1. Seasonal Malaria Chemoprevention Drug Levels and Drug Resistance Markers in Children With or Without Malaria in Burkina Faso: A Case-Control Study.
- Author
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Roh, Michelle, Zongo, Issaka, Haro, Alassane, Huang, Liusheng, Somé, Anyirékun, Yerbanga, Rakiswendé, Conrad, Melissa, Wallender, Erika, Legac, Jennifer, Aweeka, Francesca, Ouédraogo, Jean-Bosco, and Rosenthal, Philip
- Subjects
amodiaquine ,antimalarial resistance ,malaria ,seasonal malaria chemoprevention ,sulfadoxine-pyrimethamine ,Humans ,Child ,Infant ,Child ,Preschool ,Burkina Faso ,Case-Control Studies ,Seasons ,Malaria ,Antimalarials ,Sulfadoxine ,Amodiaquine ,Chemoprevention ,Drug Combinations ,Drug Resistance - Abstract
BACKGROUND: Despite scale-up of seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine (SP-AQ) in children 3-59 months of age 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. METHODS: 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. RESULTS: Compared to SMC-eligible controls, children with malaria were less likely to have any detectable SP or AQ (OR, 0.33 [95% confidence interval, .16-.67]; P = .002) and have lower drug levels (P < .05). Prevalences of mutations mediating high-level SP resistance were rare (0%-1%) and similar between cases and SMC-ineligible controls (P > .05). CONCLUSIONS: 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.
- Published
- 2023