Characterisation of malaria and glucose-6-phosphate dehydrogenase deficiency in conflict-affected zones of southern and eastern Sudan

Abstract

Malaria causes high morbidity and mortality in Sudan. Malaria control efforts have been disrupted by conflict and displacement, which affected the whole health system. This study aimed to characterize malaria and glucose-6-phosphate dehydrogenase deficiency in conflict-affected zones of southern and eastern Sudan. This cross-sectional study was conducted between 2023 and 2024, enrolling 717 patients with clinical symptoms suggestive of malaria in Kosti (southern Sudan, n = 252) and Kassala (Eastern Sudan, n = 465). Malaria infection was confirmed by light microscopy as a standard test, and qPCR was used as a reference method. Haematological indices were analysed on automated analysers, and PCR-RFLP was used to determine G6PD genotypes. Malaria prevalence was 62.6% (291/465; 95% CI 58.2–67.0%) in Kassala and 52% (133/252; 95% CI 46.6–59.0%) in Kosti using PCR. In Kassala, 157 cases (54%; 95% CI: 48.2–59.7%) were Plasmodium vivax (P.v), 99 (34%; 95% CI: 28.6–39.8%) were Plasmodium falciparum (P. f), and 35 (12%; 95% CI: 8.6–16.2%) were P. f/P. v infections. In Kosti, P. f was detected in 130 (97.7%) subjects, and P. v was detected in 3 (2.7%; all were negative by microscopy). There were 37 (8.7%) subjects not detected by microscopy but positive by PCR (submicroscopic), 20 (15%) in Kosti and 17 (5.8%) in Kassala. The G6PD B variant predominated in Kassala (438/94.2%) and Kosti (200/79.4%). The African A− variant was detected in 9 (3.5%) individuals in Kosti (7 males, 2 females). In Kosti females, BA, BA−, AA, and AA− were observed in 11 (7%), 4 (2.5%), 4 (2.5%), and 9 (5.7%), respectively, compared to 10 (4.1%), 4 (1.6%), and 7 (3%) BA, BA−, and AA cases in Kassala females. No significant association was observed between G6PD genotype and parasite density. Malaria prevalence did not differ significantly between Internally Displaced Persons (IDPs) and residents. Regional variation was observed in malaria parasite species, including submicroscopic infections, as well as in G6PD genotypes. The study identified the G6PD A− variant in Sudan. Ongoing conflict in Sudan has similarly impacted the health of both resident and displaced populations. Not applicable.