Prevalence of Antimalarial self- medication and artemisinin genotypic resistance in plasmodium falciparum parasites isolated from malaria symptomatic patients attending Dokolo Health Centre

Abstract

Background: Malaria remains the major cause of death in sub-Saharan Africa. Interventions like use of insecticide treated mosquito nets (ITNs), IRS, antimalarial drugs have been used to combat malaria in Uganda with minimal success. Malaria treatment is currently threatened by the emergence and spread of artemisinin resistance which has been associated with several factors including use of sub-standard agents and self-treatment in communities. General Objective: To assess the prevalence of antimalarial self- medication and Artemisinin genotypic resistance in Plasmodium falciparum parasites isolated from malaria symptomatic patients in Dokolo Health Centre IV, Dokolo district Methods: A cross sectional study was conducted among 384 malaria symptomatic patients attending Dokolo Health Center IV. Patients were recruited using consecutive sampling and data collected through patient interviews and laboratory experiments. The participants were interviewed using a questionnaire. Finger prick blood was then collected from the participants for malaria Rapid Diagnostic Test (mRDT) using PfHRP-2 and microscopy. Finger prick blood from patients who screen positive for P. falciparum infection was collected using a filter paper. The blood spots in the filter papers were air dried. Parasite DNA was extracted using Chelex-100 method. Extracted parasite DNA was amplified using PCR and gel electrophoresis performed to confirm the presence of the parasite DNA. The PCR products were sequenced using Sanger sequencing method. Data was entered in Epi-data ver 3.1 and analysis performed at 95 % level of significance using STATA ver 13.0 Continuous and discrete variables were summarized into percentiles and medians or means and standard deviations. Categorical variables were summarized into frequencies and percentages. Modified Poisson regression with robust standard errors was used for analysis. Bivariate analysis was performed for each of the independent variables to determine whether they were independently associated with self-medication using prevalence ratios (PR) and p values. Factors with p-value ≤0.05 were considered for multivariate analysis. In multivariate analysis, step wise backward method was used to identify independent variables with p-value ≤0.05, and then assessing for interaction by comparing the -2 Log Likelihoods of the reduced and full models. Confounding was assessed by comparing the crude xvi and adjusted PR, with a relative difference between the crude and adjusted PR being 10% or more considered as confounding. Results: The prevalence of antimalarial self-medication was 23.4%. Antimalarial self-medication was higher in males (25.0%) than in females (23.1%). One Single Nucleotide Mutation (G1406A), which led to a codon change from TGC to TAC and this consequently changed the amino acid from Cysteine to Tyrosine (Cys469Tyr) was detected in four P. falciparum parasite samples. The prevalence of K13 SNPs was 5.7% (4/70). The common reported factors associated with prior use of antimalarial agents before reporting to hospital included, long waiting time at health facilities (p-value < 0.001), long distance to health facilities (p-value < 0.001), Other reasons (drug shop closed, late time (at night) and presence of a short time reliever) (p-value = 0.001) and education level (p-value = 0.001). Conclusion and Recommendation: A single K13 mutation Cys469Tyr (C469Y) was found in low frequency among malaria patients in Dokolo district. Antimalarial self-medication is common among individuals seeking treatment for malaria related symptoms. Health care personnel need to be sensitized on the prevalence of prior antimalarial use among patients presenting with symptoms of malaria in health facilities.