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  • PA-287 Prevalence of parasite resistance amongst pregnant women receiving intermittent preventive treatment in pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP) in malaria endemic communities in Southwestern Nigeria

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PA-287 Prevalence of parasite resistance amongst pregnant women receiving intermittent preventive treatment in pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP) in malaria endemic communities in Southwestern Nigeria
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  1. Gabriel Uyaiabasi1,2,3,
  2. Atinuke Olaleye2,4,
  3. Charles Elikwu2,5,
  4. Roland Funwei1,2,
  5. Akinmade Adepoju2,6,
  6. Akinwumi Akinyede3,
  7. Olufunmilayo Adeyemi3,
  8. Oladapo Walker1,2
  1. 1Department of Pharmacology, Benjamin S. Carson (Snr) College of Health and Medical Sciences, Babcock University, Nigeria
  2. 2Centre for Advance medical Research Babcock University, Nigeria
  3. 3Department of Pharmacology, Therapeutics and Toxicology, University of Lagos, Nigeria
  4. 4Two Hills Medical Clinic, Canada
  5. 5Department of Medical Microbiology, Benjamin S. Carson (Snr) College of Health and Medical Sciences, Babcock University, Nigeria
  6. 6Centre for Research, Innovation and Development, Babcock University Teaching Hospital, Nigeria

Abstract

Background The devastating effect of malaria in pregnancy (MIP) is mitigated by periodical administration of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). Possibility of emergence of Plasmodium parasites resistant to SP portends a threat to pregnant women living in malaria endemic regions. This was an EDTCP2 funded study to assess the effect and prevalence of Plasmodia resistance to SP in selected Nigerian communities.

Methods Consenting pregnant, gestational age 16–29 weeks, having met the inclusion/exclusion criteria were enrolled into one of the 5 study centres within Ikenne and Remo North LGA, Ogun State. Subjects were screened for malaria using microscopy, RDT and PCR, from enrolment to delivery. Positive malaria parasite samples were further analysed for Plasmodium falciparum dihydrofolate-reductase (Pfdhfr) and Plasmodium falciparum dihydropteroate-synthase (Pfdhps) mutations. All result were entered into REDCap® database and statistical analysis done using Microsoft Excel® 2019 and Stata 17®.

Results A total of 520 women, mean gestational age of 21 weeks were enrolled. Participants had average of 4 visits and 4 doses of SP before delivery. The prevalence of malaria parasitaemia was 2.9%, 4.8% and 35.5% using microscopy, RDT and PCR analysis respectively. There were 87 (19.4%) clinical malaria and 361 (80.6%) asymptomatic cases during the study. A total of 114 malaria positive samples were analysed for mutations. 51.8% were positive for mutations, while 4-points mutations were most prevalent (14.0%) and 4.4% had all 10-points mutations for Pfdhfr and Pfdhps. There were significantly more Pfdhfr mutations than Pfdhps and significantly higher mutations at enrolment.

Conclusion The prevalence of clinical malaria was low considering Nigeria is endemic for the disease, but high asymptomatic cases. Higher Pfdhfr/Pfdhps mutations were seen at enrolment. This study is the first to report the use of 6 doses of IPT-SP and all 10-points mutations for Pfdhfr/Pfdhps, which are definitive markers for SP resistance.

https://doi.org/10.1136/bmjgh-2023-EDC.145

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