Efficacy of SP,SP+artesunate and coartem against falciparum malaria and frequency of Mutant genotypes in South-East Tanzania

The objective of this study was to assess and compare efficiencies of SP,SP+Artesunate and Coartem as well as frequencies of molecular markers of drug resistance for the first time in Tanzania. A total of 425 children from Lupiro and Kibiti with uncomplicated falciparum malaria, were recruited and treated with either SP,SP+Artesunate or Coartem then followed up for 28 years,130 children had treatment failures due to recruit infections (recrudescence or new infection). Nested PCR-RFLP of msp2 was carried out to discriminate recruscence from new. Pfmdrl.86 genotypes were analysed by the nested PCR-RFLP technique and SSOP for dhfrdhps point mutilation analysis. Out of the 3 treatment regimens, Coartem was found to be the most efficious cases, pfndrl 86N (wild type) parasites were selected (x2=7.17, p=0.007398). Apart from selection being an alert of Coartem efficacy drawback, this phenomenon represents CQ resistance reversal. Out of 60 and 29 children treated with SP and SP+ Artesunate, respectively, parasites with quintuple mutant genotype were the most prevalent ones, with no significant difference before and after recrudesnce (SP(x2=1.79,p-0.180854) and in SP+Artesunate (x2=0.07,p-0.770816). Generally the findings of this study have highlighted high Coartem efficacy in Tanzania under fives. In addition, selection of tolerant parasites following treatment with Coartem may translate into coatem resistance hence ways to protect the UTL of this drug should commence.