Genetic characterization of Plasmodium SPP and putative antimalarial drug resistant markers in the Central Region of Ghana

Abstract

BACKGROUND: Malaria eradication is hampered by the genetic diversity of Plasmodium falciparum, antimalarial resistance, and eco-geographical distinctions. The Central Region of Ghana harbours different ecological zones which may drive genetic diversity and influence resistance patterns in malaria infections. AIM: To investigate the genetic characteristics of Plasmodium species and putative Antimalarial drug resistant markers in the Central region. METHOD: This was a cross sectional study involving 3993 samples collected during the dry and wet seasons from selected health facilities within the Forest and Coastal zones of the Central region. Bivariate analysis determined the association of malaria with independent variables. Selective whole genome amplicon sequencing (sWGA) assay was used to characterise 522 malariapositive samples. RESULTS: Malaria prevalence was 61.8% by rapid diagnostic test and 61.1% by microscopy. Infection were associated with ecological zones (p<0.001) and seasons (p<0.001). Genomic analysis showed evidence of mixed P. falciparum, P. vivax, and P. malariae -(0.4%) amidst a high P. falciparum (98.9%) prevalence. Infections were mostly polyclonal (55.5%), ranging from one to six clones. Resistant haplotypes recorded were Pfcrt CVIET (0.5%), Pfmdr1 NFD (44%), Pfdhfr triple mutation (N51I, C59R, S108N)-76.6%, Pfdhps SGKAA (32.8%), and Pfdhps SGEAA (0.3%), and Pfkelch13 gene (48%). CONCLUSION: Malaria was prevalent in all districts and influenced by ecogeographic factors among others. Resistance was observed in all antimalarials studied. Multifaceted yet targeted interventions are required all year round for effective malaria control.