Pregnancy-Associated Malaria: Adhesion to Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine and Impact on Genetics of Drug Resistance Markers

Abstract

Cervical cancer is the only tumor using clinical staging which is continuously improved. The latest 2018 FIGO Malaria remains a major public health issue and one of the main causes of morbidity and mortality in many countries worldwide. Pregnant women are particularly concerned by this disease. To overcome this plague several African countries have adopted intermittent preventive treatment with Sulfadoxine-Pyrimethamine (IPT-SP). Studies led in several countries have shown a strong adhesion to IPTp-SP, from 59% to 94.81%. This adhesion seems to have led to the emergence of Pfdhfr (P. falciparum dihydrofolate reductase) and Pfdhps (P. falciparum dihydropteroate synthase) markers involved in SP resistance at very high levels. The strong prevalence of triple mutant I51R59N108 on Pfdhfr and double mutants G437E540 and G437S581S on Pfdhps increase the risk of therapeutic failure after treatment with SP, as do a high prevalence of haplotype Pfdhfr IRNI and haplotypes Pfdhps SGEAA and the quintuple mutant IRNI-SGEAA. The efficacy of SP could be compromised in countries in which the prevalence of Pfdhfr K540E is higher than 95% and the prevalence of Pfdhps A581G is higher than 10%.