Prevalence of molecular markers of chloroquine resistance in malaria parasites in East Africa: a systematic review and meta-analysis.

Background: Malaria is a serious global public health problem, which is caused by genus Plasmodium. Resistance of the human malaria parasite to antimalarial drugs is a public health concern in malaria endemic countries. Chloroquine is resistant for both P. vivax and P. falciparum. Chloroquine resistance is understood throughout all of Africa's P. falciparum endemic regions. Molecular markers play a crucial role in tracking and understanding the prevalence of antimalarial drug resistance. Currently, there is inadequate information on the prevalence of molecular markers of chloroquine resistance in malaria parasites.

Objective: This systematic review and meta-analysis aimed to determine the pooled prevalence of molecular markers of chloroquine resistance in malaria parasites in East Africa.

Methods: Systematic search was performed to retrieve articles from PubMed, Scopus, Science Direct, and the Google Scholar search engine. Twenty potential studies that provided important data on markers of chloroquine resistance in malaria parasites were systematically reviewed and analyzed. Five antimalarial drug resistance markers of chloroquine resistance were extracted separately into Microsoft Excel and analyzed using STATA 17.0. The Inverse of variance (I) was done to evaluate heterogeneity across studies. The funnel plot and the Egger's test were used to determine the existence or absence of publication bias. A trim-and-fill meta-analysis was carried out to generate a bias-adjusted effect estimate. A random effect model was used to determine the pooled prevalence of molecular markers associated with chloroquine resistance in malaria parasites. Subgroup analysis was performed based on country and year of publication.

Results: A total of 20 studies were included for this systematic review and meta-analysis. The molecular markers like K76T, 76T, N86Y, Y184F, and 86Y were selected for meta-analysis. From this meta-analysis, the pooled prevalence of K76T, 76T, N86Y, Y184F, and 86Y was 34.5 %, 47.3 %, 43.8 %, 58.3 %, and 29.2 %, respectively. After adjusting for publication bias, the estimated pooled prevalence of K76T, 76T, N86Y, Y184F, and 86Y were 34.5 %, 47.3 %, 43.8 %, 58.3 %, and 29.2 %, respectively. Meta-analysis showed a significant difference in all molecular marker prevalence like K76T and 86Y among studies on year of publication except 76T, N86Y, and Y184F. In addition, the meta-analysis showed a significant difference in all molecular marker prevalence like K76T, 76T, N86Y, Y184F, and 86Y among studies at the country level.

Conclusions: The findings of this systematic review and meta-analysis concerning the molecular markers of chloroquine resistance of malaria parasites in East Africa revealed a significant prevalence of antimalarial drug resistance markers of chloroquine. As a result, continued surveillance and monitoring of the prevalence of molecular markers of chloroquine resistance, identification and limitation of drug-resistant malaria parasite strains, and development of new antimalarial treatments are required to guide malaria treatment policies, interventions, control, and elimination of malaria worldwide.