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

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  • 1 Cheikh Anta Diop University, Dakar, Senegal.
  • | 2 Tulane University, New Orleans, Louisiana.
  • | 3 University of Bamako, Mali.
  • | 4 Medical Research Council, The Gambia.
  • | 5 Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
  • | 6 The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
  • | 7 Simmons College School of Nursing and Health Sciences, Boston, Massachusetts.
  • | 8 London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • | 9 Institute of Tropical Medicine, Antwerp, Belgium.
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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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