Susceptibility of Plasmodium falciparum to the drugs used to treat severe malaria (quinine) and to prevent malaria (mefloquine, cycloguanil) in Comoros Union and Madagascar

Objectives. To monitor the sensitivity of Plasmodium falciparum to the drugs used to treat severe malaria and to prevent malaria in Comoros and Madagascar. Design. We used the in vitro isotopic method to test the sensitivity of P. falciparum to quinine, mefloquine and cycloguanil.Results. We tested fresh isolates of P. falciparum, collected from patients living in urban, suburban and rural areas and suffering from uncomplicated malaria in 2001, against at least one of the antimalarials cited above. In both countries all of the successfully tested isolates were sensitive to quinine (N = 243) and to cycloguanil (N = 67). The mean IC50 ranged from 85.7 to 133.7 nM for quinine. For cycloguanil, the mean IC50 ranged from 1.4 to 20.2 nM and the highest IC50 value (102.5 nM) was recorded in Comoros. Only 0.9% (1/110) of the informative isolates from Madagascar were mefloquineresistant (0/18 in Comoros). The mefloquine mean IC50s were 8.2 nM, 14.1 nM and 11.6 nM respectively in the rural, suburban and urban areas of Madagascar, and 5.9 nM in Comoros. A positive correlation was found between quinine and mefloquine IC50s (N = 127, r = 0.48, p < 10 6 ), but in vitro mefloquine was 6 -16 times more potent than quinine. No correlation was noticed between the activities of quinine and cydoguanil or between the activities of mefloquine and cycloguaniL Conclusion. We therefore advocate the use of a full-course regimen of quinine, as recommended by the World Health Organisation (WHO), to treat above all severe malaria in Madagascar and Comoros. Our results also demonstrate that the use of mefloquine- and cycloguanil-based antimalarials is still justified to prevent malaria in both countries, mainly in the case of travellers

Madagascar (2013): [Malaria Indicator Survey: MIS] measuring [Malaria related indicator] among [Women 15-49; Children under five; Pregnant women] in [Endemic zones Nationally]. Round [2].

Malaria is one of the leading causes of morbidity, mortality and hospital admissions in Madagascar. the country conducted a crosssectional survey every two years to evaluate i mpact of malaria program implemented in Madagascar by NMCP. The objective of this MIS are to inform the RBM committee and the donors on the following reas: -Malaria and anemia prevalence, -Owning LLIN, -LLIN use, -Malaria case management among under five, -Coverage on IRS, -Use of IPT among pregnant women, -Some indicators on knowledge The baseline data was collected in 2011 and the first follow-up survey was done in 2013. Both surveys used the same methodology. This study excluded 3 Districts in central highland and the areas with an altitude more than 1,500 meters. In 2013, the sample size is approximately 9068 households to be visited. This sample size were selected in 284 EAs

Genetic diversity of Plasmodium falciparum populations in three malaria transmission settings in Madagascar

International audienceBackgroundAssessment of the genetic diversity of Plasmodium falciparum parasites from various malaria transmission settings could help to define tailored local strategies for malaria control and elimination. Such assessments are currently scarce in Madagascar. The study presented here aimed to bridge this gap by investigating the genetic diversity of P. falciparum populations in three epidemiological strata (Equatorial, Tropical and Fringes) in Madagascar.MethodsTwo-hundred and sixty-six P. falciparum isolates were obtained from patients with uncomplicated malaria enrolled in clinical drug efficacy studies conducted at health centres in Tsaratanana (Equatorial stratum), Antanimbary (Tropical stratum) and Anjoma Ramartina (Fringes) in 2013 and 2016. Parasite DNA was extracted from blood samples collected before anti-malarial treatment. Plasmodium species were identified by nested PCR targeting the 18 S rRNA gene. The genetic profiles of P. falciparum parasites were defined by allele-specific nested PCR on the polymorphic regions of the msp - 1 and msp - 2 genes.ResultsFifty-eight alleles were detected in the P. falciparum samples tested: 18 alleles for msp-1 and 40 for msp-2 . K1 (62.9%, 139/221) and FC27 (69.5%, 114/164) were the principal msp-1 and msp-2 allele families detected, although the proportions of the msp-1 and msp-2 alleles varied significantly between sites. Polyclonal infections were more frequent at sites in the Equatorial stratum (69.8%) than at sites in the Tropical stratum (60.5%) or Fringes (58.1%). Population genetics analyses showed that genetic diversity was similar between sites and that parasite flow within sites was limited.ConclusionsThis study provides recent information about the genetic diversity of P. falciparum populations in three transmission strata in Madagascar, and valuable baseline data for further evaluation of the impact of the control measures implemented in Madagascar

Etude évaluative de la rémanence des initiatives en faveur de la prévention primaire et secondaire pour l'épilepsie et la santé mentale à Madagascar

International audienceA Madagascar, des initiatives pour la prise en charge de l’épilepsie et de la santé mentale (campagnes de sensibilisation, formations, etc.) ont été réalisées entre 2013 et 2018 dans 5 des 22 régions. Notre objectif principal était d’évaluer l’efficacité de ces initiatives à moyen terme (2 à 5 ans plus tard)

Effects of mefloquine use on Plasmodium vivax multidrug resistance.

International audienceNumerous studies have indicated a strong association between amplification of the multidrug resistance-1 gene and in vivo and in vitro mefloquine resistance of Plasmodium falciparum. Although falciparum infection usually is not treated with mefloquine, incorrect diagnosis, high frequency of undetected mixed infections, or relapses of P. vivax infection triggered by P. falciparum infections expose non-P. falciparum parasites to mefloquine. To assess the consequences of such unintentional treatments on P. vivax, we studied variations in number of Pvmdr-1 (PlasmoDB accession no. PVX_080100, NCBI reference sequence NC_009915.1) copies worldwide in 607 samples collected in areas with different histories of mefloquine use from residents and from travelers returning to France. Number of Pvmdr-1 copies correlated with drug use history. Treatment against P. falciparum exerts substantial collateral pressure against sympatric P. vivax, jeopardizing future use of mefloquine against P. vivax. A drug policy is needed that takes into consideration all co-endemic species of malaria parasites