Effects of drug policy changes on the evolution of Pfmdr1 and Pfcrt resistance molecular markers of Plasmodium falciparum to chloroquine in Bangui, Central African Republic

<p>Malaria remains one of the main threats to public health. The emergence of drug resistance is a major obstacle to the fight against malaria. Due to the spread of parasites resistant to antimalarial drugs, treatment guidelines for malaria in the Central African Republic have evolved from monotherapy to artemisinin-based combination therapy. Prediction of decrease or increase in antimalarial susceptibility and fixation of multidrug resistance genotypes is essential in the fight against malaria. To assess the impact of drug policy, we examined molecular changes in the chloroquine-associated Pfcrt and Pfmdr1 resistance marker to monitor the evolution of mutant alleles since the withdrawal of chloroquine from the market following the adoption of Artemisinin based Combined Therapies (ACT) in the Central African Republic. To assess the evolution of these markers, dried blood spots were prepared from 138 children diagnosed positive for plasmodium falciparum malaria by rapid diagnostic test. DNA was then extracted from the blood and genotyped. The chi-square test was used to check for the association between the period of withdrawal and the time of sample analysis. The alleles conferring resistance to chloroquine in the Pfmdr1-86Y genotype showed a significant increase from 1.72% in 2010 to 99.1% in 2021, on the other hand, they was a reduction in the mutant alleles Pfcrt-76T and an increase in mixed infection from 0% in 2010 to 3.48% in 2021 (P<0.05). The results demonstrated a clear increase in the pfmdr1 resistant marker.  </p&gt