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Background:

Since 2014, seasonal malaria chemoprevention (SMC) with amodiaquine-sulfadoxine-pyrimethamine (AQ-SP) has been implemented on a large scale during the high malaria transmission season in Burkina Faso. We report in this paper the prevalence of microscopic and submicroscopic malaria infection at the outset and after the first round of SMC in children under five years old in Bama, Burkina Faso, as well as host and parasite factors involved in mediating the efficacy and tolerability of SMC.

Methods:

: Two sequential cross-sectional surveys were carried out in the first month of SMC in a rural area in southwest Burkina Faso. Blood smears and dried blood spots were collected from 106 and 93 children under five, respectively, at the start of SMC and again three weeks later. Malaria infection was detected by microscopy and by PCR from dried blood spots. For all children, day 7 plasma concentrations of desethyl-amodiaquine (DEAQ) were measured and CYP2C8 genetic variants influencing AQ metabolism were genotyped. Samples were additionally genotyped for pfcrt K76T and pfmdr1 N86Y, molecular markers associated with reduced amodiaquine susceptibility.

Results:

: 2.8%(3/106) of children were positive for Plasmodium falciparum infection by microscopy and 13.2%(14/106) by nested PCR within 2 days of SMC administration. Three weeks after SMC administration, in the same households, 4.3%(4/93) of samples were positive by microscopy and 14.0%(13/93) by PCR (p= 0.0007). CYP2C8* 2, associated with impaired amodiaquine metabolism, was common with an allelic frequency of 17.1%(95% CI= 10.0-24.2). Day 7 …