RESUMEN
Aims:The study sought to quantifyPlasmodiuminfection and molecular markers for chloroquine resistance among asymptomatic school children.Study Design:The study was cross-sectional.Place and Duration of Study:The study was carried out in Ekondo Titi Subdivision near Original Research Article Cameroon's south-western border with Nigeria from March to May and from September to October 2014.Methodology:The prevalence of humanPlasmodium specieswas determined by nested PCR (Polymerase Chain Reaction) using DNA from dried blood spot in six primary schools. A PCR/RFLP analysis (Restriction Fragment Length Polymorphism) was used to determine the prevalence of chloroquine resistance (CQR) associatedpfcrt76T andpfmdr1 56Y point mutations in Plasmodiumfalciparumasymptomatic school children.Results: A nested PCR amplifying the 18S small-subunit ribosomal RNA (SSU rRNA) gene of Plasmodiumin 205 samples confirmed 76.1% of the isolates as asymptomatic P.falciparuminfections, with a substantial proportion 22% ofP. malariaeinfection. Among these, 3.6% were singleP. malariaeinfections and 15.1% wereP. falciparumandP. malariaemixed infections. MixedP. falciparumandP. ovaleinfections were2.0%. Of the 156Plasmodium falciparum, positive samples by species-specific PCR, 107 samples withP. falciparummono-infection were analyzed for the presence of drug resistant allelespfcrt76T andpfmdr1-Y 86. The prevalence ofpfcrt76T mutation (74.6%) was higher than that of thepfmdr1-Y86 mutation (25.4%). Logistic regression analysis of socio-demographic factors predicted no significant association betweenpfcrt76T mutation with gender and communities.Conclusions:The results indicated a high prevalence ofP. malariaeand mixed infection in the area under study. The high-level distribution of thepfcrtT76observed in the study could be possibly attributed to the fact that CQ remained widely used at the community level more than 14 years after withdrawal
RESUMEN
Chloroquine resistant malaria is a serious problem in Indonesia particularly in Papua. A trial of the existing antimalarial drugs was conducted in Timika, Papua. The objective of the study was to determine the efficacy of cloroquine (CQ) + sulfadoxine-pyrimethamine (SP). Patients with uncomplicated malaria due to Plasmodium falciparum, P. vivax, P. ovale or P. malariae were enrolled and treated with supervised CQ+SP (P. falciparum) or CQ (non-P. falciparum). Patients were followed for 28-42 days. Patients failing therapy were retreated with unsupervised quinine±doxycycline. 207 patients were enrolled in the study (88 P. falciparum, 40 P. vivax, 15 mixed infections, 50 P. malariae and 14 P. ovale). Early treatment failures occurred in 4 of 86 (5%) patients with falciparum malaria, 6 of 37 (16%) patients with vivax malaria and none of those with P. ovale or P. malariae infections. The failure rate by day 28 for P. vivax was 22 of 30 (73%) patients, with all recurrences occurring in the presence of plasma chloroquine concentration above the minimum effective concentration (MEC>15ng/ml). After correcting for reinfections the day 42 recrudescence rate for falciparum malaria was 48% [95%CI:31-65] and in 61% of cases this was in the presence of chloroquine levels above 30 ng/ml. Retreatment with unsupervised quinine±doxycycline resulted in further recurrence of malaria in 48% [95%CI:31-65] of P. falciparum infections and 70% [95%CI:37-100] of P. vivax infections. None of the patients with P. ovale or P. malariae had treatment failures within 28 days. There is a high prevalence of antimalarial drug resistance of P. falciparum and P. vivax to the existing antimalarial drugs. However chloroquine retains adequate efficacy against P. ovale and P. malariae in Papua.