Treatment of uncomplicated malaria with artesunate plus sulfadoxine-pyrimethamine is failing in Somalia: evidence from therapeutic efficacy studies and Pfdhfr and Pfdhps mutant alleles.

OBJECTIVE: Artesunate plus sulfadoxine-pyrimethamine (AS + SP) has been Somalia's national treatment policy since 2006. Routine monitoring of first-line malaria treatment is needed to ensure appropriate national malaria treatment policy and early detection of drug resistance. For this purpose, we conducted therapeutic efficacy studies of AS + SP for the treatment of uncomplicated malaria in Somalia in 2011. METHODS: Studies were conducted in three sentinel sites. Eligible patients were evaluated for clinical and parasitological outcomes according to the WHO standard protocol. Molecular surveillance was conducted on resistance conferring mutations in the P.falciparum dihydrofolate reductase (dfhr) and dihydropteroate synthase (dhps) genes. RESULTS: The proportion of PCR-corrected treatment failures was high in Jamame (22%, 95% CI: 13.7-32.8%) and low (<5%) in Janale and Jowhar. All patients cleared parasites by day 3. Molecular markers associated with SP resistance were detected in all three sites. Treatment failure was associated with the presence of the double mutant dhps A437G/K540E (OR = 22.4, 95% CI: 5.1-98.1), quadruple mutant dhfr N51I/S108N+dhps A437G/K540E (OR = 5.5, 95% CI: 2.3-13.6), quintuple mutant dhfr N51I/C59R/S108N+dhps A437G/K540E (OR = 3.5, 95% CI: 1.4-8.8) and younger age (OR=0.86, 95% CI: 0.76-0.96). CONCLUSIONS: The high treatment failure rate observed in Jamame, together with the presence of molecular mutations associated with SP resistance, indicates P. falciparum resistance to SP. In Jowhar, high treatment failure rates were absent despite the presence of molecular mutations; signs of resistance in vivo may have been masked by the stronger immunity of the older study population. The study underscores the need to update Somalia's national malaria treatment policy.

Malaria situation in an endemic area, southeastern iran.

BACKGROUND: Malaria is an endemic infectious disease in southeastern parts of Iran. Despite years of efforts and intervention programs against malaria, transmission still occurs in Jask County. METHODS: The epidemiological perspective of malaria in Jask County was conducted by gathering data from Jask County health center, during 2006-2010. A knowledge, attitude and practice study was also carried out. Data analysis was conducted using SPSS ver. 11.5. RESULTS: A total of 2875 malaria cases were recorded, with highest and lowest numbers in 2007 and 2010, respectively. The number of cases had a decreasing trend from 1022 cases in 2006 to 114 cases in 2010. The main causative parasitic agent was Plasmodium vivax. Blood examination rate and slide positive rate were also decreased from 39.5% and 4.3% in 2006 to 15.6% and 1.4% in 2010, respectively. Most of people interviewed in the KAP study had a good knowledge about malaria transmission and symptoms but their use of the bed net for prevention was low (35%). CONCLUSION: Malaria incidence had significant reduction during the study years. The main reason for this may be due to changing environmental condition for Anopheline breeding and survival because of drought. Another reason may be integration of vector management by using long lasting insecticide treated bed nets, active case detection and treatment by implementation of mobile teams and increasing in financial sources of malaria control program. Knowledge, attitude and practice of people were good in malaria control and prevention, but needs to do more activities for health education and awareness.