Research

Antimalarial drug use in general populations of tropical Africa

Florence Gardella^1,2 , Serge Assi³ , Fabrice Simon⁴ , Hervé Bogreau^1,2 , Teunis Eggelte⁵ , Fatou Ba⁶ , Vincent Foumane⁷ , Marie-Claire Henry⁸ , Pélagie Traore Kientega⁸ , Léonardo Basco⁷ , Jean-François Trape^6,2 , Richard Lalou⁹ , Maryse Martelloni¹⁰ , Marc Desbordes¹⁰ , Meïli Baragatti^1,2 , Sébastien Briolant^1,2 , Lionel Almeras^1,2 , Bruno Pradines^1,2 , Thierry Fusai^1,2 and Christophe Rogier^1,2

¹  Unité de Recherche en Biologie et Epidémiologie Parasitaires (URBEP), IMTSSA, Parc du Pharo – B.P. 46, 13998, Marseille-Armées, France

²  Unité de recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE) – UMR 6236, Faculté de Médecine, 27 Bv Jean Moulin, 13385, Marseille, Cedex 05, France

³  Institut Pierre Richet/Institut National de Santé Publique, BP V 47, Abidjan, Cote d'Ivoire

⁴  Hôpital Laveran, BP 50, 13998, Marseille-Armées, France

⁵  Dept. Infectious Diseases, AIDS and Tropical Medicine, Dep Clinical Pharmacology Meibergdreeef 15, 1105 AX, Amsterdam, The Netherlands

⁶  UR 077 Paludologie Afrotropicale, BP1386, IRD, Dakar, Sénégal

⁷  UR 077 Paludologie Afro-Tropicale, OCEAC, BP 288, Yaoundé, Cameroun

⁸  Centre Muraz, BP 360, Bobo-Dioulasso, Burkina-Faso

⁹  LPED, Université de provence, case 10, 3, place Victor-Hugo, 13331, Marseille, cedex 3, France

¹⁰  Unité de Recherche en Pharmacologie et Physiopathologie Parasitaires, IMTSSA, Parc du Pharo – B.P. 46, 13998, Marseille-Armées, France

author email corresponding author email

Malaria Journal 2008, 7:124doi:10.1186/1475-2875-7-124

Published:	8 July 2008

Abstract

Background

The burden of Plasmodium falciparum malaria has worsened because of the emergence of chloroquine resistance. Antimalarial drug use and drug pressure are critical factors contributing to the selection and spread of resistance. The present study explores the geographical, socio-economic and behavioural factors associated with the use of antimalarial drugs in Africa.

Methods

The presence of chloroquine (CQ), pyrimethamine (PYR) and other antimalarial drugs has been evaluated by immuno-capture and high-performance liquid chromatography in the urine samples of 3,052 children (2–9 y), randomly drawn in 2003 from the general populations at 30 sites in Senegal (10), Burkina-Faso (10) and Cameroon (10). Questionnaires have been administered to the parents of sampled children and to a random sample of households in each site. The presence of CQ in urine was analysed as dependent variable according to individual and site characteristics using a random – effect logistic regression model to take into account the interdependency of observations made within the same site.

Results

According to the sites, the prevalence rates of CQ and PYR ranged from 9% to 91% and from 0% to 21%, respectively. In multivariate analysis, the presence of CQ in urine was significantly associated with a history of fever during the three days preceding urine sampling (OR = 1.22, p = 0.043), socio-economic level of the population of the sites (OR = 2.74, p = 0.029), age (2–5 y = reference level; 6–9 y OR = 0.76, p = 0.002), prevalence of anti-circumsporozoite protein (CSP) antibodies (low prevalence: reference level; intermediate level OR = 2.47, p = 0.023), proportion of inhabitants who lived in another site one year before (OR = 2.53, p = 0.003), and duration to reach the nearest tarmacked road (duration less than one hour = reference level, duration equal to or more than one hour OR = 0.49, p = 0.019).

Conclusion

Antimalarial drug pressure varied considerably from one site to another. It was significantly higher in areas with intermediate malaria transmission level and in the most accessible sites. Thus, P. falciparum strains arriving in cross-road sites or in areas with intermediate malaria transmission are exposed to higher drug pressure, which could favour the selection and the spread of drug resistance.