Evidence of Self-Medication with Chloroquine before Consultation for Malaria in the Southern Pacific Coast Region of Colombia

• Published in: The American journal of tropical medicine and hygiene Vol. 100; no. 1; pp. 66 - 71
• Main Authors: Diaz, Gustavo, Lasso, Alvaro Mauricio, Murillo, Claribel, Montenegro, Lidia M, Echeverry, Diego F
• Format: Journal Article
• Language: English
• Published: United States Institute of Tropical Medicine 01.01.2019; The American Society of Tropical Medicine and Hygiene
• Subjects: Adolescent; Adult; Alleles; Antimalarials - therapeutic use; Antimalarials - urine; Chloroquine - therapeutic use; Chloroquine - urine; Colombia; Drug Resistance, Multiple - genetics; Female; Humans; Malaria; Malaria, Falciparum - drug therapy; Male; Membrane Transport Proteins - genetics; Middle Aged; Mutation; Plasmodium falciparum - drug effects; Plasmodium falciparum - genetics; Pregnancy; Protozoan Proteins - genetics; Self Medication - statistics & numerical data; Self-medication; Young Adult; Colombia
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.18-0515

Self-medication with antimalarial drugs is a major factor in the development of drug resistance, exerting subtherapeutic drug pressure on circulating parasite populations. Data on self-medication with antimalarials from the Southern Pacific coast region of Colombia, where 4-aminoquinolines resistance and political instability prevail, are vital to elimination strategies. We present results of an exploratory study of 254 individuals having malaria symptoms who sought malaria diagnosis in two hospitals in Tumaco, Department of Nariño, Colombia. Thirty-two percent (82/254) of participants had positive Saker-Solomons urine tests, indicating self-medication with chloroquine (CQ) before consultation for diagnosis. Notably, among 30 pregnant women participating in the study, 43% were Saker--Solomons positive. Molecular analysis of the K76T position encoded by the gene revealed the mutant allele in all four samples that were both positive for and positive for the Saker-Solomons test, suggesting persistent CQ pressure. The high frequency of self-medication, particularly among pregnant women merits attention by public health authorities and comprehensive investigation.