West Africa International Centers of Excellence for Malaria Research: Drug Resistance Patterns to Artemether–Lumefantrine in Senegal, Mali, and The Gambia

Baba Dieye Cheikh Anta Diop University, Dakar, Senegal.

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Muna Affara Medical Research Council, The Gambia.

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Lassana Sangare University of Bamako, Mali.

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Fatou Joof Medical Research Council, The Gambia.

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Yaye D. Ndiaye Cheikh Anta Diop University, Dakar, Senegal.

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Jules F. Gomis Cheikh Anta Diop University, Dakar, Senegal.

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Mouhamadou Ndiaye Cheikh Anta Diop University, Dakar, Senegal.

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Aminata Mbaye Cheikh Anta Diop University, Dakar, Senegal.

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Mouhamadou Diakite University of Bamako, Mali.

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Ngayo Sy Cheikh Anta Diop University, Dakar, Senegal.

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Babacar Mbengue Cheikh Anta Diop University, Dakar, Senegal.

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Awa B. Deme Cheikh Anta Diop University, Dakar, Senegal.

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Rachel Daniels Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

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Ambroise D. Ahouidi Cheikh Anta Diop University, Dakar, Senegal.

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Tandakha Dieye Cheikh Anta Diop University, Dakar, Senegal.

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Ahmad Abdullahi Medical Research Council, The Gambia.

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Seydou Doumbia University of Bamako, Mali.

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Jean L. Ndiaye Cheikh Anta Diop University, Dakar, Senegal.

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Ayouba Diarra University of Bamako, Mali.

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Abubakar Ismaela Medical Research Council, The Gambia.

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Mamadou Coulibaly University of Bamako, Mali.

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Clint Welty Tulane University, New Orleans, Louisiana.

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Alfred Amambua Ngwa Medical Research Council, The Gambia.

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Jeffrey Shaffer Tulane University, New Orleans, Louisiana.

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Umberto D'Alessandro Medical Research Council, The Gambia.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
Institute of Tropical Medicine, Antwerp, Belgium.

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Sarah K. Volkman Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
Simmons College School of Nursing and Health Sciences, Boston, Massachusetts.

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Dyann F. Wirth Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.

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Donald J. Krogstad Tulane University, New Orleans, Louisiana.

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Ousmane Koita University of Bamako, Mali.

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Davis Nwakanma Medical Research Council, The Gambia.

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Daouda Ndiaye Cheikh Anta Diop University, Dakar, Senegal.

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In 2006, artemether–lumefantrine (AL) became the first-line treatment of uncomplicated malaria in Senegal, Mali, and the Gambia. To monitor its efficacy, between August 2011 and November 2014, children with uncomplicated Plasmodium falciparum malaria were treated with AL and followed up for 42 days. A total of 463 subjects were enrolled in three sites (246 in Senegal, 97 in Mali, and 120 in Gambia). No early treatment failure was observed and malaria infection cleared in all patients by day 3. Polymerase chain reaction (PCR)-adjusted adequate clinical and parasitological response (ACPR) was 100% in Mali, and the Gambia, and 98.8% in Senegal. However, without PCR adjustment, ACPR was 89.4% overall; 91.5% in Mali, 98.8% in Senegal, and 64.3% in the Gambia (the lower value in the Gambia attributed to poor compliance of the full antimalarial course). However, pfmdr1 mutations were prevalent in Senegal and a decrease in parasite sensitivity to artesunate and lumefantrine (as measured by ex vivo drug assay) was observed at all sites. Recrudescent parasites did not show Kelch 13 (K13) mutations and AL remains highly efficacious in these west African sites.

Author Notes

* Address correspondence to Daouda Ndiaye, Avenue Cheikh Anta Diop University, PO Box 5005, Dakar-Fann. E-mail: dndiaye@hsph.harvard.edu
† These authors contributed equally to this work.

Financial support: The work was supported by the NIH/ICEMR, International Centre of Excellence for Malaria Research, west Africa (U19AI089696).

Authors' addresses: Baba Dieye, Yaye D. Ndiaye, Jules F. Gomis, Mouhamadou Ndiaye, Aminata Mbaye, Ngayo Sy, Babacar Mbengue, Awa B. Deme, Ambroise D. Ahouidi, Tandakha Dieye, Jean L. Ndiaye, and Daouda Ndiaye, Université Cheikh Anta Diop, BP 5005, Dakar, Fann, Sénégal, E-mails: dieyebaba2004@yahoo.fr, ydndiaye@gmail.com, jules.gomis@gmail.com, mouhamadou.ndiaye@ucad.edu.sn, natou5002@yahoo.fr, ngayosy50@hotmail.com, b.mbengue@yahoo.fr, deme.awa@gmail.com, aahouidi@gmail.com, tandakha.dieye@ucad.edu.sn, jeanloab.ndiaye@ucad.edu.sn, and dndiaye@hsph.harvard.edu. Muna Affara, Fatou Joof, Ahmad Abdullahi, Abubakar Ismaela, Alfred Amambua Ngwa, Umberto D'Alessandro, and Davis Nwakanma, Medical Research Council Unit, Atlantic Boulevard, Fajara, Banjul, The Gambia, E-mails: maffara@mrc.gm, fajoof@mrc.gm, aahmad@mrc.gm, iabubakar@mrc.gm, angwa@mrc.gm, udalessandro@mrc.gm, and dnwakanma@mrc.gm. Lassana Sangre, Mouhamadou Diakite, Seydou Doumbia, Ayouba Diarra, Mamadou Coulibaly, and Ousmane Koita, Université de Bamako, BP 1805, Bamako, Mali, E-mails: lansana.sangare@gmail.com, mdiakite@icermali.org, sdoumbi@gmail.com, adiarra@icemrwaf.org, doudou@icermali.org, and okoita@icermali.org. Clint Welty, Jeffrey Shaffer, and Donald J. Krogstad, Tulane University, New Orleans, LA, E-mails: cwelty@icemrwaf.org, jshaffer@tulane.edu, and donkrogstad@gmail.com. Rachel Daniels, Sarah K. Volkman, and Dyann F. Wirth, Harvard T. H. Chan School of Public Health, Boston, MA, E-mails: rdaniels@broadinstitute.org, svolkman@hsph.harvard.edu, and dfwirth@hsph.harvard.edu.

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