Mutations Associated with Sulfadoxine-Pyrimethamine and Chlorproguanil Resistance in Plasmodium falciparum Isolates from Blantyre, Malawi

We conducted a prevalence study of mutations in Plasmodium falciparum that are associated with antifolate resistance in Blantyre, Malawi. The dihydrofolate reductase 164-Leu mutation, which confers resistance to both pyrimethamine and chlorproguanil, was found in 4.7% of the samples. Previously unreported mutations in dihydropteroate synthase were also found

Decreasing Burden of Malaria in Pregnancy in Malawian Women and Its Relationship to Use of Intermittent Preventive Therapy or Bed Nets

The World Health Organization recommends insecticidal bednets and intermittent preventive treatment to reduce malaria in pregnancy. Longitudinal data of malaria prevalence and pregnancy outcomes are valuable in gauging the impact of these antimalarial interventions.We recruited 8,131 women delivering in a single Malawian hospital over 9 years. We recorded demographic data, antenatal prescription of intermittent preventive therapy during pregnancy with sulfadoxine-pyrimethamine and bed net use, and examined finger-prick blood for malaria parasites and hemoglobin concentration. In 4,712 women, we examined placental blood for malaria parasites and recorded the infant's birth weight. Peripheral and placental parasitemia prevalence declined from 23.5% to 5.0% and from 25.2% to 6.8% respectively. Smaller declines in prevalence of low birth weight and anemia were observed. Coverage of intermittent preventive treatment and bednets increased. Number of sulfadoxine-pyrimethamine doses received correlated inversely with placental parasitemia (Odds Ratio (95% CI): 0.79 (0.68, 0.91)), maternal anemia (0.81, (0.73, 0.90)) and low birth weight from 1997-2001 (0.63 (0.53, 0.75)), but not from 2002-2006. Bednet use protected from peripheral parasitemia (0.47, (0.37, 0.60)) and placental parasitemia (0.41, (0.31, 0.54)) and low birth weight (0.75 (0.59, 0.95)) but not anemia throughout the study. Compared to women without nets who did not receive 2-dose sulfadoxine-pyrimethamine, women using nets and receiving 2-dose sulfadoxine-pyrimethamine were less likely to have parasitemia or low birth weight babies. Women receiving 2-dose sulfadoxine-pyrimethamine alone had little evidence of protection whereas bednets alone gave intermediate protection.Increased bednet coverage explains changes in parasitemia and birth weight among pregnant women better than sulfadoxine-pyrimethamine use. High bed net coverage, and sulfadoxine-pyrimethamine resistance, may be contributing to its apparent loss of effectiveness

The Effects of Malaria and Intermittent Preventive Treatment During Pregnancy on Fetal Anemia in Malawi

Background. Fetal anemia is common in malarious areas and is a risk factor for infant morbidity and mortality. Malaria during pregnancy may cause decreased cord hemoglobin (Hb) and fetal anemia among newborns. Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine–pyrimethamine (SP) is protective against malaria but may also affect hematopoiesis and contribute to fetal anemia. Methods. Peripheral, placental, and cord blood were examined for malaria parasitemia and Hb concentration in a cross-section of 3848 mothers and infants delivered at Queen Elizabeth Central Hospital in Blantyre, Malawi between 1997 and 2006. Unconditional linear and logistic regressions were performed with multiple imputation for missing covariates to assess the associations between malaria, IPTp with SP, and fetal anemia. Results. The overall prevalence of fetal anemia was 7.9% (n = 304). Malaria parasitemia at delivery was associated with an adjusted decrease in cord Hb of −0.24 g/dL (95% confidence interval [CI], −.42 to −.05). The adjusted prevalence odds ratio for the effect of malaria on fetal anemia was 1.41 (95% CI, 1.05–1.90). Primigravidae who did not take IPTp had infants at highest risk for fetal anemia, and density of parasitemia was correlated with the decrease in cord Hb. There was no significant association between SP use and cord Hb or fetal anemia. Conclusions. Malaria during pregnancy, but not IPTp, decreases cord Hb and is a risk factor for fetal anemia in Malawi. Intermittent preventive treatment during pregnancy with SP may continue to be safe and effective in preventing malaria during pregnancy and fetal anemia despite development of SP resistance

Función paterna en adolescentes en tratamiento por consumo de sustancias psicoactivas: clínica CEMIC- El Faro

La siguiente investigación aborda la importancia de la función paterna en los adolescentes en tratamiento por consumo de sustancias psicoactivas en la clínica CEMIC: el faro, de la ciudad de Cartagena- Bolívar. El consumo de sustancias psicoactivas es un malestar social, familiar y de salud que es muy evidente, teniendo en cuenta que el índice de crecimiento progresivo en diferentes estratos socioeconómicos es elevado. Es importante resaltar que: “El significado de la palabra “droga” varia a menudo, según el contexto en que use. Desde un punto de vista estrictamente científico, la droga es una sustancia química que afecta las funciones de los seres vivientes. Sin embargo en el caso del “abuso” o del “problema” de las drogas, el significado de la palabra adquiere un matiz social más que científico” (Sarason, I., Sarason, B. 1990, p. 383)

Summary of parasite density among malaria infected women from 1999 to 2006.

<p>Lines indicate geometric mean parasite density and error bars indicate 95% CI.</p

Association between bednet usage and prevalence of parasitemia, anemia and LBW^a.

<p>NOTE. –LBW  =  Low Birth Weight; OR  =  Odds Ratio; CI  =  Confidence Interval;</p>a<p>Adjusted for year and season of delivery, gravidity and 6 months rainfall prior to delivery.</p>b<p>Odds Ratio for women using bednet compared to women who did not use bednet.</p>c<p>Predicted mean change for women using bednet compared to women who did not use bednet.</p

Independent lineages of highly sulfadoxine-resistant Plasmodium falciparum haplotypes, Eastern Africa

Sulfadoxine-resistant Plasmodium falciparum undermines malaria prevention with sulfadoxine/pyrimethamine. Parasites with a highly resistant mutant dihydropteroate synthase (dhps) haplotype have recently emerged in eastern Africa; they negated preventive benefits of sulfadoxine/pyrimethamine, and might exacerbate placental malaria. We explored emerging lineages of dhps mutant haplotypes in Malawi, the Democratic Republic of the Congo, and Tanzania by using analyses of genetic microsatellites flanking the dhps locus. In Malawi, a triple-mutant dhps SGEG (mutant amino acids are underlined) haplotype emerged in 2010 that was closely related to pre-existing double-mutant SGEA haplotypes, suggesting local origination in Malawi. When we compared mutant strains with parasites from the Democratic Republic of the Congo and Tanzania by multiple independent analyses, we found that SGEG parasites were partitioned into separate lineages by country. These findings support a model of local origination of SGEG dhps haplotypes, rather than geographic diffusion, and have implications for investigations of emergence and effects of parasite drug resistance

SP IPTp and ITN coverage between 1997 and 2006.

<p>Percentage of women receiving the first dose of IPTp (dashed line), second dose of IPTp (dotted line), and women reporting bednet use (solid line). Error bars indicate 95% CI.</p