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Background  The emergence and spread of drug resistance represents one of the biggest challenges for malaria control in endemic regions. Sulfadoxine-pyrimethamine (SP) is currently deployed as intermittent preventive treatment in pregnancy (IPTp) to prevent the adverse effects of malaria on the mother and her offspring. Nevertheless, its efficacy is threatened by SP resistance which can be estimated by the prevalence of dihydropteroate synthase ( dhps ) and dihydrofolate reductase ( dhfr ) mutations. This was measured among pregnant women in the health district of Nanoro, Burkina Faso.    Methods  From June to December 2010, two hundred and fifty six pregnant women in the second and third trimester, attending antenatal care with microscopically confirmed malaria infection were invited to participate, regardless of malaria symptoms. A blood sample was collected on filter paper and analyzed by PCR-RFLP for the alleles 51, 59, 108, 164 in the  pfdhfr  gene and 437, 540 in the  pfdhps  gene.    Results  The genes were successfully genotyped in all but one sample (99.6%; 255/256) for  dhfr  and in 90.2% (231/256) for  dhps . The  dhfr  C59R and S108N mutations were the most common, with a prevalence of 61.2% (156/255) and 55.7% (142/255), respectively; 12.2% (31/255) samples had also the  dhfr  N51I mutation while the I164L mutation was absent. The  dhps  A437G mutation was found in 34.2% (79/231) isolates, but none of them carried the codon K540E. The prevalence of the  dhfr  double mutations N  RN  I and the triple mutations   IRN  I was 35.7% (91/255) and 11.4% (29/255), respectively.    Conclusion  Though the mutations in the  pfdhfr  and  pfdhps  genes were relatively common, the prevalence of the triple  pfdhfr  mutation was very low, indicating that SP as IPTp is still efficacious in Burkina Faso.

plos one

Prevalence of the dhfr and dhps Mutations among Pregnant Women in Rural Burkina Faso Five Years after the Introduction of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine