Seasonal malaria chemoprevention drug levels and drug resistance markers in children with or without malaria in Burkina Faso: a case control study.

Despite scale-up of seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine (SP-AQ) in children <5 years old in Burkina Faso, malaria incidence remains high, raising concerns regarding SMC effectiveness and selection of drug resistance. Using a case-control design, we determined associations between SMC drug levels, drug resistance markers, and presentation with malaria.We enrolled 310 children presenting at health facilities in Bobo-Dioulasso. Cases were SMC-eligible children 6-59 months of age diagnosed with malaria. Two controls were enrolled per case: SMC-eligible children without malaria and older (5-10 years old), SMC-ineligible children with malaria. We measured SP-AQ drug levels among SMC-eligible children and SP-AQ resistance markers among parasitemic children. Conditional logistic regression was used to compute odds ratios (ORs) comparing drug levels between cases and controls.Compared to SMC-eligible controls, children with malaria were less likely to have any detectable SP or AQ (OR = 0.33 [95% CI: 0.16-0.67]; p = 0.002) and have lower drug levels (p < 0.05). Prevalences of mutations mediating high-level SP resistance were rare (0-1%) and similar between cases and SMC-ineligible controls (p > 0.05).Incident malaria among SMC-eligible children was likely due to suboptimal levels of SP-AQ, resulting from missed cycles, rather than increased antimalarial resistance to SP-AQ.© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Citation

Michelle E Roh, Issaka Zongo, Alassane Haro, Liusheng Huang, Anyirékun Fabrice Somé, Rakiswendé Serge Yerbanga, Melissa D Conrad, Erika Wallender, Jennifer Legac, Francesca Aweeka, Jean-Bosco Ouédraogo, Philip J Rosenthal. Seasonal malaria chemoprevention drug levels and drug resistance markers in children with or without malaria in Burkina Faso: a case control study. The Journal of infectious diseases. 2023 May 23

PMID: 37221018

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