Author: Obasi Doris Olachi
Department: Pharmaceutical Microbiology and Biotechnology
Affiliation: Nnamdi Azikiwe University Awka

Sulfadoxine-pyrimethamine (SP) is no longer recommended for the treatment of uncomplicated falciparum malaria due to its increasing failure rate, but is still being used as intermittent preventive treatment in pregnancy (IPT-p). This can continually maintain selective pressure on the drugs target by the active site mutations in dihydrofolate reductase and dihydroptereoate synthase in the parasite, even in patients that are not pregnant. This study determined the prevalence of Plasmodium falciparum and of molecular markers of P. falciparium resistant to SP among out-patients in two public Hospitals and a private medical Laboratory in Awka South metropolis, Anambra State, several years after the change of the malaria treatment policy. Blood samples were obtained from 210 patients (ages 5-64 years) with febrile conditions and were screened for malaria parasite using thick and thin blood smear stained with giemsa to investigate the Plasmodium species, degree of parasitaemia and the parasite density. Semi-structured questionnaires were administered to evaluate the patient’s knowledge, attitude and practice (KAP) towards malaria, its preventive measures and treatment strategies. Molecular studies were performed by DNA isolation and polymerase chain reaction (PCR). The malaria-related KAP evaluation showed that a good number of patients have good knowledge of malaria, its prevention and control measures, yet have very poor attitude and poor practice that eventually predispose them to malaria infection. The overall prevalence of Plasmodium falciparum malaria in the study was 74.8 % out of which 19.1 % (30 samples) had high parasite count of ≥ 4000 asexual parasite /μL of blood. Molecular studies on 23 of the 30 isolates with high yield and purity amplified, had high prevalence of Plasmodium falciparum carrying point mutations against SP in 52.2 % (12 isolates). Out of which 17.4 % (4 isolates) with single mutations on the dhfr gene, 17.4 % (4 isolates) with single mutations on the dhps gene (of which 4.4 % (1 isolate) presented double mutated gene forms of dhps) and 17.4 % (4 isolates) with double mutation for both dhfr and dhps genes. A substantial number of people in Awka South were found to be infected with Plasmodium falciparum in spite of the National Malaria Control Programme. There is a high level of resistance of Plasmodium falciparum to SP despite the change in malaria treatment policy and this presents a challenge in its continual use in intermittent preventive treatment during pregnancy.

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