Antimalarial drug resistance and population structure of Plasmodium falciparum in Mozambique using genomic surveillance at health facilities in 2021 and 2022

Antimalarial drug resistance and population structure of Plasmodium falciparum in Mozambique using genomic surveillance at health facilities in 2021 and 2022

Abstract Monitoring the emergence and spread of drug-resistant parasites is essential for effective malaria control. Here, we describe the prevalence of genetic markers of Plasmodium falciparum antimalarial drug resistance and parasite population structure in Mozambique. Drug resistance loci and mic...

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Main Authors: Simone Boene, Eduard Rovira-Vallbona, Clemente da Silva, Manuel García-Ulloa, Bernardete Rafael, Neide Canana, Andrés Aranda-Díaz, Pau Cisteró, Carla García-Fernández, Dário Tembisse, Nelo Ndimande, Arlindo Chidimatembue, Glória Matambisso, Brian Palmer, Ana Rita Chico, Mércia Dimene, Abuchahama Saifodine, José Inácio, Mariana da Silva, Mateusz Plucinski, Craig Bonnington, Flavio Wate, Eva de Carvalho, Guidion Mathe, Arnau Pujol, Beatriz Arregui-Gallego, Kiba Comiche, Abel Nhama, Lídia Nhamussua, Pedro Aide, Francisco Saute, Sónia Enosse, Bryan Greenhouse, Baltazar Candrinho, Alfredo Mayor
Format: Article
Language:English
Published: Nature Portfolio 2025-08-01
Series:Scientific Reports
Subjects:
Plasmodium falciparum
Malaria
Genomics
Surveillance
Drug resistance
Artemisinin
Online Access:https://doi.org/10.1038/s41598-025-02166-w
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Summary:Abstract Monitoring the emergence and spread of drug-resistant parasites is essential for effective malaria control. Here, we describe the prevalence of genetic markers of Plasmodium falciparum antimalarial drug resistance and parasite population structure in Mozambique. Drug resistance loci and microhaplotypes were genotyped by multiplex targeted amplicon sequencing of 1146 P. falciparum samples collected in 2021 (n = 321) and 2022 (n = 825 rainy season, and n = 155 dry season). pfpm2 gene copy number (associated to piperaquine resistance) was assessed using real-time quantitative PCR. No pfk13 markers of partial artemisinin resistance nor pfpm2 duplications were observed. Prevalence of pfdhfr/pfdhps quintuple mutants associated with sulfadoxine-pyrimethamine (SP) resistance was high across all regions (> 92.5% in 2021 and > 87.8% in 2022), but pfdhps-A581G mutation was rare (1.6% in 2021 and 0.8% 2022). Both prevalence of mutations in pfdhps-436 (p < 0.001) and genetic complexity of infections increased from South to North. These results support the continued use of artemisinin-based combination therapies in Mozambique, call for a close monitoring of chemopreventive efficacy based on SP, and confirm the spatial genetic distinction in P. falciparum population observed across the country.
ISSN:2045-2322

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