Association between the presence of DHPS and DHFR resistant markers and the level of parasitaemia, preterm birth and low birth weight among pregnant women in Ogun state, Nigeria

Abstract

Objective: There have been reports of resistance to Intermittent Preventive Therapy with Sulphadoxine-Pyrimethamine, probably due to the accumulation of mutations at the dihydrofolate reductase and dihydropteroate synthase genes of the malaria parasite. This study aimed to determine the association between the presence of dihydrofolate reductase markers and dihydropteroate synthase markers and birth outcomes (parasitaemia, low birth weight and preterm delivery) among pregnant women in Ogun State, Nigeria.

Methodology: This was a cross-sectional study of pregnant women, 28- and 40-week gestational age with malaria parasitaemia, who were screened for malaria parasitaemia with rapid diagnostic test kits, thick and thin blood films for microscopy, and DNA analysis using PCR during the antenatal clinic. Gestational age at delivery and birth weight were obtained from the delivery records. Data were entered into SPSS version 22.0. Bivariate analysis of categorical variables was done using the Chi-square or Fisher's exact test as appropriate. The significance level was set at p<0.05.

Result: Of the 270 women, only 30 (11.1%) of the participants had parasitaemia on microscopy. The mean parasite density was 5,540 microliter/ml ±1,090.66. The mean gestational age at delivery was 39 weeks 3 days ±1.67, while the mean birthweight was 3.1kg ±0.46. Bivariate analysis showed statistically significant associations between the presence of resistance markers to sulphadoxine-pyrimethamine and the occurrence of microscopic parasitaemia and adverse birth outcomes (preterm delivery and low birth weight).

Conclusion: The presence of Triple, quadruple and quintuple resistant markers may be associated with severe parasitaemia (> 5000/mcl), preterm delivery, and low birthweight.