ArticleThe Journal of infectious diseases2026
Recurrent Plasmodium falciparum Parasitemia and Drug Resistance Mutations During Intermittent Preventive Treatment of Malaria in Pregnancy in Uganda.
Article in The Journal of infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Sustained high prevalence of multiple antimalarial drug resistance markers in Uganda in 2023-2024.Antimicrobial agents and chemotherapy · 2026Article
- Sustained High Prevalence of Multiple Antimalarial Drug Resistance Markers in Uganda in 2023-24.medRxiv : the preprint server for health sciences · 2026Article
Corrections and comments
- Update ofRecurrent2025
Authors and funding
16 authors.
Funding
Abstract
backgroundIntermittent preventive treatment with monthly sulfadoxine-pyrimethamine (IPTp-SP) is recommended during pregnancy in malaria-endemic countries. However, widespread resistance of Plasmodium falciparum to SP has compromised its efficacy, and the alternative dihydroartemisinin-piperaquine (DP) is under study. Potential selection of drug resistance is important.
methodsWe sequenced 1377 samples collected from pregnant women enrolled in a trial comparing monthly SP, DP, and DP + SP for IPTp in Busia, Uganda and with asymptomatic parasitemia at the time of IPTp administration. We characterized known markers of drug resistance and assessed the 28-day cumulative risk of recurrent parasitemia, with genotyping to distinguish recrudescence from new infections.
resultsAmong 771 samples collected on the day IPTp was initiated, the prevalences of 5 resistance mutations in P. falciparum dihydrofolate reductase (PfDHFR) and dihydropteroate synthase (PfDHPS) were nearly 100%, and the PfDHFR I164L and PfDHPS A581G mutations, associated with high-level resistance, had combined prevalence of 26.5%. The cumulative risks of recurrent parasitemia (SP 57.8%, DP 4.1%, DP + SP 3.9%), symptomatic malaria (SP 9.3%, DP 1.1%, DP + SP 0.3%), and recrudescent parasitemia (SP 40.1%, DP 2.0%, DP + SP 0.8%) were all significantly greater in the SP arm, with risks greatest in primigravidae. In the IPT-SP arm, the combined prevalence of the PfDHFR I164L and PfDHPS A581G mutations increased significantly from 24.9% at initiation of IPTp to 35.2% after receipt of IPTp-SP. Infection with mutant parasites was associated with non-significant increases in risks of recrudescence.
conclusionsIntermittent preventive treatment with monthly sulfadoxine-pyrimethamine had poor antimalarial preventive efficacy and selected for increased drug resistance, questioning the value of this intervention.
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