Temporal dynamics of molecular markers of antimalarial drug resistance in P. falciparum parasite populations in Senegal using routinely collected malaria rapid diagnostic tests

In Senegal, Intermittent Presumptive Treatment in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP) and Seasonal Malaria Chemoprevention (SMC) using SP plus amodiaquine (AQ) have been implemented while artesunate-amodiaquine or artemether-lumefantrine are used as treatment against uncomplicated malaria. These drugs have largely contributed to the reduced malaria-associated morbidity and mortality in the country reported in recent years. However, the successful control of malaria is highly dependent on continued effectiveness of these drugs which may be compromised by the spread of drug resistance and therefore, surveillance of drug resistance in the malaria parasites is considered essential.

The main objective of this study is to test the feasibility of routinely sampled malaria rapid diagnostic tests (RDTs) at a national scale to assess the temporal changes in the molecular profiles of antimalarial drug resistance markers of Plasmodium falciparum parasites. Through collaboration with the National Malaria Control Program which is responsible for monitoring quality control of the RDTs, the study will establish a routine sampling procedure of RDTs at 20 sentinel sites over one year during the dry and rainy seasons. As a proof of concept, a subset of used RDTs will be analysed for Single Nucleotide Polymorphisms (SNPs) in various P. falciparum genes known to be associated with P. falciparum drug resistance, e.g. Pfcrt and Pfmdr1. The results will be uploaded into a web-based regional map of SNP distribution enabling a user-friendly assessment of possible temporal changes in SNPs related to local or regional differences in drug pressure. Once proven, such routine cost-effective sampling and analyses will facilitate rapid public health responses to changes in resistance profiles.