Effectiveness of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine in Pregnancy: Low Coverage and High Prevalence of Plasmodium falciparum dhfr-dhps Quintuple Mutants as Major Challenges in Douala, an Urban Setting in Cameroon

Carole Else Eboumbou Moukoko (1) , Loick Pradel Kojom Foko (2) , Angèle Ayina (3) , Bernard Tornyigah (4, 5) , Annie Rachel Epote (1) , Ida Calixte Penda (3) , Patricia Epee Eboumbou (3) , Serge Bruno Ebong (3) , Gaetan Texier (6, 7) , Sandrine Eveline Nsango (3, 1) , Lawrence Ayong (1) , Nicaise Tuikue Ndam (5) , Albert Same Ekobo (3)

1 Centre Pasteur du Cameroun
2 ICMR-National Institute of Malaria Research, Dwarka, New Delhi
3 Université de Douala
4 Université du Ghana = University of Ghana
5 MERIT - UMR_D 261 - Mère et enfant en milieu tropical : pathogènes, système de santé et transition épidémiologique
6 VITROME - Vecteurs - Infections tropicales et méditerranéennes
7 Service de Santé des Armées

Intermittent preventive treatment in pregnancy with sulfadoxine and pyrimethamine (IPTp-SP) is a key component in the malaria control strategy implemented in Africa. The aim of this study was to determine IPTp-SP adherence and coverage, and the impact on maternal infection and birth outcomes in the context of widespread SP resistance in the city of Douala, Cameroon. Clinical and demographic information were documented among 888 pregnant women attending 3 health facilities, from the antenatal care visit to delivery. Positive samples were genotyped for P. falciparum gene (dhfr, dhps, and k13) mutations. The overall IPTp-SP coverage (≥three doses) was 17.5%, and 5.1% received no dose. P. falciparum prevalence was 16%, with a predominance of submicroscopic infections (89.3%). Malaria infection was significantly associated with locality and history of malaria, and it was reduced among women using indoor residual spraying. Optimal doses of IPTp-SP were significantly associated with reduced infection among newborns and women (secundiparous and multiparous), but there was no impact of IPTp-SP on the newborn bodyweight. Pfdhfr-Pfdhps quintuple mutants were over-represented (IRNI-FGKAA, IRNI-AGKAA), and sextuple mutants (IRNI-AGKAS, IRNI-FGEAA, IRNI-AGKGS) were also reported. The Pfk13 gene mutations associated with artemisinin resistance were not detected. This study highlights the role of ANC in achieving optimal SP coverage in pregnant women, the mitigated impact of IPTp-SP on malaria outcomes, and the high prevalence of multiple SP-resistant P. falciparum parasites in the city of Douala that could compromise the efficacy of IPTp-SP.

Mots clés: malaria infection; IPTp-SP; pregnant women; effectiveness; dhfr; dhps; k13 mutations; Cameroon

Domaines: Bactériologie; Cardiologie et système cardiovasculaire; Maladies émergentes; Maladies infectieuses; Parasitologie; Virologie

Carole Else Eboumbou Moukoko, Loick Pradel Kojom Foko, Angèle Ayina, Bernard Tornyigah, Annie Rachel Epote, et al.. Effectiveness of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine in Pregnancy: Low Coverage and High Prevalence of Plasmodium falciparum dhfr-dhps Quintuple Mutants as Major Challenges in Douala, an Urban Setting in Cameroon. Pathogens, 2023, 12 (6), pp.844. ⟨10.3390/pathogens12060844⟩. ⟨hal-04148697⟩