ABSTRACT
Objective: Artemisinin derivatives constitute a key component of the present-day treatment for Plasmodium falciparum malaria. In Zambia the national malaria policy was revised in 2003 to replace chloroquine mono-treatment with artemisinin combination therapy (ACT). Resistance to artemisinin is associated with a S769N point mutation in the sarcoendoplasmic reticulum calcium-dependant ATPase6 (SERCA-PfATPase6) gene of P. falciparum. However; the baseline or current levels of this mutation in Zambia remain unknown. The present study was aimed at determining the prevalence of the putative artemisinin resistance marker and the extent to which the recommended ACT (artemether-lumefantrine) was in use in Lusaka Urban district. Design: This was a cross sectional prospective study. Using a nested PCR and allele specific restriction enzyme digestion strategy; P. falciparum infections from ten sites in Lusaka urban district were assayed for the prevalence of the PfATPase6 S769N mutation. The availability of current ACT and the extent to which it has been used since introduction were assessed using interview by questionnaire. Main Outcome: The PfATPase6 S769N mutation was not found on any of the infections analyzed in the present study. Artemether-lumefantrine ACT was readily available in both government-owned health centres and private drug stores as first line malaria treatment in Lusaka urban district. Conclusion: The absence of the PfATPase6 S769N mutation suggests 100artemisinin sensitivity unless a different resistance mechanism exists. Continued resistance monitoring and investigation of other potential molecular markers is recommended as wider ACT use is scaled up in the country
Subject(s)
Drug Therapy , MalariaABSTRACT
Malaria has remained a major cause of morbidity and mortality in the under developed and developing countries of the tropical and sub-tropical regions of the world. Globally 3.3 billion people live in areas where malaria exists; affecting 300-500 million people annually and it is estimated to be killing approximately 1-3 million people each year and 90of these mortalities occur in African children especially in sub Saharan Africa. Currently; although several control methods are beginning to result in downward trends in incidence in some countries; the gross number of malaria cases is still on the increase due to several factors including poor and ineffective diagnosis. Prompt and effective diagnosis is essential for the management and control of malaria. Over the years evidence has shown that traditional methods for diagnosing malaria remain problematic with a number of limitations. In this synoptic review an update of malaria diagnosis is presented and discussed highlighting the limitations and difficulties of both clinical (symptoms/ clinical signs-based) and laboratory (parasite-based) diagnosis of malaria. Enhancement of accurate malaria diagnosis is now more imperative than ever not only in the background of the current new era of malaria treatment with relatively expensive artemisinin-based combination therapies (ACTs); but more so in the heightened global campaign to effectively control; manage and possibly eradicate malaria from the face of the globe
Subject(s)
Clinical Laboratory Techniques , Malaria/diagnosis , Microscopy , Molecular Diagnostic TechniquesABSTRACT
Using an analytical case control study; five hundred and sixty pregnant women attending antenatal care (ANC) at 12 preselected health centres in Gokwe district during the peak malaria transmission season were screened for malaria and anaemia using the blood slide method and Spencer haemoglobinometer; respectively. One of the findings was that there was highly significant association between malaria infection and anaemia both in primigravidae and multigravidae. Across parity groups; prevalence of anaemia in malaria-infected pregnant women was more than 3 times that in uninfected pregnant women. Relative risk for anaemia associated with malaria in pregnancy was 4.1 as estimated using the odds ratio