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; Loick Pradel Kojom Foko; Angèle Ayina; Bernard Tornyigah; Annie Rachel Epote; Ida Calixte Penda; Patricia Epee Eboumbou; Serge Bruno Ebong; Gaetan Texier; Sandrine Eveline Nsango; Lawrence Ayong; Nicaise Tuikue Ndam; Albert Same Ekobo

doi:10.3390/pathogens12060844

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 Jun 19;12(6):844. doi: 10.3390/pathogens12060844.

Authors

Carole Else Eboumbou Moukoko^{1

2

3}, Loick Pradel Kojom Foko⁴, Angèle Ayina^{1

5}, Bernard Tornyigah^{6

7}, Annie Rachel Epote⁸, Ida Calixte Penda⁹, Patricia Epee Eboumbou^{9

10}, Serge Bruno Ebong¹¹, Gaetan Texier¹², Sandrine Eveline Nsango^{1

2}, Lawrence Ayong¹, Nicaise Tuikue Ndam^{6

7}, Albert Same Ekobo²

Affiliations

¹ Malaria Research Unit, Centre Pasteur Cameroon, Yaoundé P.O. Box 1274, Cameroon.
² Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, Douala P.O. Box 24157, Cameroon.
³ Laboratory of Parasitology, Mycology and Virology, Postgraduate Training Unit for Health Sciences, Postgraduate School for Pure and Applied Sciences, The University of Douala, Douala P.O. Box 24157, Cameroon.
⁴ ICMR-National Institute of Malaria Research, Dwarka, New Delhi 110077, India.
⁵ Pharmaceutical Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, Douala P.O. Box 24157, Cameroon.
⁶ Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra P.O. Box 1181, Ghana.
⁷ UMR 261 MERIT, Institut de Recherche pour le Développement (IRD), Université de Paris, 75006 Paris, France.
⁸ Haematology Laboratory, Centre Pasteur Cameroon, Yaoundé P.O. Box 1274, Cameroon.
⁹ Clinical Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, Douala P.O. Box 24157, Cameroon.
¹⁰ Pediatric Wards, Bonassama Hospital, Douala P.O. Box 9023, Cameroon.
¹¹ Animal Organisms Biology and Physiology Department, Faculty of Sciences, The University of Douala, Douala P.O. Box 24157, Cameroon.
¹² UMR 257-Vecteurs, Infections Tropicales et Méditerranéennes-VITROME-IRD/SSA/AP-HM, Aix-Marseille University, 13005 Marseille, France.

Abstract

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.

Keywords: Cameroon; IPTp-SP; dhfr; dhps; effectiveness; k13 mutations; malaria infection; pregnant women.

Grants and funding

This research was supported by the Centre Pasteur Cameroon (Call for proposals for internal projects of the Centre Pasteur of Cameroon 2019, the CPC’s internal funding N°012/2015/CPC/DS) and genotyping by the French Institute for Sustainable Development (IRD).