Plasmodium falciparum resistance to sulfadoxine-pyrimethamine in Africa: a systematic analysis of national trends
Introduction The rising burden of drug resistance is a major challenge to the global fight against malaria. We estimated national Plasmodium falciparum resistance to sulfadoxine-pyrimethamine (SP) across Africa, from 2000 to 2020.Methods We assembled molecular, clinical and endemicity data covering...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-11-01
|
| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/11/e003217.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850245267591266304 |
|---|---|
| author | Floriano Amimo Anthony Magit Jahit Sacarlal Kenji Shibuya Masahiro Hashizume |
| author_facet | Floriano Amimo Anthony Magit Jahit Sacarlal Kenji Shibuya Masahiro Hashizume |
| author_sort | Floriano Amimo |
| collection | DOAJ |
| description | Introduction The rising burden of drug resistance is a major challenge to the global fight against malaria. We estimated national Plasmodium falciparum resistance to sulfadoxine-pyrimethamine (SP) across Africa, from 2000 to 2020.Methods We assembled molecular, clinical and endemicity data covering malaria-endemic African countries up to December 2018. Subsequently, we reconstructed georeferenced patient data, using pfdhps540E and pfdhps581G to measure mid-level and high-level SP resistance. Gaussian process regression was applied to model spatiotemporal standardised prevalence.Results In eastern Africa, mid-level SP resistance increased by 64.0% (95% uncertainty interval, 30.7%–69.8%) in Tanzania, 55.4% (31.3%–65.2%) in Sudan, 45.7% (16.8%–54.3%) in Mozambique, 29.7% (10.0%–45.2%) in Kenya and 8.7% (1.4%–36.8%) in Malawi from 2000 to 2010. This was followed by a steady decline of 76.0% (39.6%–92.6%) in Sudan, 65.7% (25.5%–85.6%) in Kenya and 17.4% (2.6%–37.5%) in Tanzania from 2010 to 2020. In central Africa, the levels increased by 28.9% (7.2%–62.5%) in Equatorial Guinea and 85.3% (54.0%–95.9%) in the Congo from 2000 to 2020, while in the other countries remained largely unchanged. In western Africa, the levels have remained low from 2000 to 2020, except for Nigeria, with a reduction of 14.4% (0.7%–67.5%) and Mali, with an increase of 7.0% (0.8%–25.6%). High-level SP resistance increased by 5.5% (1.0%–20.0%) in Malawi, 4.7% (0.5%–25.4%) in Kenya and 2.0% (0.1%–39.2%) in Tanzania, from 2000 to 2020.Conclusion Under the WHO protocols, SP is no longer effective for intermittent preventive treatment in pregnancy and infancy in most of eastern Africa and parts of central Africa. Strengthening health systems capacity to monitor drug resistance at subnational levels across the endemicity spectrum is critical to achieve the global target to end the epidemic. |
| format | Article |
| id | doaj-art-e05462523de14be295cd2578821286fa |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-e05462523de14be295cd2578821286fa2025-08-20T01:59:30ZengBMJ Publishing GroupBMJ Global Health2059-79082020-11-0151110.1136/bmjgh-2020-003217Plasmodium falciparum resistance to sulfadoxine-pyrimethamine in Africa: a systematic analysis of national trendsFloriano Amimo0Anthony Magit1Jahit Sacarlal2Kenji Shibuya3Masahiro Hashizume4Faculty of Medicine, Eduardo Mondlane University, Maputo, MozambiqueHuman Research Protection Program, University of California San Diego School of Medicine, University of California System, San Diego, California, USAFaculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique1 Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanprofessorIntroduction The rising burden of drug resistance is a major challenge to the global fight against malaria. We estimated national Plasmodium falciparum resistance to sulfadoxine-pyrimethamine (SP) across Africa, from 2000 to 2020.Methods We assembled molecular, clinical and endemicity data covering malaria-endemic African countries up to December 2018. Subsequently, we reconstructed georeferenced patient data, using pfdhps540E and pfdhps581G to measure mid-level and high-level SP resistance. Gaussian process regression was applied to model spatiotemporal standardised prevalence.Results In eastern Africa, mid-level SP resistance increased by 64.0% (95% uncertainty interval, 30.7%–69.8%) in Tanzania, 55.4% (31.3%–65.2%) in Sudan, 45.7% (16.8%–54.3%) in Mozambique, 29.7% (10.0%–45.2%) in Kenya and 8.7% (1.4%–36.8%) in Malawi from 2000 to 2010. This was followed by a steady decline of 76.0% (39.6%–92.6%) in Sudan, 65.7% (25.5%–85.6%) in Kenya and 17.4% (2.6%–37.5%) in Tanzania from 2010 to 2020. In central Africa, the levels increased by 28.9% (7.2%–62.5%) in Equatorial Guinea and 85.3% (54.0%–95.9%) in the Congo from 2000 to 2020, while in the other countries remained largely unchanged. In western Africa, the levels have remained low from 2000 to 2020, except for Nigeria, with a reduction of 14.4% (0.7%–67.5%) and Mali, with an increase of 7.0% (0.8%–25.6%). High-level SP resistance increased by 5.5% (1.0%–20.0%) in Malawi, 4.7% (0.5%–25.4%) in Kenya and 2.0% (0.1%–39.2%) in Tanzania, from 2000 to 2020.Conclusion Under the WHO protocols, SP is no longer effective for intermittent preventive treatment in pregnancy and infancy in most of eastern Africa and parts of central Africa. Strengthening health systems capacity to monitor drug resistance at subnational levels across the endemicity spectrum is critical to achieve the global target to end the epidemic.https://gh.bmj.com/content/5/11/e003217.full |
| spellingShingle | Floriano Amimo Anthony Magit Jahit Sacarlal Kenji Shibuya Masahiro Hashizume Plasmodium falciparum resistance to sulfadoxine-pyrimethamine in Africa: a systematic analysis of national trends BMJ Global Health |
| title | Plasmodium falciparum resistance to sulfadoxine-pyrimethamine in Africa: a systematic analysis of national trends |
| title_full | Plasmodium falciparum resistance to sulfadoxine-pyrimethamine in Africa: a systematic analysis of national trends |
| title_fullStr | Plasmodium falciparum resistance to sulfadoxine-pyrimethamine in Africa: a systematic analysis of national trends |
| title_full_unstemmed | Plasmodium falciparum resistance to sulfadoxine-pyrimethamine in Africa: a systematic analysis of national trends |
| title_short | Plasmodium falciparum resistance to sulfadoxine-pyrimethamine in Africa: a systematic analysis of national trends |
| title_sort | plasmodium falciparum resistance to sulfadoxine pyrimethamine in africa a systematic analysis of national trends |
| url | https://gh.bmj.com/content/5/11/e003217.full |
| work_keys_str_mv | AT florianoamimo plasmodiumfalciparumresistancetosulfadoxinepyrimethamineinafricaasystematicanalysisofnationaltrends AT anthonymagit plasmodiumfalciparumresistancetosulfadoxinepyrimethamineinafricaasystematicanalysisofnationaltrends AT jahitsacarlal plasmodiumfalciparumresistancetosulfadoxinepyrimethamineinafricaasystematicanalysisofnationaltrends AT kenjishibuya plasmodiumfalciparumresistancetosulfadoxinepyrimethamineinafricaasystematicanalysisofnationaltrends AT masahirohashizume plasmodiumfalciparumresistancetosulfadoxinepyrimethamineinafricaasystematicanalysisofnationaltrends |