DISTRIBUTION OF PLASMODIUM FALCIPARUM MULTIDRUG RESISTANT 1 AND KELCH 13 MUTANT GENES AMONG CHILDREN ATTENDING MOTHER AND CHILD HOSPITAL, AKURE.

Abstract

Malaria is an infectious disease caused by the protozoan parasites of the genus Plasmodium. Globally, malaria remains the major cause of morbidity and mortality especially among children and pregnant women. A multi-centre study done across 10 countries in 2014 reported increasing resistance of P. falciparum to the Artemisinin Combination Therapy (ACTs) currently in use and there is a dearth of information about the presence of the mutant genes in Ondo State. The study therefore, set out to determine the distribution of Plasmodium falciparum multidrug resistant 1 and Kelch 13 mutant genes (Pfmdr1 and PfKelch 13) among children who are 5 years and below attending Mother and Child Hospital, Akure (MCHA), Ondo State, Southwest, Nigeria. Approval for the study was sought from the Research and Ethics Committee of MCHA and the State Ministry of Health while informed consent was obtained from the parents of the study participants. Five hundred blood samples were collected for malaria parasite test while two hundred samples were randomly selected from the positive samples for the molecular tests. Genotyping analysis of Pf kelch protein gene on chromosome 13 (kelch13) and Pfmdr 1 mutant genes were done following standard protocols. Chi-Square analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 20.0 and probability was set at 0.05. The results showed that the prevalence of malaria infection among the neonates (aged 1 to 28 days) was 60.4% which was significantly higher (p<0.05) than the infants (49.2%) while the prevalence among the children >12 months to 5 years was 52.9%. The prevalence of malaria was significantly higher (p<0.05) in male (30.4%) than the female (21.8%). The prevalence of malaria infection among birth orders was 41%, 28%, 22.6%, 5.3% and 3.1% for the first, second, third, fourth, and fifth birth orders respectively. The highest percentage distribution of malaria (58.2%) was observed in the blood group O while the least was observed in blood group AB (5.7%). The results further showed that 464 mothers (92.8%) of the 500 children had prior knowledge about Insecticide Treated Nets (ITN) while 36 (7.2%) were completely ignorant of the ITN and not all the respondents who had the ITN actually slept under it at night. The results also further revealed that there was no statistical difference between respondents who used Indoor residual spray (IRS) and those who did not use it, however malaria prevalence was significantly higher in respondents whose mothers did not use Intermittent Preventive Therapy (IPT) during pregnancy (55.5%) than those who used it (50.16%), p<0.05. After sequencing, the Pfmdr were categorized and the mutant/wild group were the highest (38.5%), followed by the mutant genes (35.5%) and wild genes (20.5%), the resistant genes were absent in 11 infected children. Point mutations in the codon 557 in the PfK13 was also discovered in the blood samples of some of the participants in the current study. The study therefore revealed that both PfK13 and Pfmdr mutant genes were identifiable in children aged 5 years and below in MCHA and use of IPT in pregnant mothers should be encouraged so as to reduce the prevalence of neonatal malaria.