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Molecular Markers of Plasmodium falciparum Drug Resistance in Parasitemic Pregnant Women in the Middle Forest Belt of Ghana
Data on prevalence of antimalarial molecular resistance markers in pregnant women in Ghana is scarce. Prevalence of single nucleotide polymorphisms/haplotypes in the Pfcrt, Pfmdr1, Pfdhfr, and Pfdhps genes was assessed in a cross-sectional study involving 200 pregnant women. Almost 90% of infections were wild type at the Pfcrt gene whereas the Pfmdr1 NFD mutant haplotype occurred in 43% of samples. Prevalence of Pfdhfr/Pfdhps quadruple mutation was 92.6% whereas Pfdfr/Pfdhps 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.
Author Notes
Financial support: This forms part of J.O.’s doctoral research work which was funded by the Malaria Capacity Development Consortium (MCDC). MCDC is in turn funded by the Wellcome Trust Grant WT084289MA and Bill & Melinda Gates Foundation Grant 51941 (http://www.mcdconsortium.org).
Authors’ addresses: Joseph Osarfo, Ghana Health Service, Effiduase District Hospital, Effiduase, Ashanti Region, Ghana, E-mail: josarfo@yahoo.co.uk. Harry Tagbor, School of Medicine, University of Health and Allied Sciences, Ho, Ghana, E-mail: htagbor@uhas.edu.gh. Pascal Magnussen, Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark, and Department of Veterinary and Aquatic Sciences, Section for Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, E-mail: pma@sund.ku.dk. Michael Alifrangis, Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark, and Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark, E-mail: micali@sund.ku.dk.