Assessment of Glucose-6 phosphate dehydrogenase deficiency in malaria suspected patients attending at Shele and Lante Health Center, Southern Ethiopia

Abstract

Background In Ethiopia, an estimated 68 million peoples are at risk of malaria – 60% caused by Plasmodium falciparum and 40% by Plasmodium vivax. The national elimination program has begun a journey since 2016 with a vision to see a malaria-free country by 2030. The radical cure of P. vivax with the drug primaquine is an important component of the elimination strategy. However, Primaquine causes acute hemolytic anemia in glucose-6 phosphate dehydrogenase enzyme deficient cases and is a threat to P. vivax elimination. G6PD is a cytoplasmic enzyme for all human cells that involves in the pentose phosphate pathway of metabolic reaction and protects red blood cells from cellular oxidative damage by detoxifying free radicals. This study is therefore carried out to determine the G6PD deficiency prevalence among malaria-suspected patients in the study sites. Method Health facility-based cross-sectional study was conducted in 2021 at Shele and Lante health centers. A total of 858 self-presented malaria suspected patients were enrolled in this study. The socio-demographic and clinical information of the study participants were collected using a pre-validated questionnaire, entered into Epi Info™ 7 software, and analyzed using SPSS V.20 statistical software. Finger prick blood samples were collected for onsite CareSTART G6PD biosensor analyzer test, dried blood spot (DBS) preparation, and malaria microscopy. The DBS samples are used for molecular confirmation of G6PD deficiency. Results A total of 858 study participants of which 49.3% (423) were males with the median and interquartile age range of 26 and 21 years, respectively were enrolled in the study. Of all the study participants, 14.3%, 9.3%, and 4.1% were microscopy positive for P. falciparum, P. vivax, and mixed parasites, respectively. The phenotypic CareSTART biosensor analyzer G6PD deficiency rate was 4.8% (41/858). Whereas the molecular genotyping result analyzed in selected 13 patients have shown G6PD gene mutation in 10 (76.9%) of the samples. Particularly G267 + 119C/T mutations were seen in 9 of 13 (69.2%), A376G in 3/13 (23.1%), and G1116A in 3/13 (23.1%). In addition, new mutations such as A376T (A◊T) 2/13 (15.4%) and G1116T (G◊T 1/13 (77 %) were also identified. Conclusion and recommendation : The result implied that G6PD deficiency among the study participants is not significantly high. In addition, the G267 + 119C/T mutation was the most frequent variant reported in this study. Therefore, it is recommended to consider hemolysis risk while prescribing the primaquine drug in the study area.