Drug resistance markers within an evolving efficacy of anti-malarial drugs in Cameroon: a systematic review and meta-analysis (1998-2020)

Publikation: Bidrag til tidsskriftTidsskriftartikelfagfællebedømt

  • Peter Thelma Ngwa Niba
  • Akindeh M Nji
  • Marie-Solange Evehe
  • Innocent M Ali
  • Palmer Masumbe Netongo
  • Randolph Ngwafor
  • Marcel N Moyeh
  • Lesley Ngum Ngum
  • Oliva Ebie Ndum
  • Fon Abongwa Acho
  • Cyrille Mbanwi Mbu'u
  • Dorothy A Fosah
  • Barbara Atogho-Tiedeu
  • Olivia Achonduh-Atijegbe
  • Rosine Djokam-Dadjeu
  • Jean Paul Kengne Chedjou
  • Jude D Bigoga
  • Carole Else Eboumbou Moukoko
  • Anthony Ajua
  • Eric Achidi
  • Esther Tallah
  • Rose G F Leke
  • Alexis Tourgordi
  • Pascal Ringwald
  • Wilfred F Mbacham

BACKGROUND: Malaria remains highly endemic in Cameroon. The rapid emergence and spread of drug resistance was responsible for the change from monotherapies to artemisinin-based combinations. This systematic review and meta-analysis aimed to determine the prevalence and distribution of Plasmodium falciparum drug resistance markers within an evolving efficacy of anti-malarial drugs in Cameroon from January 1998 to August 2020.

METHODS: The PRISMA-P and PRISMA statements were adopted in the inclusion of studies on single nucleotide polymorphisms (SNPs) of P. falciparum anti-malarial drug resistance genes (Pfcrt, Pfmdr1, Pfdhfr, Pfdhps, Pfatp6, Pfcytb and Pfk13). The heterogeneity of the included studies was evaluated using the Cochran's Q and I2 statistics. The random effects model was used as standard in the determination of heterogeneity between studies.

RESULTS: Out of the 902 records screened, 48 studies were included in this aggregated meta-analysis of molecular data. A total of 18,706 SNPs of the anti-malarial drug resistance genes were genotyped from 47,382 samples which yielded a pooled prevalence of 35.4% (95% CI 29.1-42.3%). Between 1998 and 2020, there was significant decline (P < 0.0001 for all) in key mutants including Pfcrt 76 T (79.9%-43.0%), Pfmdr1 86Y (82.7%-30.5%), Pfdhfr 51I (72.2%-66.9%), Pfdhfr 59R (76.5%-67.8%), Pfdhfr 108 N (80.8%-67.6%). The only exception was Pfdhps 437G which increased over time (30.4%-46.9%, P < 0.0001) and Pfdhps 540E that remained largely unchanged (0.0%-0.4%, P = 0.201). Exploring mutant haplotypes, the study observed a significant increase in the prevalence of Pfcrt CVIET mixed quintuple haplotype from 57.1% in 1998 to 57.9% in 2020 (P < 0.0001). In addition, within the same study period, there was no significant change in the triple Pfdhfr IRN mutant haplotype (66.2% to 67.3%, P = 0.427). The Pfk13 amino acid polymorphisms associated with artemisinin resistance were not detected.

CONCLUSIONS: This review reported an overall decline in the prevalence of P. falciparum gene mutations conferring resistance to 4-aminoquinolines and amino alcohols for a period over two decades. Resistance to artemisinins measured by the presence of SNPs in the Pfk13 gene does not seem to be a problem in Cameroon. Systematic review registration PROSPERO CRD42020162620.

OriginalsprogEngelsk
Artikelnummer32
TidsskriftMalaria Journal
Vol/bind20
Antal sider20
ISSN1475-2875
DOI
StatusUdgivet - 2021

Antal downloads er baseret på statistik fra Google Scholar og www.ku.dk


Ingen data tilgængelig

ID: 255041754