Eboumbou Moukoko Carole Else, Kojom Foko Loick Pradel, Ayina Angèle, Tornyigah Bernard, Epote Annie Rachel, Penda Ida Calixte, Epee Eboumbou Patricia, Ebong Serge Bruno, Texier Gaetan, Nsango Sandrine Eveline, Ayong Lawrence, Tuikue Ndam Nicaise, Same Ekobo Albert
Malaria Research Unit, Centre Pasteur Cameroon, Yaoundé P.O. Box 1274, Cameroon.
Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, Douala P.O. Box 24157, Cameroon.
Pathogens. 2023 Jun 19;12(6):844. doi: 10.3390/pathogens12060844.
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 gene (, , and ) mutations. The overall IPTp-SP coverage (≥three doses) was 17.5%, and 5.1% received no dose. 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. - quintuple mutants were over-represented (IRNI-FGKAA, IRNI-AGKAA), and sextuple mutants (IRNI-AGKAS, IRNI-FGEAA, IRNI-AGKGS) were also reported. The 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 parasites in the city of Douala that could compromise the efficacy of IPTp-SP.
孕期使用周效磺胺和乙胺嘧啶进行间歇性预防治疗（IPTp-SP）是非洲实施的疟疾控制策略的关键组成部分。本研究的目的是在喀麦隆杜阿拉市广泛存在磺胺多辛-乙胺嘧啶（SP）耐药的背景下，确定IPTp-SP的依从性和覆盖率，以及对孕产妇感染和分娩结局的影响。记录了888名在3家医疗机构就诊的孕妇从产前检查到分娩的临床和人口统计学信息。对阳性样本进行了 基因（ 、 和 ）突变的基因分型。IPTp-SP的总体覆盖率（≥3剂）为17.5%，5.1%的孕妇未接受任何剂量的治疗。疟原虫血症患病率为16%，以亚显微镜感染为主（89.3%）。疟疾感染与地区和疟疾病史显著相关，在使用室内滞留喷洒的妇女中感染率降低。IPTp-SP的最佳剂量与新生儿和妇女（经产妇和多产妇）感染率降低显著相关，但IPTp-SP对新生儿体重没有影响。-五重突变体（IRNI-FGKAA、IRNI-AGKAA）占比过高，也报告了六重突变体（IRNI-AGKAS、IRNI-FGEAA、IRNI-AGKGS）。未检测到与青蒿素耐药相关的 基因突变。本研究强调了产前保健在实现孕妇最佳SP覆盖率方面的作用、IPTp-SP对疟疾结局的缓解影响，以及杜阿拉市多重SP耐药疟原虫的高流行率，这可能会损害IPTp-SP的疗效。
