Surveillance of Molecular Markers of Plasmodium falciparum Resistance to Sulphadoxine-Pyrimethamine 5 Years after the Change of Malaria Treatment Policy in Ghana

Nancy O. Duah Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana; Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Korle-Bu, Accra, Ghana; United States Naval Medical Research Unit No. 3, Cairo, Egypt

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Neils B. Quashie Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana; Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Korle-Bu, Accra, Ghana; United States Naval Medical Research Unit No. 3, Cairo, Egypt

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Benjamin K. Abuaku Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana; Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Korle-Bu, Accra, Ghana; United States Naval Medical Research Unit No. 3, Cairo, Egypt

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Peter J. Sebeny Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana; Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Korle-Bu, Accra, Ghana; United States Naval Medical Research Unit No. 3, Cairo, Egypt

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Karl C. Kronmann Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana; Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Korle-Bu, Accra, Ghana; United States Naval Medical Research Unit No. 3, Cairo, Egypt

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Kwadwo A. Koram Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana; Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Korle-Bu, Accra, Ghana; United States Naval Medical Research Unit No. 3, Cairo, Egypt

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In 2005, sulphadoxine-pyrimethamine (SP) became the drug of choice for intermittent preventive treatment of Plasmodium falciparum malaria in pregnancy (IPTp) in Ghana. Reports suggest the use of SP by others to treat uncomplicated malaria. Because of the increased use of SP, the prevalence of mutations in the genes, dihydrofolate reductase (dhfr), and dihydropteroate synthetase (dhps), linked to SP resistance in P. falciparum were determined. Blood samples from 945 children with uncomplicated malaria collected at nine sites from 2003 to 2010 were analyzed using polymerase chain reaction and restriction fragment length polymorphism. Prevalence of the dhfr triple and dhfr plus dhps quadruple mutations showed significant increase in trend from 2003 to 2010 (χ2 = 18.78, P < 0.001, χ2 = 15.11, P < 0.001, respectively). For dhps double mutant G437 + E540 the prevalence was low (1.12%) caused by the very low prevalence of E540. Our findings show the wide use of SP in Ghana and therefore its use for IPTp needs to be closely monitored.

Author Notes

* Address correspondence to Nancy O. Duah, Noguchi Memorial Institute for Medical Research, P.O. Box LG581, Legon, Accra, Ghana. E-mail: nduah@noguchi.mimcom.org

Financial support: The molecular aspect of this work was funded by the Global Emerging Infections Surveillance and Response System (GEIS), a Division of the Armed Forces Health Surveillance Center (AFHSC) [Project no. C0437_10_N3]. The field work aspect was funded by the Global Fund for TB, Aids, and Malaria/National Malaria Control Program and the WHO/Multilateral Initiative in Malaria (MIM) [Project no. 980034].

Disclosure: Karl C. Kronmann and Peter Sebeny are military service members. This work was prepared as part of their official duties. Title 17 U.S.C. §105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person's official duties.

Authors' addresses: Nancy O. Duah, Benjamin K. Abuaku, and Kwadwo A. Koram, Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana, E-mails: nduah@noguchi.mimcom.org, babuaku@noguchi.mimcom.org, and kkoram@noguchi.mimcom.org. Neils B. Quashie, Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana, E-mail: nquashie@noguchi.mimcom.org. Peter J. Sebeny, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, MD, E-mail: Peter.Sebeny@med.navy.mil. Karl C. Kronmann, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt, E-mail: karl.kronmann@med.navy.mil.

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