrimethamine in falciparum malaria. Proc Natl Acad Sci USA 85: 91149118. [Google Scholar]
  5. Wang P, Read M, Sims PF, Hyde JE, , 1997. Sulfadoxine resistance in the human malaria parasite Plasmodium falciparum is determined by mutations in dihydropteroate synthase and an additional factor associated with folate utilization. Mol Microbiol 23: 979986. [Google Scholar]
  6. Sidhu AB, Valderramos SG, Fidock DA, , 2005. Pfmdr1 mutations contribute to quinine resistance and enhance mefloquine and artemisinin sensitivity in Plasmodium falciparum. Mol Microbiol 57: 913926. [Google Scholar]
  7. Malmberg M, 2013. Temporal trends of molecular markers associated with artemether-lumefantrine tolerance/resistance in Bagamoyo district, Tanzania. Malar J 12: 103. [Google Scholar]
  8. Djimde A, 2001. A molecular marker for chloroquine-resistant falciparum malaria. N Engl J Med 344: 257263. [Google Scholar]
  9. National Malaria Control Programme, Ghana, 2015. Malaria in Pregnancy. Available at: http://www.ghanahealthservice.org/malaria/subcategory.php. Accessed October 17, 2017.
  10. Mockenhaupt FP, Eggelte TA, Till H, Bienzle U, , 2001. Plasmodium falciparum Pfcrt and Pfmdr1 polymorphisms are associated with the Pfdhfr N108 pyrimethamine-resistance mutation in isolates from Ghana. Trop Med Int Health 6: 749755. [Google Scholar]
  11. Mockenhaupt FP, Bedu-Addo G, Junge C, Hommerich L, Eggelte TA, Bienzle U, , 2007. Markers of sulfadoxine-pyrimethamine-resistant Plasmodium falciparum in placenta and circulation of pregnant women. Antimicrob Agents Chemother 51: 332334. [Google Scholar]
  12. Mockenhaupt FP, Bedu-Addo G, Eggelte TA, Homerich L, Holmberg V, von Oertzen C, Bienzle U, , 2008. Rapid increase in the prevalence of sulfadoxine-pyrimethamine resistance among Plasmodium falciparum isolated from pregnant women in Ghana. J Infect Dis 198: 15451549. [Google Scholar]
  13. Osarfo J, Tagbor H, Cairns M, Alifrangis M, Magnussen P, , 2017. Dihydroartemisinin-piperaquine versus artesunate-amodiaquine for treatment of malaria infection in pregnancy in Ghana: an open-label, randomised, non-inferiority trial. Trop Med Int Health 22: 10431052. [Google Scholar]
  14. Wooden J, Kyes S, Sibley CH, , 1993. PCR and strain identification in Plasmodium falciparum. Parasitol Today 9: 303305. [Google Scholar]
  15. Alifrangis M, Enosse S, Pearce R, Drakeley C, Roper C, Khalil IF, Nkya WM, Rønn AM, Theander TG, Bygbjerg IC, , 2005. Simple, high-throughput method to detect Plasmodium falciparum single nucleotide polymorphisms in the dihydrofolate reductase, dihydropteroate synthase, and P. falciparum chloroquine resistance transporter genes using polymerase chain reaction- and enzyme-linked immunosorbent assay-based technology. Am J Trop Med Hyg 72: 155162. [Google Scholar]
  16. Thomsen TT, Ishengoma DS, Mmbando BP, Lusingu JP, Vestergaard LS, Theander TG, Lemnge MM, Bygbjerg IC, Alifrangis M, , 2011. Prevalence of single nucleotide polymorphisms in the Plasmodium falciparum multidrug resistance gene (Pfmdr-1) in Korogwe District in Tanzania before and after introduction of artemisinin-based combination therapy. Am Trop Med Hyg 85: 979983. [Google Scholar]
  17. Afoakwa R, Boampong JN, Egyir-Yawson A, Nwaefuna EK, Verner ON, Asare KK, , 2014. High prevalence of PfCRT K76T mutation in Plasmodium falciparum isolates in Ghana. Acta Trop 136: 3236. [Google Scholar]
  18. Sisowath C, Petersen I, Veiga MI, Mårtensson A, Premji Z, Björkman A, Fidock DA, Gil JP, , 2009. In vivo selection of Plasmodium falciparum parasites carrying the chloroquine-susceptible Pfcrt K76 allele after treatment with artemether-lumefantrine in Africa. J Infect Dis 199: 750755. [Google Scholar]
  19. Venkatesan M, 2014. Polymorphisms in Plasmodium falciparum chloroquine resistance transporter and multidrug resistance 1 genes: parasite risk factors that affect treatment outcomes for P. falciparum malaria after artemether-lumefantrine and artesunate-amodiaquine. Am J Trop Med Hyg 91: 833843. [Google Scholar]
  20. Mousiliou A, De Tove YS, Doritchamou J, Luty AJF, Massougbodji A, Alifrangis M, Deloron P, Ndam NT, , 2013. High rates of parasite recrudescence following intermittent preventive treatment with sulphadoxine-pyrimethamine during pregnancy in Benin. Malar J 12: 195. [Google Scholar]

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  • Received : 05 Jan 2018
  • Accepted : 11 Feb 2018
  • Published online : 26 Mar 2018

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