Abstract
BackgroundGlucose-6-phosphate dehydrogenase (G6PD) is a rate limiting enzyme of the pentose phosphate pathway and is closely associated with the haemolytic disorders among patients receiving anti-malarial drugs, such as primaquine. G6PD deficiency (G6PDd) is an impending factor for radical treatment of malaria which affects the clearance of gametocytes from the blood and subsequent delay in the achievement of malaria elimination. The main objective of this study was to assess the prevalence of G6PD deficiency in six malaria endemic districts in Southern Nepal.MethodsA cross-sectional population based prevalence survey was conducted in six malaria endemic districts of Nepal, during April–Dec 2013. A total of 1341 blood samples were tested for G6PDd using two different rapid diagnostic test kits (Binax-Now® and Care Start™). Equal proportions of participants from each district (n ≥ 200) were enrolled considering ethnic and demographic representation of the population groups.ResultsOut of total 1341 blood specimens collected from six districts, the overall prevalence of G6PDd was 97/1341; 7.23% on Binax Now and 81/1341; 6.0% on Care Start test. Higher prevalence was observed in male than females [Binax Now: male 10.2%; 53/521 versus female 5.4%; 44/820 (p = 0.003) and Care Start: male 8.4%; 44/521 versus female 4.5%; 37/820 (p = 0.003)]. G6PDd was higher in ethnic groups Rajbanshi (11.7%; 19/162) and Tharu (5.6%; 56/1005) (p = 0.006), major inhabitant of the endemic districts. Higher prevalence of G6PDd was found in Jhapa (22/224; 9.8%) and Morang districts (18/225; 8%) (p = 0.031). In a multivariate analysis, male were found at more risk for G6PDd than females, on Binax test (aOR = 1.97; CI 1.28–3.03; p = 0.002) and Care Start test (aOR = 1.86; CI 1.16–2.97; p = 0.009).ConclusionsThe higher prevalence of G6PDd in certain ethnic group, gender and geographical region clearly demonstrates clustering of the cases and ascertained the risk groups within the population. This is the first study in Nepal which identified the vulnerable population groups for G6PDd in malaria endemic districts. The finding of this study warrants the need for G6PDd testing in vulnerable population groups in endemic districts, and also facilitates use of primaquine in mass supporting timely progress for malaria elimination.
Highlights
Glucose-6-phosphate dehydrogenase (G6PD) is a rate limiting enzyme of the pentose phosphate pathway and is closely associated with the haemolytic disorders among patients receiving anti-malarial drugs, such as primaquine
Demographic characteristics in Binax test result On BinaxNOW ® G6PD test, higher G6PD deficiency was found associated with male (53/1341; 10.2%) compared to female (44/820; 5.4%) (p = 0.001) (Table 1)
One of the recent studies conducted in Afghanistan, Bangladesh, Bhutan, India, Nepal, and Pakistan found that the G6PD deficiency (G6PDd) prevalence ranges from 3.8 to 15%, with
Summary
Glucose-6-phosphate dehydrogenase (G6PD) is a rate limiting enzyme of the pentose phosphate pathway and is closely associated with the haemolytic disorders among patients receiving anti-malarial drugs, such as primaquine. At therapeutic dose against the hypnozoites, primaquine can cause a self-limiting to severe haemolytic anaemia in patients with an inborn deficiency of enzyme-G6PD [5, 6]. Deficiency of G6PD (G6PDd) is a genetic abnormality, one of the most prevalent polymorphisms and enzymopathies in humans, in males [7]. This genetic defect was discovered in 1956 after the development of haemolytic anaemia following the administration of the anti-malarial primaquine [8]. About 8% of the people who are exposed to malaria have an inherited disorder that impairs G6PD, leaving them vulnerable to develop clinical consequences (haemolytic anaemia). About 400 million people worldwide are estimated to be affected by G6PDd in malaria endemic regions [6]
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