Status of the Artemisinin Resistance-Associated PfATPase6 S769N Mutation in Plasmodium Falciparum Infections of Lusaka Urban District; Zambia

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

Presence of Schistomiasis in Genital Biopsies from Patients at the University Teaching Hospital in Lusaka; Zambia

Background: Ectopic localizations of the adult Schistosomes and ova in the genital tract of individuals living in schistosoma endemic areas are common. The infection can affect both male and female reproductive organs; and although it is predominant in adult women; case reports in girls younger than 15 years of age have been documented. Objective: The objective of this review was to determine and document the presence of genital schistosomiasis from biopsy specimens. Methods: Patients' laboratory records at the University Teaching Hospital histopathology laboratory for the period 2001 to 2007 were retrieved and reviewed for reports on the presence of schistosomiasis. Data were analysed by age; sex and biopsy site. Results: Thirty eight (65.5) of the 58 specimens with schistosomiasis were from the genital organs. Female genital tract schistosomiasis was more prevalent (84.2) than male genital schistosomiasis (15.8); p0.001. Schistosomiasis was high in biopsy specimens collected from the cervix

Geophagy as a Risk Factor for Helminth Infections in Pregnant Women in Lusaka; Zambia

It has been reported that geophagy is closely associated with helminthic diseases (1; 2; 3) and it has been especially linked to Ascaris and Trichuris infections among pregnant women (4). Hitherto proof of existence of viable infective ova in geophageal material has been anecdotal. This study was undertaken to determine the possible direct role of geophagy in helminthiases of pregnant women. Eighty-five pregnant women between the ages of 15 and 44 years of age were recruited into the study in order to determined the prevalence of geophagy among pregnant women resident in high a density and low income areas of Lusaka. The study showed that 31;8of the pregnant women interviewed practised geophagy at the time of the study; and that 71had a history of deliberate ingestion of soil. The preferences for the soil types were ranked as clay; termite mounds from tree trunks; and soft stone. Some respondents reported a preference for smoked; roasted or baked clay soils. Perceived benefits of geophagy included diminished craving when they ate soil ( 35.2); prevention of vomiting and nausea ( 32.4); and others ingested soil for the taste (32.4). Most women who were interviewed (91.8) were aware of possible health risks involved in geophagy such as constipation; heartburn; anemia; coughing; infections with worms; and abdominal discomfort. This study sought to recover and identify helminth ova from a total 3.15Kg. Submitted or collected soil types ingested by the women in the study. No ova was recovered from the soil samples by both the sedimentation and Zinc Sulphate; as well as saturated sodium chloride floatation techniques. These techniques reliably yielded Ascaris; Schistosome; and hookworm ova and Strongyloides larvae in spiked control specimens. Notably; Ascaris lumbricoides; and Trichuris trichiura ova require moisture to survive and embryonate. The soils ingested by the respondents were dried; some of which are roasted; backed or smoked before ingestion and thus rendering them unsuitable for the survival of ova; let alone the support of embryonated ova which are the infectious stages. This study has demonstrated that no ova were recovered from any of the soil types preferred by the pregnant women; and as such geophagy was an unlikely risk factor for geohelminth infections. Other explanations for the high helminth infection rates among pregnant women recorded in the literature must be sought; such as pica; poor hygiene; and unsanitary environments