Abstract
BackgroundGlucose-6-phosphate dehydrogenase deficiency (G6PDd) is widespread across malaria endemic regions. G6PD-deficient individuals are at risk of haemolysis when exposed, among other agents, to primaquine and tafenoquine, which are capable of blocking malaria transmission by killing Plasmodium falciparum gametocytes and preventing Plasmodium vivax relapses by targeting hypnozoites. It is evident that no measures are currently in place to ensure safe delivery of these drugs within the context of G6PDd risk. Thus, determining G6PDd prevalence in malarious areas would contribute towards avoiding possible complications in malaria elimination using the drugs. This study, therefore, was aimed at determining G6PDd prevalence in Gambella hospital, southwest Ethiopia, using CareStart™ G6PDd fluorescence spot test.MethodsVenous blood samples were collected from febrile patients (n = 449) attending Gambella hospital in November-December 2013. Malaria was diagnosed using blood films and G6PDd was screened using CareStart™ G6PDd screening test (Access Bio, New Jersey, USA). Haematological parameters were also measured. The association of G6PD phenotype with sex, ethnic group and malaria smear positivity was tested.ResultsMalaria prevalence was 59.2% (96.6% of the cases being P. falciparum mono infections). Totally 33 participants (7.3%) were G6PD-deficient with no significant difference between the sexes. The chance of being G6PD-deficient was significantly higher for the native ethnic groups (Anuak and Nuer) compared to the ‘highlanders’/settlers (odds ratio (OD) = 3.9, 95% confidence interval (CI) 0.481-31.418 for Anuak vs ‘highlanders’; OD = 4.9, 95% CI 0.635-38.00 for Nuer vs ‘highlanders’). G6PDd prevalence among the Nuer (14.3%) was significantly higher than that for the Anuak (12.0%).ConclusionsG6PDd prevalence in the area is substantial with 30 (90.9%) of the 33 deficient individuals having malaria suggesting the non-protective role of the disorder at least from clinical malaria. The indigenous Nilotic people tend to have a higher chance of being G6PD-deficient as 32 (96.9%) of the total 33 cases occurred among them.
Highlights
Glucose-6-phosphate dehydrogenase deficiency (G6PDd) is widespread across malaria endemic regions
Population screening is recommended in regions where G6PDd prevalence is ≥3–5% to decide on the use of primaquine/tafenoquine and minimize the risk of primaquine/tefenoquine-induced complications in malaria elimination schemes [13]
The odds of being G6PDdeficient were 4.9 [95% confidence interval (CI) 0.635-38.00] and 3.9 [95% CI 0.481-31.418] times higher for the Nuer and Anuak ethnic groups compared to the ‘highlanders’, respectively (p < 0.0001) (Table 2)
Summary
Glucose-6-phosphate dehydrogenase deficiency (G6PDd) is widespread across malaria endemic regions. Determining G6PDd prevalence in malarious areas would contribute towards avoiding possible complications in malaria elimination using the drugs. In some studies glucose-6-phosphate dehydrogenase deficiency (G6PDd) is associated with protection from severe malaria [4,5] deficient individuals are reported to suffer from haemolytic anaemia when treated with primaquine [6], which is the only available drug against Plasmodium falciparum gametocytes [7] and a radical cure of Plasmodium vivax [8]. Population screening is recommended in regions where G6PDd prevalence is ≥3–5% to decide on the use of primaquine/tafenoquine and minimize the risk of primaquine/tefenoquine-induced complications in malaria elimination schemes [13]. This study, was aimed at bridging the gap by diagnosing G6PDd among malaria suspects attending Gambella hospital, southwest Ethiopia, using a qualitative rapid G6PDd screening kit
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