{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T09:45:34Z","timestamp":1769852734147,"version":"3.49.0"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,1,25]],"date-time":"2015-01-25T00:00:00Z","timestamp":1422144000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Artesunate plus sulfadoxine\u2013pyrimethamine (AS\u00a0+\u00a0SP) has been Somalia's national treatment policy since 2006. Routine monitoring of first\u2010line malaria treatment is needed to ensure appropriate national malaria treatment policy and early detection of drug resistance. For this purpose, we conducted therapeutic efficacy studies of AS\u00a0+\u00a0SP for the treatment of uncomplicated malaria in Somalia in 2011.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Studies were conducted in three sentinel sites. Eligible patients were evaluated for clinical and parasitological outcomes according to the WHO standard protocol. Molecular surveillance was conducted on resistance conferring mutations in the <jats:italic>P.falciparum<\/jats:italic> dihydrofolate reductase (<jats:italic>dfhr<\/jats:italic>) and dihydropteroate synthase (<jats:italic>dhps<\/jats:italic>) genes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The proportion of PCR\u2010corrected treatment failures was high in Jamame (22%, 95% CI: 13.7\u201332.8%) and low (&lt;5%) in Janale and Jowhar. All patients cleared parasites by day 3. Molecular markers associated with SP resistance were detected in all three sites. Treatment failure was associated with the presence of the double mutant <jats:italic>dhps<\/jats:italic> A437G\/K540E (OR\u00a0=\u00a022.4, 95% CI: 5.1\u201398.1), quadruple mutant <jats:italic>dhfr<\/jats:italic> N51I\/S108N+<jats:italic>dhps<\/jats:italic> A437G\/K540E (OR\u00a0=\u00a05.5, 95% CI: 2.3\u201313.6), quintuple mutant <jats:italic>dhfr<\/jats:italic> N51I\/C59R\/S108N+<jats:italic>dhps<\/jats:italic> A437G\/K540E (OR\u00a0=\u00a03.5, 95% CI: 1.4\u20138.8) and younger age (OR=0.86, 95% CI: 0.76\u20130.96).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The high treatment failure rate observed in Jamame, together with the presence of molecular mutations associated with SP resistance, indicates <jats:italic>P.\u00a0falciparum<\/jats:italic> resistance to SP. In Jowhar, high treatment failure rates were absent despite the presence of molecular mutations; signs of resistance <jats:italic>in vivo<\/jats:italic> may have been masked by the stronger immunity of the older study population. The study underscores the need to update Somalia's national malaria treatment policy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12458","type":"journal-article","created":{"date-parts":[[2015,1,13]],"date-time":"2015-01-13T07:55:05Z","timestamp":1421135705000},"page":"510-517","source":"Crossref","is-referenced-by-count":23,"title":["Treatment of uncomplicated malaria with artesunate plus sulfadoxine\u2013pyrimethamine is failing in Somalia: evidence from therapeutic efficacy studies and <i>Pfdhfr<\/i> and <i>Pfdhps<\/i> mutant alleles"],"prefix":"10.1111","volume":"20","author":[{"given":"Marian","family":"Warsame","sequence":"first","affiliation":[{"name":"Global Malaria Programme World Health Organization Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdillahi Mohamed","family":"Hassan","sequence":"additional","affiliation":[{"name":"World Health Organization WHO Office Mogadishu Somalia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Barrette","sequence":"additional","affiliation":[{"name":"Global Malaria Programme World Health Organization Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali Mohamed","family":"Jibril","sequence":"additional","affiliation":[{"name":"INTERSOS Jowhar Hospital Middle Shabele Somalia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Husein Haji","family":"Elmi","sequence":"additional","affiliation":[{"name":"Muslim Aid UK Jamame Lower Juba Region Somalia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulkadir Mohamed","family":"Arale","sequence":"additional","affiliation":[{"name":"Ministry of Health and Human Service Mogadishu Somalia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanan El","family":"Mohammady","sequence":"additional","affiliation":[{"name":"US Naval Medical Research Unit\u20103 Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rania A.","family":"Nada","sequence":"additional","affiliation":[{"name":"US Naval Medical Research Unit\u20103 Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamal Ghilan Hefzullah","family":"Amran","sequence":"additional","affiliation":[{"name":"World Health Organization WHO Somalia Warwick Centre UN Avenue Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdikarim","family":"Muse","sequence":"additional","affiliation":[{"name":"World Health Organization WHO Office Hargeisa Somalia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fahmi Essa","family":"Yusuf","sequence":"additional","affiliation":[{"name":"World Health Organization WHO Office Hargeisa Somalia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdiqani Sheikh","family":"Omar","sequence":"additional","affiliation":[{"name":"Ministry of Health and Human Service Mogadishu Somalia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,1,25]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"World Malaria Report 2013","author":"WHO","year":"2013"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-7-159"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2008.10.009"},{"key":"e_1_2_6_5_1","volume-title":"Global Report on Antimalarial Efficacy and Drug Resistance: 2000\u20132010","author":"WHO","year":"2010"},{"key":"e_1_2_6_6_1","volume-title":"Guidelines for the Treatment of Malaria","author":"WHO","year":"2010"},{"key":"e_1_2_6_7_1","volume-title":"Updated WHO Policy Recommendation: Intermittent Preventive Treatment of Malaria in Pregnancy Using Sulfadoxine\u2010Pyrimethamine (IPTp\u2010SP)","author":"WHO","year":"2012"},{"key":"e_1_2_6_8_1","volume-title":"Status Report on Artemisinin Resistance","author":"WHO","year":"2014"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)12951-0"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/3-540-29088-5_3"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001432-200312000-00007"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1086\/338566"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-10-123"},{"key":"e_1_2_6_14_1","doi-asserted-by":"crossref","first-page":"696","DOI":"10.4269\/ajtmh.2004.71.696","article-title":"Therapeutic efficacy of sulfadoxine\u2010pyrimethamine and prevalence of resistance markers in Tanzania prior to revision of malaria treatment policy: Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase mutations in monitoring in vivo resistance","volume":"71","author":"Mugittu K","year":"2004","journal-title":"Am J Trop Med Hyg"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1086\/315731"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1086\/315520"},{"key":"e_1_2_6_17_1","volume-title":"Methods for Surveillance of Antimalarial Drug Efficacy","author":"WHO","year":"2009"},{"key":"e_1_2_6_18_1","volume-title":"Methods and Techniques for Clinical Trials on Antimalarial Drug Efficacy: Genotyping to Identify Parasite Populations","author":"WHO","year":"2008"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1996.55.209"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00299-001-0399-7"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0035-9203(01)90250-0"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2004.01239.x"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pt.2007.11.008"},{"key":"e_1_2_6_24_1","doi-asserted-by":"crossref","first-page":"558","DOI":"10.4269\/ajtmh.2003.69.558","article-title":"Clearance of drug\u2010resistant parasites as a model for protective immunity in Plasmodium falciparum malaria","volume":"69","author":"Djimde AA","year":"2003","journal-title":"Am J Trop Med Hyg"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2005.06.015"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0025992"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-8-141"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1098876"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir376"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiq072"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0001934"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0009438"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1086\/592455"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2011.10-0512"}],"container-title":["Tropical Medicine &amp; International Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Ftmi.12458","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tmi.12458","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T20:21:55Z","timestamp":1696191715000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tmi.12458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,1,25]]},"references-count":33,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2015,4]]}},"alternative-id":["10.1111\/tmi.12458"],"URL":"https:\/\/doi.org\/10.1111\/tmi.12458","archive":["Portico"],"relation":{},"ISSN":["1360-2276","1365-3156"],"issn-type":[{"value":"1360-2276","type":"print"},{"value":"1365-3156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,1,25]]}}}