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Malaria: Efficacy of monotherapies in Cameroon

verage of 7.3 and 9.9% respectively) obtained for the whole set of sites studied. In order to avoid the development of new resistance, these treatments must however be combined with the most recent therapies using artemisinine derivatives, for which no form of resistance currently exists. Amodiaquine, which is generally administered as soon as the first malaria symptoms appear, seems to be the best candidate for these combinations of therapies.

The series of investigations was run from 1999 to 2004, following a protocol established by the WHO (World Health Organization), which advocates regular clinical examination and blood tests for each patient, for 14 days. This protocol enables clinicians to take into account the whole range of factors governing the parasite-host interaction (such as acquired immunity, pharmacokinetics, synergy between constituents, and also the degree of chemoresistance of Plasmodium). However, implementation of this has proved a long and intricate process in Cameroon, where transmission does not have the same pattern and rate of development everywhere. Faced with these constraints, the researchers turned to molecular markers, quick and practical to use for resistance assessment (2). They used the blood samples taken from the different sites under study to estimate the degree of resistance to pyrimethamine, one of the components of sulfadoxine-pyrimethamine. The sequence of a particular gene of Plasmodium (dhfr, dihydrofolate reductase gene) was analysed, in the search for occasional mutations that might provide the parasite with resistance to this agent. The proportion of strains of mutant Plasmodium in the samples is thus a direct expression of the resistance.

Geographical mapping of the occurrence of pyrimethamine resistance was subsequently conducted. The frequency of mutant resistant strains and the number of mutations were plotted for the different areas. The data obtained, such as the lower proportion of these resi
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Contact: Marie Guillaume-Signoret
fichesactu@paris.ird.fr
33-014-803-7607
Institut de Recherche Pour le Dveloppement
13-Oct-2006


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