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Background  After years of disuse of chloroquine (CQ) as first-line anti-malarial drug in Ghana, reports from molecular studies conducted in parts of the country indicate varying prevalence of T76 mutation in the  pfcrt  gene. This situation has several health implications, one being that mutations that confer resistance to CQ have been reported to show substantial cross-resistance to other anti-malarial drugs. It is important to identify some of the factors contributing to the continuous presence of CQ resistance markers in the country. This study determined the prevalence of T76 mutation in  pfcrt  gene of  Plasmodium falciparum  isolates collected from selected areas of the Central region of Ghana and correlated with the level of CQ use in these areas.    Methods   Plasmodium falciparum  DNA was extracted from collected blood-blot filter paper samples in the study sites. The prevalence of T76 point mutation in  pfcrt  gene was assessed using nested PCR followed by RFLP. CQ from pharmacy and chemical shops was obtained using mystery buying method. The extent of CQ use by the participants was determined by measuring the level of the drug in their urine samples using the Saker-Solomon method.    Results  Of the 214  P. falciparum  isolates analysed, 71.9% were found to have T76 mutation of  pfcrt  gene. The study revealed that 14.49% of community pharmacies and chemical shops had stocks of CQ for sale while 16.9% of the participants had CQ in their urine samples. There is five times more risks of becoming infected with CQ resistant strain for staying in an area where CQ is stocked for sale [RR = 0.20, p < 0.0001] and thirteen times more risks of having CQ-resistant mutant from those who still use CQ than non-users [OR = 0.08, p < 0.0001].    Conclusion  This study has shown that high variation in the prevalence of T76 mutations of  P. falciparum  is linked with the level of CQ stocking and usage within study area.

Use of proscribed chloroquine is associated with an increased risk of pfcrt T76 mutation in some parts of Ghana