FACTORS INFLUENCING SULFADOXINE-PYRIMETHAMINE RESISTANCE IN PLASMODIUM FALCIPARUM AMONG PREGNANT WOMEN IN ILORIN, NIGERIA
Abstract
Malaria remains a significant public health concern in sub-Saharan Africa, especially among pregnant women. Resistance to sulfadoxine-pyrimethamine (SP), a key drug for treatment and prevention, is rising. This study investigated the prevalence of SP resistance among pregnant women in Ilorin, Nigeria, across pregnancy trimesters and healthcare facility types, and identified influencing factors. A cross-sectional study was conducted among 764 pregnant women attending Primary, Secondary, Tertiary, and Private Health Facilities. Facilities were categorized as Primary (basic care), Secondary, Tertiary (advanced care), and Private (privately owned, with varying levels of specialisation). Resistance prevalence was defined as the percentage of pregnant women in each trimester exhibiting resistance to SP. Prevalence rates were 37.6% (first trimester), 28.9% (second trimester), 31.9% (third trimester), and 38.7% (at delivery). The highest prevalence occurred in Private Health Facilities during the first trimester (45.5%) and Secondary Health Facilities at delivery (66.7%). Multivariate regression analysis revealed that occupation, blood group, and IPTp use were the significant predictors of SP resistance. For instance, occupation was associated negatively with resistance in the first trimester: coefficient = -0.144, p = 0.027, whereas hypertension and proximity to stagnant water were significant at delivery, coefficients -0.342, p = 0.009 and -0.296, p = 0.035, respectively. These findings call for targeted malaria control strategies, considering trimester-specific risk factors and healthcare facility type. For example, improved access to IPTp and early detection of hypertension in the second and third trimesters may reduce resistance.
References
Adebobola, O. K. (2021). Prevalence of mutant dihydrofolate reductase gene (DHFR) and its implication on pyrimethamine resistance in rural Kwara State, Nigeria (Master's thesis, Kwara State University, Nigeria).
Adeniran, A., Mobolaji-Ojibara, M. U., Adesina, K. T., Aboyeji, A., Ijaiya, M., & Balogun, O. R. (2018). Intermittent preventive therapy in pregnancy with sulfadoxine/pyrimethamine for malaria prophylaxis among parturients in Ilorin, Nigeria. Journal of Medicine in the Tropics, 20, 30. https://doi.org/10.4103/jomt.jomt_32_17 DOI: https://doi.org/10.4103/jomt.jomt_32_17
Ajonina, M. U., Ajonina-Ekoti, I. U., Ngulefac, J., Fosah, S., Ware, K. B., Nche, C. M., ... & Apinjoh, T. O. (2024). Uptake of intermittent preventive treatment with sulfadoxinepyrimethamine (IPTp-SP) in pregnancy and associated factors in a malaria endemic setting of Sub-Saharan Africa. DOI: https://doi.org/10.21203/rs.3.rs-5143172/v1
Apinjoh, T., Ntui, V., Hanesh, F., Moyeh, M., Toussi, C., Mayaba, J., & Titanji, V. (2022). Intermittent preventive treatment with sulphadoxine-pyrimethamine (iptp-sp) is associated with protection against sub-microscopic p. falciparum infection in pregnant women during the low transmission dry season in southwestern cameroon: a semi - longitudinal study. Plos One, 17(9), e0275370. https://doi.org/10.1371/journal.pone.0275370 DOI: https://doi.org/10.1371/journal.pone.0275370
Desai, M., Gutman, J., Taylor, S. M., Wiegand, R. E., Khairallah, C., Kayentao, K. (2016).Impact of sulfadoxinepyrimethamine resistance on effectiveness of intermittent preventive therapy for malaria in pregnancy at clearing infections and preventing low birth weight. Clin Infect Dis. 2016; 62:32333. DOI: https://doi.org/10.1093/cid/civ881
Dosoo, D. K., Bailey, J. A., Asante, K. P., Oppong, F. B., Niar, K., Opoku-Mensah, J., Owusu-Agyei, S., Greenwood, B., & Chandramohan, D. (2022). The prevalence of molecular markers of resistance to sulfadoxine-pyrimethamine among pregnant women at first antenatal clinic attendance and delivery in the forest-savannah area of Ghana. PLOS ONE, 17(8), e0271489. https://doi.org/10.1371/journal.pone.0271489 DOI: https://doi.org/10.1371/journal.pone.0271489
Emmanuel, B.N., Chessed, G., Erukainure, F.E. (2024). Prevalence of malaria parasite and its effects on some hematological parameters amongst pregnant women in Yola, Nigeria. J.Umm Al-Qura Univ. Appll. Sci. 10, 200210. https://doi.org/10.1007/s43994-023-00092-z DOI: https://doi.org/10.1007/s43994-023-00092-z
Fagbemi, K. A., Adebusuyi, S. A., Nderu, D., Adedokun, S. A., Pallerla, S. R., Amoo, A. O. J., Thomas, B. N., Velavan, T. P., & Ojurongbe, O. (2020). Analysis of sulphadoxine-pyrimethamine resistance-associated mutations in Plasmodium falciparum isolates obtained from asymptomatic pregnant women in Ogun State, Southwest Nigeria. Infection, Genetics and Evolution: Journal of Molecular Epidemiology and Evolutionary Genetics in Infectious Diseases, 85, 104503. https://doi.org/10.1016/j.meegid.2020.104503 DOI: https://doi.org/10.1016/j.meegid.2020.104503
Fana, S., Bunza, M., Anka, S., Imam, A., & Nataala, S. (2015). Prevalence and risk factors associated with malaria infection among pregnant women in a semi-urban community of north-western nigeria. Infectious Diseases of Poverty, 4(1). https://doi.org/10.1186/s40249-015-0054-0 DOI: https://doi.org/10.1186/s40249-015-0054-0
Garba, I., Umar, A., Tijjani, M., Aliyu, M., Muhammad, H., Raji, M. & Thompson, J. (2023). Aematological changes in malaria infection among pregnant women in sokoto metropolis nigeria. Fudma Journal of Sciences, 7(3), 283-287. https://doi.org/10.33003/fjs-2023-0703-1870 DOI: https://doi.org/10.33003/fjs-2023-0703-1870
Gikunju, S., Agola, E., Ondondo, R., Kinyua, J., Kimani, F., LaBeaud, A., & Mutuku, F. (2020). Prevalence of pfdhfr and pfdhps mutations in plasmodium falciparum associated with drug resistance among pregnant women receiving iptp-sp at msambweni county referral hospital, kwale county, kenya. Malaria Journal, 19(1). https://doi.org/10.1186/s12936-020-03263-z DOI: https://doi.org/10.1186/s12936-020-03263-z
Gleave, K., Guy, A., Mechan, F., Emery, M., Murphy, A., Voloshin, V., & McCall, P. (2023). Impacts of dual active-ingredient bed nets on the behavioural responses of pyrethroid resistant anopheles gambiae determined by room-scale infrared video tracking. Malaria Journal, 22(1). https://doi.org/10.1186/s12936-023-04548-9 DOI: https://doi.org/10.1186/s12936-023-04548-9
Gontie, G., Wolde, H., & Baraki, A. (2020). Prevalence and associated factors of malaria among pregnant women in sherkole district, benishangul gumuz regional state, west ethiopia. BMC Infectious Diseases, 20(1). https://doi.org/10.1186/s12879-020-05289-9 DOI: https://doi.org/10.1186/s12879-020-05289-9
Grais, R., Laminou, I., Woi-Messe, L., Makarimi, R., Bouriema, S., Langendorf, C., & Sibley, C. (2018). Molecular markers of resistance to amodiaquine plus sulfadoxinepyrimethamine in an area with seasonal malaria chemoprevention in south central niger. Malaria Journal, 17(1). https://doi.org/10.1186/s12936-018-2242-4 DOI: https://doi.org/10.1186/s12936-018-2242-4
Hill, J., Kayentao, K., Achieng, F., Diarra, S., Dellicour, S., Diawara, S., & Webster, J. (2015). Access and use of interventions to prevent and treat malaria among pregnant women in kenya and mali: a qualitative study. Plos One, 10(3), e0119848. https://doi.org/10.1371/journal.pone.0119848 DOI: https://doi.org/10.1371/journal.pone.0119848
Kane, J., Li, X., Kumar, S., Button-Simons, K. A., Brenneman, K. M. V., Dahlhoff, H., Sievert, M. A. C., Checkley, L. A., Shoue, D. A., Singh, P. P., Abatiyow, B. A., Haile, M. T., Nair, S., Reyes, A., Tripura, R., Peto, T., Lek, D., Kappe, S. H. I., Dhorda, M., Nkhoma, S. C., Cheeseman, I. H., Vaughan, A. M., Anderson, T. J. C., & Ferdig, M. T. (2023). A Plasmodium falciparum genetic cross reveals the contributions of pfcrt and plasmepsin II/III to piperaquine drug resistance. bioRxiv. https://doi.org/10.1101/2023.06.06.543862 DOI: https://doi.org/10.1101/2023.06.06.543862
Kasso, T., Oboro, I., Maduka, O., Awopeju, A., Paul, N., Yaguo-Ide, L., & Nwauche, C. (2020). Malaria preventive practices among pregnant women in akwa ibom state, southern nigeria. Archives of Current Research International, 1-8. https://doi.org/10.9734/acri/2019/v19i330158 DOI: https://doi.org/10.9734/acri/2019/v19i330158
Kimbi, H., Nkesa, S., Ndamukong-Nyanga, J., Sumbele, I., Atashili, J., & Atanga, M. (2014). Knowledge and perceptions towards malaria prevention among vulnerable groups in the buea health district, cameroon. BMC Public Health, 14(1). https://doi.org/10.1186/1471-2458-14-883 DOI: https://doi.org/10.1186/1471-2458-14-883
Koehne, E. J. (2022). *Assessment of the drug activity of anti-infectives against Plasmodium falciparum and Schistosoma mansoni (Doctoral dissertation, Universitt Tbingen).
Mlugu, E., Minzi, O., Kamuhabwa, A., & Aklillu, E. (2021). Effectiveness of intermittent preventive treatment with dihydroartemisininpiperaqunine against malaria in pregnancy in tanzania: a randomized controlled trial. Clinical Pharmacology & Therapeutics, 110(6), 1478-1489. https://doi.org/10.1002/cpt.2273 DOI: https://doi.org/10.1002/cpt.2273
Mohammed, M. (2023). The association between periodontal disease and chronic migraine: a systematic review. International Dental Journal, 73(4), 481-488. https://doi.org/10.1016/j.identj.2023.04.007 DOI: https://doi.org/10.1016/j.identj.2023.04.007
Moussiliou, A., De Tove, Y. S., Doritchamou, J., Luty, A. J., Massougbodji, A., Alifrangis, M.,Deloron, P., Ndam, N. T. (2013). High rates of parasite recrudescence following intermittent preventive treatment with sulphadoxine-pyrimethamine during pregnancy in Benin. Malar J 12:195. DOI: https://doi.org/10.1186/1475-2875-12-195
Mpogoro, F., Matovelo, D., Dosani, A., Ngallaba, S., Mugono, M., & Mazigo, H. (2014). Uptake of intermittent preventive treatment with sulphadoxine-pyrimethamine for malaria during pregnancy and pregnancy outcomes: a cross-sectional study in geita district, north-western tanzania. Malaria Journal, 13(1). https://doi.org/10.1186/1475-2875-13-455 DOI: https://doi.org/10.1186/1475-2875-13-455
Muthiani, Y., Hunter, P. J., Nsnen-Gilmore, P. K., Koivu, A. M., Isojrvi, J., Luoma, J., Salenius, M., Hadji, M., Ashorn, U., & Ashorn, P. (2023). Antenatal interventions to reduce risk of low birth weight related to maternal infections during pregnancy. The American Journal of Clinical Nutrition, 117(Supplement 2), S118-S133. https://doi.org/10.1016/j.ajcnut.2023.02.025 DOI: https://doi.org/10.1016/j.ajcnut.2023.02.025
Nwankwo, N., KuKui, J., Longdet, I., & Kutshik, R. (2022). Polymorphisms in plasmodium falciparum dihydropteroate synthetase (540pfdhps) gene responsible for sulphadoxinepyrimethamine resistant malaria in jos, nigeria.. https://doi.org/10.21203/rs.3.rs-1796186/v1 DOI: https://doi.org/10.21203/rs.3.rs-1796186/v1
Nyanga, J., Wolloh, G., Yunga, N., Jacqueline, N., & Ndamukong, N. (2020). Malaria parasitaemia and variations in haematological parameters among pregnant women in buea. International Journal of Pathogen Research, 8-16. https://doi.org/10.9734/ijpr/2020/v4i330112 DOI: https://doi.org/10.9734/ijpr/2020/v4i330112
Ogba, P., Baumann, A., Chidwick, H., Banfield, L., & DiLiberto, D. D. (2022). Barriers and facilitators to access and uptake of intermittent preventive treatment with sulfadoxine-pyrimethamine among pregnant women in Nigeria: a scoping review. MalariaWorld Journal, 13.
Ogunleye, B., & Hassan, R. (2020). Temperature trends and effects in Kwara State. Nigerian Journal of Environmental Science, 18(2), 112-123.
Orish, V., Onyeabor, O., Boampong, J., Afoakwah, R., Nwaefuna, E., Acquah, S., & Iriemenam, N. (2016). Prevalence of intermittent preventive treatment with sulphadoxine-pyrimethamine (iptp-sp) use during pregnancy and other associated factors in sekondi-takoradi, ghana. African Health Sciences, 15(4), 1087. https://doi.org/10.4314/ahs.v15i4.6 DOI: https://doi.org/10.4314/ahs.v15i4.6
Ouzennou, N., Amor, H., & Baali, A. (2019). Socio-economic, cultural and demographic profile of a group of moroccan anaemic pregnant women. African Health Sciences, 19(3), 2654-2659. https://doi.org/10.4314/ahs.v19i3.41 DOI: https://doi.org/10.4314/ahs.v19i3.41
Rosillo, S. R., Dimbu, P. R., Cndido, A. L. M., Oh, J. M., Ferreira, C. M., Nieto Andrade, B., Labuda, S., Horth, R., Kelley, J., Morais, J. F. M., Fortes, F., Martins, J. F., Talundzic, E., & Pluciski, M. M. (2023). Molecular markers of sulfadoxine-pyrimethamine resistance in samples from children with uncomplicated Plasmodium falciparum at three sites in Angola in 2019. Antimicrobial Agents and Chemotherapy, 67(4), e0160122. https://doi.org/10.1128/aac.01601-22 DOI: https://doi.org/10.1128/aac.01601-22
Sabin, L., Hecht, E., Brooks, M., Singh, M., Yeboah-Antwi, K., Rizal, A., & Hamer, D. (2018). Prevention and treatment of malaria in pregnancy: what do pregnant women and health care workers in east india know and do about it?. Malaria Journal, 17(1). https://doi.org/10.1186/s12936-018-2339-9 DOI: https://doi.org/10.1186/s12936-018-2339-9
Tuedom, A. G. B., Sarah-Matio, E. M., Moukoko, C. E. E., Feufack-Donfack, B. L., Maffo, C. N., Bayibeki, A. N., ... & Nsango, S. E. (2021). Antimalarial drug resistance in the Central and Adamawa regions of Cameroon: Prevalence of mutations in P. falciparum crt, Pfmdr1, Pfdhfr and Pfdhps genes. PLoS One, 16(8), e0256343. DOI: https://doi.org/10.1371/journal.pone.0256343
Vandy, A., Peprah, N., Jerela, J., Titiati, P., Manu, A., Akamah, J., & Torpey, K. (2019). Factors influencing adherence to the new intermittent preventive treatment of malaria in pregnancy policy in keta district of the volta region, ghana. BMC Pregnancy and Childbirth, 19(1). https://doi.org/10.1186/s12884-019-2544-8 DOI: https://doi.org/10.1186/s12884-019-2544-8
Wang, X., Zhang, X., Chen, H., Lu, Q., Ruan, W., & Chen, Z. (2022). Molecular determinants of sulfadoxine-pyrimethamine resistance in Plasmodium falciparum isolates from Central Africa between 2016 and 2021: Wide geographic spread of highly mutated Pfdhfr and Pfdhps alleles. Microbiology Spectrum, 10(5), e02005-22. DOI: https://doi.org/10.1128/spectrum.02005-22
World Health Organization. (2021). World Malaria Report 2020. World Health Organization.Geneva. Accessed Sept 11, 2021.
Yola, A., Tukur, Z., & Dantata, A. (2018). Prevalence of malaria infection in pregnant women attending bamalli nuhu maternity specialist hospital, kano, nigeria. Bayero Journal of Pure and Applied Sciences, 11(1), 82-85. https://doi.org/10.4314/bajopas.v11i1.15 DOI: https://doi.org/10.4314/bajopas.v11i1.15
Copyright (c) 2025 FUDMA JOURNAL OF SCIENCES
This work is licensed under a Creative Commons Attribution 4.0 International License.
FUDMA Journal of Sciences
