Drugs Resistance Gene Mutation (MDR1) of Plasmodium falciparum in East, South and Central Sudan

Introduction: Malaria remains a major public health concern worldwide. According to the World Health Organization (WHO), in 2017, an estimated 219 million people were infected with malaria, leading to 435,000 deaths, predominantly affecting vulnerable populations in Africa. In 2004, Sudan implemented the artesunate and sulfadoxine/pyrimethamine (SP) combination as its primary treatment due to the significant resistance of falciparum to antimalarial medications. Every year, epidemic malaria claims the lives of around one million people, the majority of whom are not African. With an estimated 7.5 million cases and 35000 fatalities annually, malaria remains a serious health issue in Sudan. Methods: The purpose of this comprehensive study was to identify the antidrug-resistant gene (1-Pfmdr) across four states in Sudan. This cross-sectional study, conducted from July 2019 to December 2022, involved the collection of three ml blood samples from all study participants to identify the malaria parasite Falciparum using blood smears stained with Giemsa. The study focused on 225 positive samples of Falciparum, collected from five states: Kassala, Khartoum, Singa, Abu Hojar, and Damazin, including 50.3% males and 49.7% females, for the detection of the multidrug resistance gene (1-Pfmdr), which encompasses comprehensive, intermediate, and low endemic areas in Sudan. Results: Of the 193 samples screened using PCR, seventeen positive results were sent for genetic sequencing to analyze genetic mutations across different areas in Sudan from ages 1 to 60 years. The highest prevalence of the mutant allele N (26.9%) was recorded in Ad-Damazin, while the lowest prevalence of N (8.8%) was found in Khartoum. The study indicated the presence of five genetic mutations of the malaria resistance gene P. falciparum at position 184 of the gene sequence, revealing a significant relationship between the parasite load and the study site P=0.000 while showing no significant relationship between parasite load and age group P=0.655 or sex P=0.148. Conclusion: The findings suggest the occurrence of genetic mutations in malaria resistance markers following the implementation of dual treatment.