BackgroundSince 2006, the artemisinin-based combination therapy (ACT) are recommended to treat uncomplicated malaria including non Plasmodium falciparum malaria in Madagascar. Artesunate–amodiaquine (ASAQ) and artemether–lumefantrine are the first- and second-line treatment in uncomplicated falciparum malaria, respectively. No clinical drug efficacy study has been published since 2009 to assess the efficacy of these two artemisinin-based combinations in Madagascar, although the incidence of malaria cases has increased from 2010 to 2016. In this context, new data about the efficacy of the drug combinations currently used to treat malaria are needed.MethodsTherapeutic efficacy studies evaluating the efficacy of ASAQ were conducted in 2012, 2013 and 2016 among falciparum malaria-infected patients aged between 6 months and 56 years, in health centres in 6 sites representing different epidemiological patterns. The 2009 World Health Organization protocol for monitoring anti-malarial drug efficacy was followed.ResultsA total of 348 enrolled patients met the inclusion criteria including 108 patients in 2012 (n = 64 for Matanga, n = 44 for Ampasipotsy), 123 patients in 2013 (n = 63 for Ankazomborona, n = 60 for Anjoma Ramartina) and 117 patients in 2016 (n = 67 for Tsaratanana, n = 50 for Antanimbary). The overall cumulative PCR-corrected day 28 cure rate was 99.70% (95% IC 98.30–99.95). No significant difference in cure rates was observed overtime: 99.02% (95% IC 94.65–99.83) in 2012; 100% (95% IC 96.8–100) in 2013 and 100% (95% IC 96.65–100) in 2016.ConclusionThe ASAQ combination remains highly effective for the treatment of uncomplicated falciparum malaria in Madagascar.

BackgroundThe assessment of the genetic diversity of Plasmodium falciparum parasites from various malaria transmission settings could help to define tailored and dedicated local strategies for malaria control and elimination. To date, this information is scarce in Madagascar. To fill this gap, a study aiming at investigating the genetic diversity of P. falciparum populations in three epidemiological facies (Equatorial, Tropical and Fringes) in Madagascar was conducted.MethodsTwo hundred sixty-six P. falciparum isolates were obtained from patients with uncomplicated malaria enrolled in clinical drug efficacy studies conducted in health centers at Tsaratanana (Equatorial facies), Antanimbary (Tropical facies) and Anjoma Ramartina (Fringes) in 2013 and 2016. Parasite DNA was extracted from blood samples collected prior antimalarial treatment. Plasmodium species were identified by nested-PCR targeting 18S rRNA gene. The genetic profiles of P. falciparum parasites were defined by assessing the polymorphic regions of the msp-1 and msp-2 genes using allele-specific nested-PCR.ResultsA total of 58 alleles were detected for msp-1 (18 alleles) and msp-2 (40 alleles) among P. falciparum samples tested. K1 (62.9%, 139/221) and FC27 (69.5%, 114/164) were the most predominant msp-1 and msp-2 allelic families, although the proportions of the msp-1 and msp-2 alleles varied significantly between sites. Polyclonal infections were more frequent in site located in the Equatorial facies (69.8%) compared to sites in the Tropical facies (60.5%) and Fringes (58.1%). Population genetic measures showed that the genetic diversity was similar between sites and the parasite flow within sites was limited.ConclusionThis study provides recent information on the genetic diversity of P. falciparum populations in three transmission facies in Madagascar and valuable baseline data to further evaluate the impact of the control measures implemented in Madagascar.

Background Assessment of the genetic diversity of Plasmodium falciparum parasites from various malaria transmission settings could help to define tailored local strategies for malaria control and elimination. Such assessments are currently scarce in Madagascar. The study presented here aimed to bridge this gap by investigating the genetic diversity of P. falciparum populations in three epidemiological strata (Equatorial, Tropical and Fringes) in Madagascar. Methods Two-hundred and sixty-six P. falciparum isolates were obtained from patients with uncomplicated malaria enrolled in clinical drug efficacy studies conducted at health centres in Tsaratanana (Equatorial stratum), Antanimbary (Tropical stratum) and Anjoma Ramartina (Fringes) in 2013 and 2016. Parasite DNA was extracted from blood samples collected before anti-malarial treatment. Plasmodium species were identified by nested PCR targeting the 18 S rRNA gene. The genetic profiles of P. falciparum parasites were defined by allele-specific nested PCR on the polymorphic regions of the msp-1 and msp-2 genes. Results Fifty-eight alleles were detected in the P. falciparum samples tested: 18 alleles for msp-1 and 40 for msp-2. K1 (62.9%, 139/221) and FC27 (69.5%, 114/164) were the principal msp-1 and msp-2 allele families detected, although the proportions of the msp-1 and msp-2 alleles varied significantly between sites. Polyclonal infections were more frequent at sites in the Equatorial stratum (69.8%) than at sites in the Tropical stratum (60.5%) or Fringes (58.1%). Population genetics analyses showed that genetic diversity was similar between sites and that parasite flow within sites was limited. Conclusions This study provides recent information about the genetic diversity of P. falciparum populations in three transmission strata in Madagascar, and valuable baseline data for further evaluation of the impact of the control measures implemented in Madagascar.