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    Genetic diversity and drug resistance surveillance of Plasmodium falciparum for malaria elimination: is there an ideal tool for resource-limited sub-Saharan Africa?

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    Author
    Apinjoh, T.O.
    Ouattara, A.
    Titanji, V.P.K.
    Date
    2019
    Journal
    Malaria journal
    Publisher
    BioMed Central
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1186/s12936-019-2844-5
    Abstract
    The intensification of malaria control interventions has resulted in its global decline, but it remains a significant public health burden especially in sub-Saharan Africa (sSA). Knowledge on the parasite diversity, its transmission dynamics, mechanisms of adaptation to environmental and interventional pressures could help refine or develop new control and elimination strategies. Critical to this is the accurate assessment of the parasite's genetic diversity and monitoring of genetic markers of anti-malarial resistance across all susceptible populations. Such wide molecular surveillance will require selected tools and approaches from a variety of ever evolving advancements in technology and the changing epidemiology of malaria. The choice of an effective approach for specific endemic settings remains challenging, particularly for countries in sSA with limited access to advanced technologies. This article examines the current strategies and tools for Plasmodium falciparum genetic diversity typing and resistance monitoring and proposes how the different tools could be employed in resource-poor settings. Advanced approaches enabling targeted deep sequencing is valued as a sensitive method for assessing drug resistance and parasite diversity but remains out of the reach of most laboratories in sSA due to the high cost of development and maintenance. It is, however, feasible to equip a limited number of laboratories as Centres of Excellence in Africa (CEA), which will receive and process samples from a network of peripheral laboratories in the continent. Cheaper, sensitive and portable real-time PCR methods can be used in peripheral laboratories to pre-screen and select samples for targeted deep sequence or genome wide analyses at these CEAs.
    Keyword
    Drug resistance
    Genetic diversity
    Monitoring
    Plasmodium falciparum
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85068895175&doi=10.1186%2fs12936-019-2844-5&partnerID=40&md5=a7ee667599293eaee534976b87d0abd0; http://hdl.handle.net/10713/10643
    ae974a485f413a2113503eed53cd6c53
    10.1186/s12936-019-2844-5
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    UMB Open Access Articles 2019

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