The return of chloroquine susceptible Plasmodium falciparum in Sub-Saharan Africa: a protocol for systematic review [post]

George M Bwire, Ritah Mutagonda, Amisa Tindamanyile, Tosi Mwakyandile, Belinda Jackson Njiro, Deodatus Sabas
2020 unpublished
Background: Following withdrawal and/or restricted use of chloroquine (CQ) as first line malaria treatment in many countries, studies have reported an increased number of CQ susceptible Plasmodium falciparum in several countries with subsequent dropping of CQ resistance. Since the future of malaria control and elimination is still uncertain with rising resistance in currently available antimalarials such as artemisinin based combination therapy (ACT), a review on current resistance profile of
more » ... stance profile of CQ in P. falciparum is of paramount importance.Methods: A systematic search in PubMed/MEDLINE, EMBASE, COCHRANE central, Google Scholar and Web of science will be done. We will consult thesis repositories to identify additional studies and search the websites of key healthcare organizations (World Health Organization (WHO), public health agencies). Similarly, a grey literature search will be done with help of Google. Data from 2000 and onwards published in English will be included and the reporting will be done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses Protocol (PRISMA-P).Discussion: This article provides a detailed account of this systematic review protocol that will be used to report the current status of CQ resistance in P. falciparum following its restricted use and/ or withdrawal as the first-line treatment of uncomplicated malaria. Mutations in P. falciparum chloroquine transporter (pfcrt) gene and P. falciparum multidrug resistance (pfmdr1) gene, predict the clinical outcomes following treatment using CQ. On the other hand, countries with restricted use of CQ observed CQ-susceptible P. falciparum reemergence and are now predominant. Subject to its susceptibility profile that will be generated from this review, CQ may still be considered for malaria prevention in some population groups such as children with sickle cell disease and pregnant women. Additionally, CQ may be reintroduced in future, ideally in combination with other antimalarial drugs, especially in areas where disappearance of chloroquine resistance is evident while safe and affordable alternatives antimalarials are limited.Systematic review registration: PROSPERO registration number CRD42020154844
doi:10.21203/rs.3.rs-26925/v1 fatcat:kt7p447mkvfzrh75j2p2ooz67i