title: High prevalence of dhfr and dhps molecular markers in Plasmodium falciparum in pregnant women of Nchelenge district, Northern Zambia.
abstract: BACKGROUND
  Sulphadoxine-pyrimethamine (SP) is the recommended drug for intermittent preventive treatment in pregnancy (IPTp) in most African countries, including Zambia. However, malaria is still one of the leading causes of morbidity and mortality in pregnant women despite reports of greater than 50% of women taking at least two doses of SP in IPTp. Studies have shown that resistance to SP is associated with mutations in the dhfr and dhps gene of Plasmodium falciparum. This study examined the prevalence of dhfr and dhps polymorphisms in P. falciparum found in pregnant women of Nchelenge district.
  
  
  METHODS
  This cross-sectional study was conducted in 2013 in Nchelenge, a holoendemic area with malaria prevalence estimated at 50% throughout the year. Three rural health centres were randomly selected and a census survey carried out at each health centre. A questionnaire was administered and malaria testing done using RDT and microscopy, with collection of a dried blood spot. A chelex extraction was done to extract parasite DNA from dried blood spots followed by nested PCR and enzyme restriction digestion.
  
  
  RESULTS
  Of the enrolled participants (n = 375), the median age of the women was 23. The prevalence of malaria by PCR was 22%. The PCR positive samples examined (n = 72) showed a high prevalence of dhfr triple (Asn-108 + Arg-59 + Ile-59) mutant (68%) and dhps double (Gly -437 + Glu-540) mutant (21%). The quintuple haplotype was found in 17% with 2 samples with an additional Gly-581mutation. In addition 6% mutations at Val-16 were found and none found at Thr-108 respectively, these both confer resistance to cycloguanil. Multivariate analysis showed that there was an association between malaria and women aged 30-34 years old p < 0.05(AOR: 0.36) at 95% CI.
  
  
  CONCLUSIONS
  This study showed a high number of mutations in the dhfr and dhps genes. The high malaria endemicity in the general population of this area may have contributed to the high prevalence of resistant parasites in pregnant women, suggesting a need to examine the efficacy of SP given that it is the only approved drug for IPTp in Zambia.
authors.affiliation: Department of Public health, University of Zambia, School of Medicine, Lusaka, Zambia. siame_mwiche@yahoo.com.|Macha Research Trust, Choma, Zambia. siame_mwiche@yahoo.com.
authors.forename: Mwiche N P
authors.initials: MN
authors.lastname: Siame
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. smharak1@jhu.edu.
authors.forename: Sungano
authors.initials: S
authors.lastname: Mharakurwa
authors.affiliation: Department of Public health, University of Zambia, School of Medicine, Lusaka, Zambia. jameschipeta@smuth-mru.org.zm.
authors.forename: James
authors.initials: J
authors.lastname: Chipeta
authors.affiliation: Macha Research Trust, Choma, Zambia. phil.thuma@macharesearch.org.
authors.forename: Philip
authors.initials: P
authors.lastname: Thuma
authors.affiliation: Department of Public health, University of Zambia, School of Medicine, Lusaka, Zambia. ccmichelo@yahoo.com.
authors.forename: Charles
authors.initials: C
authors.lastname: Michelo
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000494:pharmacology; D003430:Cross-Sectional Studies; D004094:Dihydropteroate Synthase / Q000235:genetics* / Q000378:metabolism; D004338:Drug Combinations; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000469:parasitology; D009154:Mutation; D010963:Plasmodium falciparum / Q000187:drug effects / Q000235:genetics* / Q000378:metabolism; D011247:Pregnancy; D015995:Prevalence; D015800:Protozoan Proteins / Q000235:genetics* / Q000378:metabolism; D011739:Pyrimethamine / Q000494:pharmacology; D013413:Sulfadoxine / Q000494:pharmacology; D013762:Tetrahydrofolate Dehydrogenase / Q000235:genetics* / Q000378:metabolism; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D015800:Protozoan Proteins; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D013762:Tetrahydrofolate Dehydrogenase; D004094:Dihydropteroate Synthase; D011739:Pyrimethamine