Prevalence and molecular basis of glucose-6-phosphate dehydrogenase deficiency in Afghan populations: implications for treatment policy in the region

Malaria Journal

Research

Mohammad A Beg¹  Bushra Moiz¹  Amna Nasir¹  Martijn Vink²  Nader Mohammad³  Haroon ur Rasheed³  Omar Amanzai³  Abdul M Siddiqi³  Sakhi Jan³  Toby Leslie⁴ 

[1] Aga Khan University, Karachi, Pakistan;HealthNet TPO, Amsterdam, The Netherlands;HealthNet TPO, Kabul, Afghanistan;HealthNet TPO, Kabul, Afghanistan;London School of Hygiene and Tropical Medicine, London, UK;

关键词: Malaria;    G6PD;    Glucose-6-phosphate dehydrogenase deficiency;    Afghanistan;    Primaquine;    Vivax;    Relapse;   

DOI  :  10.1186/1475-2875-12-230

 received in 2013-04-25, accepted in 2013-07-01,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundGlucose-6-phosphate dehydrogenase deficiency (G6PD), an x-linked inherited enzymopathy, is a barrier to malaria control because primaquine cannot be readily applied for radical cure in individuals with the condition. In endemic areas, including in Afghanistan, the G6PD status of vivax patients is not routinely determined so the drug is rarely, if ever, prescribed even though it is included as a recommended treatment in local, regional and global guidelines. This study assessed the prevalence and genotype of G6PD deficiency in Afghan populations and examined the need for routine G6PD testing as a malaria treatment and control tool.MethodsA cross-sectional household survey was conducted using random sampling in five Afghan cities to determine the prevalence of G6PD deficiency in Afghan ethnic groups. Filter-paper blood spots were analysed for phenotypic G6PD deficiency using a fluorescent spot test. Molecular analysis was conducted to identify the genetic basis of the disorder.ResultsOverall, 45/1,436 (3.1%) people were G6PD deficient, 36/728 (5.0%) amongst males and 9/708 (1.3%) amongst females. Amongst males the prevalence was highest in the Pashtun ethnic group (10%, 26/260) while in Tajik males it was 8/250 (3.2%); in Hazara males it was 1/77 (1.3%) and in Uzbek males is was 0/125. Genetic testing in those with deficiency showed that all were of the Mediterranean type (Med-) characterized by a C-T change at codon 563 of the G6PD gene.ConclusionPrevalence of G6PD deficiency in Afghanistan varies considerably by ethnic group and is predominantly of the Mediterranean type. G6PD deficient individuals are susceptible to potentially severe and life-threatening haemolysis after standard primaquine treatment. If the aim of increasing access to radical treatment of vivax is to be successful reliable G6PD testing needs to be made routinely available within the health system.

【 授权许可】

CC BY   
© Leslie et al.; licensee BioMed Central Ltd. 2013