Abstract
Antimalarial drug resistance monitoring is the key factor in malaria control policy for early detection and subsequent prevention of drug resistance spread. This review was performed to collate all available data of P. falciparum resistant genes in the Horn of Africa as a baseline for future appraisal of the regional malaria control policy. The search of this review was performed in January 2018 using the scientific databases Pub Med and Google Scholar. The search terms used included: Plasmodium falciparum AND drug resistance genes OR molecular marks AND Somalia OR Ethiopia OR Eritrea OR Djibouti. The majority of studies (9 of 18 studies, 50%) examined pfdhfr, pfcrt and pfmdr 1 genes. Eight (44%), 4 (22%), and 2 (11%) studies analyzed pfdhps, pfk 13 and pfatp 6 genes, respectively. The Pfcytbc1 associated with atovaquone resistance is the only gene with no mutation detected. High frequencies of pfdhfr and pfdhps mutations were reported with an association to treatment failure after the artemisinin-based combination therapy (ACT) - artesunate + sulfadoxine/pyrimethamine. The aminoquinoline resistance genes such as pfmdr1, and pfatp 6 were only reported with low frequency. The 76T mutation of pfcrt ranged from 4 to 100%, while pfmdr1 mutations at codon 86 and 184 varied depending on geographical locations. The 402V and 431K mutations of pfatp 6 were found highly prevalent at 93 % and 58 % in Southwestern Ethiopia, respectively. The pfk13 gene mutation at codon 622I was 2.4%, with an association to artemether-lumefantrine efficacy and delay of parasite clearance on day 3. Key words: Plasmodium falciparum, Drug resistance gene, Molecular marker, Somalia, Ethiopia, Eritrea, and Djibouti.
Highlights
Malaria is an arthropod-borne disease with a major impact on the world's human population health
In 2015, about 1.9 million malaria cases were reported from Ethiopia, while 20,963 cases were reported from Somalia and 19,372 from Eritrea (WHO, 2016)
Six duplicate articles were removed using EndNote X7; 39 articles were excluded after screening their titles and abstracts against the inclusion criteria; and 19 articles were excluded from the review after full-text assessment due to following reasons: in vivo studies, studies conducted outside the Horn of Africa, studies focusing on treatment adherence, studies with repeated sample analysis, and studies with unsuitable findings
Summary
Malaria is an arthropod-borne disease with a major impact on the world's human population health. The Horn of Africa consists of four countries, i.e., Djibouti, Ethiopia, Eritrea, and Somalia (Figure 1). Drug resistance is the major problem confronting malaria control in the region (Heuchert et al, 2015). Ethiopia was the first country in the Horn of Africa to document CQ resistance in 1985. The resistant isolates in Ethiopia were reported from areas bordering Kenya, Somalia, and Sudan, while the central part was apparently free from resistant strains (Alene and Bennett, 1996). In 1998, Ethiopia switched to SP as the first-line treatment for uncomplicated P. falciparum malaria. In 2004, an artemisinin combination therapy (ACT) called artemether-lumefantrine (AL) became Ethiopia’s first-line treatment for uncomplicated falciparum malaria (Heuchert et al, 2015; Mekonnen et al, 2014). In 2016, AL became the first line drug in Somalia's national plan for uncomplicated P. falciparum malaria (Warsame et al, 2017)
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