Prevalence, genetic variants and clinical implications of G-6-PD deficiency in Burkina Faso: a systematic review

Abstract

Background: It is now well-known that some antimalarials such as primaquine may induce severe hemolytic anemia in people with G-6-PD deficiency. Antimalarial drug prescriptions must, therefore take into account the patient's G-6-PD status in malaria endemic areas such as Burkina Faso, where the prevalence of this genetic abnormality is relatively high. Although great clinical heterogeneity is observed depending on the molecular nature of the deficiency and the residual enzyme activity in the red blood cell, there is very poor data on the prevalence of G-6-PD deficiency and the distribution of involved genetic variants in Burkina Faso. In this systematic review, we present a synthesis of the various studies carried out on the G-6-PD deficiency in Burkina Faso in order to determine its prevalence, probable distribution of the genetic variants involved and their clinical implications for a national systematic screening policy among the groups most vulnerable to malaria.

Methods: A systematic review was carried out to analyze available published data on the prevalence, phenotypes and mutations responsible for G-6-PD deficiency in Burkina Faso. The key words used were "G-6-PD deficiency AND Burkina Faso" or "Déficit en G-6-PD AND Burkina Faso" in French. To identify the relevant articles, two independent reviewers reviewed the titles, abstracts and the full text of the selected papers.

Results: An average prevalence of 16.6% (183/1100; CI 95%: 0.145-0.190) and 6.5% (69/1066; CI 95%: 0.051-0.081) of G-6-PD deficiency was found respectively in men and women in this systematic review. Although the predominance (99.8% of G-6-PD deficient cases) of 202A/376G G-6-PD A- variant, the Santamaria and Betica Selma variants were identified in Burkina Faso. Independently of the method used, the enzymatic deficiency was significantly higher in males (2.5-20.5%) compared to females (3.3-12.3%).

Conclusion: This systematic review suggests that despite the ubiquity of the 202A/376G G-6-PD A- variant in Burkina Faso, it will be necessary to consider the Santamaria and Betica Selma variants although their frequencies remain to be specified. A systematic screening of the G-6-PD deficiency is also needed to prevent the occurrence of iatrogenic hemolytic accidents.

Keywords: Burkina Faso; G-6-PD deficiency; Haplotype; Malaria; Polymorphism.

Fig. 1

Flow diagram showing the method for the papers selection. The database search according to the search strategy described in the methodology section was clean up to exclude duplicates. Titles and abstract were initially screened to include all relevant studies describing the prevalence and/or genetic variants of the G-6-PD deficiency in Burkina Faso. Review articles, articles without abstract or without full text as well as those that did not meet the inclusion criteria were then excluded during the full-text review. Seven (7) research relevant articles and one (1) conference paper were finally selected for this review of the literature

Fig. 2

G-6-PD deficiency genetics variants and allelic frequency in Burkina Faso. The different colored areas (blue and dark green) represent the provinces or cities with data on the prevalence of the G-6-PD deficiency according to Table 1. The different genetic variants identified are represented by colored triangles (ref. [28]). Only data from dark green areas (shown in Table 2) were used for Inverse Distance weighted interpolation of the allelic frequency of G-6-PD deficiency in Burkina Faso because data from other areas did not allow the evaluation of the allelic frequency. There were no data on the G-6-PD genetics variants in Banfora because the prevalence was determined by measuring G-6-PD activity [Source: AKO]