Chloroquine Can No Longer be Considered as First Line of Treatment of P.falciparum malaria in Gezira State, Sudan.

  • Mohammed Abdelwahed National Cancer Institute, University of Gezira (NCI-UofG)-Sudan
  • Ahmed El Tahir King Fahad medical city, Riyadh, Saudi Arabia
  • Moawia Elbalal Faculty of Medicine University of Gezira-Sudan
  • Mohammed Elamien 2. King Fahad medical city, Riyadh, Saudi Arabia
  • Azahari M. H. National Cancer Institute, University of Gezira (NCI-UofG)-Sudan
  • Adil Mergani Taif University, College of Applied Health Sciences
  • Nasr Eldin . M. A. Elwali College of Medicine, Imam Muhammed Bin Saud Islamic University, Riyadh, Saudi Arabia


Malaria is an infectious disease caused by Plasmodium family which transmitted by the Anopheles mosquito. Chloroquine resistant malaria is alarming severe health problem worldwide. The use of in vivo, in vitro and molecular markers in surveying chloroquine resistance may constitute as an important tool to overcome this problem. The aim of this study is to assess the chloroquine resistance of P. falciparum in central Sudan using in vivo and in vitro assays.

Sixty-four (64) patients affected with P. falciparum were selected. Follow-up for fourteen days was used. Only forty patients completed the follow-up.

The in vitro assay showed that 32/40 (80%) of the P. falciparum isolates were resistant to Chloroquine and 10/40 (20%) isolates were sensitive to chloroquine regimen.

The in vivo study showed that 22/40 (54%) were found to be very well responded with adequate clinical response, however, 18/40 (46%) were being resistant with 9/40 (23%) having early treatment failure (ETF) and 9/40 (23%) having late treatment failure (LTF). All the treatment failures were treated with Artemether or Quinine.

The study concluded that chloroquine could no longer be considered as the first defense line of treating the P. falciparum malaria parasite in central Sudan.


1. WHO. World malaria report 2014. Geneva: WHO; 2014. Google Scholar. 2016:32 - 42.
2. Milner DA, Jr. Malaria Pathogenesis. Cold Spring Harbor perspectives in medicine. 2018;8(1).
3. WHO. Severe falciparum malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2000;94:1-90.
4. Perkins DJ, Were T, Davenport GC, Kempaiah P, Hittner JB, Ong'echa JM. Severe malarial anemia: innate immunity and pathogenesis. International journal of biological sciences. 2011;7(9):1427.
5. Rich SM, Leendertz FH, Xu G, LeBreton M, Djoko CF, Aminake MN, Takang EE, Diffo JL, Pike BL, Rosenthal BM, Formenty P, Boesch C, Ayala FJ, Wolfe ND. The origin of malignant malaria. Proceedings of the National Academy of Sciences of the United States of America. 2009;106(35):14902-7.
6. Perlmann P, Bjorkman A. Malaria research: host-parasite interactions and new developments in chemotherapy, immunology and vaccinology. Current opinion in infectious diseases. 2000;13(5):431-43.
7. Report. WM. Switzerland: Geneva: World Health Organization; 2014. p. pp. 32-42. ISBN 978-92-4156483-0.

8. Elovainio M, Heponiemi T, Kuusio H, Sinervo T, Hintsa T, Aalto AM. Developing a short measure of organizational justice: a multisample health professionals study. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. 2010;52(11):1068-74.
9. Mullegger RR, Glatz M. Skin manifestations of lyme borreliosis: diagnosis and management. Am J Clin Dermatol. 2008;9(6):355-68.
10. Noedl H, Se Y, Schaecher K, Smith BL, Socheat D, Fukuda MM. Evidence of artemisinin-resistant malaria in western Cambodia. New England Journal of Medicine. 2008;359(24):2619-20.
11. WHO. Guidelines for the treatment of malaria: World Health Organization; 2015.
12. Omer AH. Response of Plasmodium falciparum in Sudan to oral chloroquine. The American journal of tropical medicine and hygiene. 1978;27(5):853-7.
13. Wernsdorfer WH, Kouznetsov RL. Drug-resistant malaria--occurrence, control, and surveillance. Bulletin of the World Health Organization. 1980;58(3):341-52.
14. Bayoumi RA, Bashir AH, Abdulhadi NH. Resistance to falciparum malaria among adults in central Sudan. Am J Trop Med Hyg. 1986;35(1):45-55.
15. Bayoumi RA, Babiker HA, Ibrahim SM, Ghalib HW, Saeed BO, Khider S, Elwasila M, Karim EA. Chloroquine-resistant Plasmodium falciparum in eastern Sudan. Acta tropica. 1989;46(3):157-65.
16. Ibrahim AM, Ali FR, Ali ME. Assessment of chloroquine resistance of Plasmodium falciparum in children of Wad Medani (Central Sudan). Journal of tropical pediatrics. 1992;38(4):162-6.
17. WHO. Assessment of therapeutic efficacy for uncomplicated falciparum malaria in areas with intense transmission. Geneva, WHO. 1996;(WHO/MAL/96.1077).

18. Rieckmann KH, Campbell GH, Sax LJ, Mrema JE. Drug sensitivity of plasmodium falciparum. An in-vitro microtechnique. Lancet. 1978;1(8054):22-3.
19. Wongsrichanalai C, Pickard AL, Wernsdorfer WH, Meshnick SR. Epidemiology of drug-resistant malaria. The Lancet Infectious diseases. 2002;2(4):209-18.
20. Yousif MA, Adeel AA. Antimalarials prescribing patterns in Gezira State: precepts and practices. Eastern Mediterranean health journal. 2000;6(5-6):939-47.
21. Yavo W, Menan EI, Adjetey TA, Barro-Kiki PC, Nigue L, Konan YJ, Nebavi NG, Kone M. [In vivo sensitivity of Plasmodium falciparum to amino-4-quinolines and sulfadoxine pyrimethamine in Agou (Ivory Coast)]. Pathologie-biologie. 2002;50(3):184-8.
22. Villadary I, Paquet C, Hemelsdael E, Blanchard G, Saki ZM. [In vivo drug sensitivity of Plasmodium falciparum in the Tabou region of Ivory Coast]. Bull Soc Pathol Exot. 1997;90(1):10-3.
23. Landgraf B, Kollaritsch H, Wiedermann G, Wernsdorfer WH. Plasmodium falciparum: susceptibility in vitro and in vivo to chloroquine and sulfadoxine-pyrimethamine in Ghanaian schoolchildren. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1994;88(4):440-2.
24. Rukaria RM, Ojwang SB, Oyieke JB, Kigondu CB. In vivo and in vitro response of Plasmodium falciparum to chloroquine in pregnant women in Kilifi district, Kenya. East African medical journal. 1992;69(6):306-10.
25. Hastings IM, D'Alessandro U. Modelling a predictable disaster: the rise and spread of drug-resistant malaria. Parasitol Today. 2000;16(8):340-7.
26. Wernsdorfer WH, Payne D. The dynamics of drug resistance in Plasmodium falciparum. Pharmacology & therapeutics. 1991;50(1):95-121.
27. Wongsrichanalai C, Sirichaisinthop J, Karwacki JJ, Congpuong K, Miller RS, Pang L, Thimasarn K. Drug resistant malaria on the Thai-Myanmar and Thai-Cambodian borders. The Southeast Asian journal of tropical medicine and public health. 2001;32(1):41-9.
28. Winstanley P. Modern chemotherapeutic options for malaria. The Lancet Infectious diseases. 2001;1(4):242-50.
29. Wernsdorfer WH. Epidemiology of drug resistance in malaria. Acta tropica. 1994;56(2-3):143-56.
30. Djimde AA, Doumbo OK, Traore O, Guindo AB, Kayentao K, Diourte Y, Niare-Doumbo S, Coulibaly D, Kone AK, Cissoko Y, Tekete M, Fofana B, Dicko A, Diallo DA, Wellems TE, Kwiatkowski D, Plowe CV. Clearance of drug-resistant parasites as a model for protective immunity in Plasmodium falciparum malaria. The American journal of tropical medicine and hygiene. 2003;69(5):558-63.
31. Ibrahim AM. Response of Plasmodium falciparum to antimalarial drugs in vitro at Wad Madani, Sudan. Acta Path Microbiol Scand. 1988;3:4-6.
32. Kouznetsov RL, Rooney W, Wernsdorfer WH, El Gaddal AA, Payne D, Abdalla RE. Use of the in vitro microtechnique for the assessment of drug sensitivity of Plasmodium falciparum in Sennar, Sudan. Bulletin of the World Health Organization. 1980;58(5):785-9.
33. Baird JK, Basri H, Jones TR, Purnomo, Bangs MJ, Ritonga A. Resistance to antimalarials by Plasmodium falciparum in Arso PIR, Irian Jaya, Indonesia. The American journal of tropical medicine and hygiene. 1991;44(6):640-4.
34. Basco LK, Ringwald P. Molecular epidemiology of malaria in Yaounde, Cameroon II. Baseline frequency of point mutations in the dihydropteroate synthase gene of Plasmodium falciparum. Am J Trop Med Hyg. 1998;58(3):374-7.
How to Cite
ABDELWAHED, Mohammed et al. Chloroquine Can No Longer be Considered as First Line of Treatment of P.falciparum malaria in Gezira State, Sudan.. Gezira Journal of Health Sciences, [S.l.], v. 14, n. 2, dec. 2018. ISSN 1810-5386. Available at: <>. Date accessed: 25 mar. 2019.