Prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in a malaria endemic region of Colombia: Implications for radical cure of Plasmodium vivax

Glucose-6-phosphate dehydrogenase deficiency (G6PDd) has important implications for the treatment of Plasmodium vivax , the predominant malaria species in Latin America. The only drug class available for P. vivax radical cure, the 8-aminoquinolines, can induce hemolysis in individuals with G6PDd. However, G6PDd prevalence among subpopulations and its relationship with Plasmodium infection remain poorly characterized. In Quibdó, Colombia, an area co-endemic for P. vivax and Plasmodium falciparum , cross-sectional surveys were conducted in three groups: 1) the general population, 2) Emberá dobida indigenous communities, and 3) febrile outpatients. G6PD status was determined using a quantitative test (STANDARD™ G6PD Test, SD BIOSENSOR, South Korea), and Plasmodium infection was assessed by polymerase chain reaction. G6PD activity was classified as deficient (≤4.0 IU/g hemoglobin), intermediate (4.1–6.0 in females), or normal (≥6.1 in females, ≥ 4.1 in males). Among 1,267, 194, and 542 participants in groups 1, 2, and 3, respectively, G6PDd prevalence was 10.4% overall and 13.7% among males in the predominantly Afro-Colombian general population, with no cases among indigenous participants. Among febrile outpatients, G6PDd prevalence was 6.9% overall and 8.2% among males, with a comparable but slightly lower prevalence among those with confirmed malaria. Plasmodium infection prevalence was 17.8%, 40.7%, and 47.8%, respectively. P. vivax mono-infection predominated in community surveys (59.1% and 60.8%), whereas P. falciparum predominated among febrile outpatients (55.6%). After adjustment for sex, Afro-Colombian ethnicity, and prior malaria, G6PD-deficient individuals in the asymptomatic general population had a lower risk of Plasmodium infection, primarily P. vivax (aPR, 0.05; 95% CI, 0.01–0.18), and none had P. vivax infection. These findings highlight high G6PDd prevalence among Afro-Colombians and its absence among an indigenous population with the highest P. vivax burden, suggesting that G6PDd may confer partial protection against P. vivax . This information can inform prioritization of more effective radical cure for at-risk subpopulations.