Ex vivo Sensitivity Profile of Plasmodium falciparum Clinical Isolates to a Panel of Antimalarial Drugs in Ghana 13 Years After National Policy Change
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Dovepress
Abstract
Purpose: Malaria continues to be a major health issue globally with almost 85% of the
global burden and deaths borne by sub-Saharan Africa and India. Although the current
artemisinin derived combination therapies in Ghana are still efficacious against the
Plasmodium falciparum (Pf) parasite, compounding evidence of artemisinin and amodiaquine resistance establish the need for a full, up-to-date understanding and monitoring of
antimalarial resistance to provide evidence for planning control strategies.
Materials and Methods: The study was cross-sectional and was conducted during the peak
malaria transmission seasons of 2015, 2016, and 2017 in two ecological zones of Ghana.
Study participants included children aged 6 months to 14 years. Using ex vivo 4,6-diamidino-2-phenylindole (DAPI) drug sensitivity assay, 330 Pf isolates were used to investigate
susceptibility to five antimalarial drugs: chloroquine (CQ), amodiaquine (AMD) dihydroartemisinin (DHA), artesunate (ART) and mefloquine (MFQ).
Results: The pooled geometric mean IC50S (GMIC50) of the five drugs against the parasites
from Cape Coast and Begoro were 15.5, 42.4, 18.9, 4.6 and 27.3nM for CQ, AMD, DHA,
ART, and MFQ, respectively. The GMIC50 values for CQ (p<0.001), ART (p<0.011) and
DHA (p<0.018) were significantly higher for Cape Coast isolates as compared to Begoro
isolates. However, GMIC50 estimates for MFQ (p<0.022) were significantly higher for
Begoro isolates. Positive correlations were found between each pair of drugs with the
weakest found between MFQ and DHA (r = 0.34;p<0.001), and the strongest between
ART and DHA (r =0.66; p<0.001).
Conclusion: The parasites showed reduced sensitivities to three (AMD, DHA and MFQ)
out of the five drugs assessed. The study also demonstrated the continual return of chloroquine-sensitive parasites after 13 years of its withdrawal as the first-line drug for the
treatment of uncomplicated malaria in Ghana. The ex vivo DAPI assay is a reliable method
for assessing antimalarial drug sensitivities of Pf field isolates under field settings.
Description
Research Article
Keywords
malaria, Plasmodium falciparum, anti-malarial drugs, field isolates, DAPI, uncomplicated malaria