Table 4. G6PD deficiency prevalences*, testing, and primaquine policies in African malaria-endemic countries.
| Country | Estimated G6PD deficiency prevalences for common variants* | G6PD deficiency testing before primaquine** | Single-dose primaquine for Pf** | Primaquine use for Pv** |
|---|---|---|---|---|
| Bioko Island, Equatorial Guinea | 4,144 subjects (66.6% males) by FST showed 8.7% G6PD deficiency [57]; genotyping showed 99.2%, (356/359) A- variant (G202A/A376G) | Required, not implemented | Not used | Not used |
| Mali, Cameroon°, Guinea, Gabon | >10%–13% [24] | Not required | Not used | Not used |
| Togo, Benin | >20%–23% [24] | No policy | Not used | Not used |
| Ghana | >17%–20% [24] | Not required | Not used | Not used |
| Côte d’Ivoire, Chad | >13%–17% [24] | Not required | Not used | Not used |
| Comoros | 9.5% [59] | Not required | SLD primaquine is policy | Not used |
| Mayotte | 9.5% [59] | Required | SLD primaquine is policy | PQ used as radical treatment (DOT) |
| Congo, Democratic Republic of Congo°, Zambia, Malawi | >20%–23% [24] | Not required | Not used | Not used |
| Burkina Faso, Sierra Leone, Liberia, Burundi, Central African Republic, Guinea-Bissau | >7%–10% [24] | Not required | Not used | Not used |
| Mauritania | >7%–10% [24] | Required since 2014 | Not used | Started PQ policy of 0.25 mg/kg/day for 14 days since 2014 |
| Madagascar° | >20%–23% [24] | Not required | Started SLD PQ policy in low-transmission (pre-elimination) areas in 2015; Pf PQ for children in remote areas not widely implemented because of dosing difficulties | 0.25 mg/kg/day for 14 days since 2015 |
| Kenya | >10%–13% [24] | Not required | Not used | No policy |
| Ethiopia° | >1%–3% [24,60] N = 555 survey in 2014 in the southwest, no G6PDd A- or Mediterranean samples were found by genotyping [58] |
Not required | SLD PQ (0.25 mg/kg) introduced recently | Use of PQ for Pv radical cure in elimination districts with G6PD deficiency testing is planned (not yet implemented) |
| Djibouti | No published estimates | Not required | Not used | Not used |
| The Gambia, Uganda, United Republic of Tanzania, Zanzibar, Zimbabwe, Senegal, Nigeria | >13%–17% [24] | Not required | Implemented in Zanzibar and Zimbabwe (DOT) only | Not used |
| Sudan°, South Sudan | >13%–17% [24] | Not required | Not used | 0.25 mg/kg/day for 14 days in Sudan since 2005 although not widely implemented |
| Mozambique | >20%–23% [24] | No policy | No policy | No policy |
| Namibia | No published estimates | Not required | SLD PQ policy as DOT | Radical cure as DOT is policy |
| Sao Tomé and Principe | 10.8% [61] | Required | SLD PQ policy as DOT | Radical cure as DOT is policy |
| Swaziland | >7%–10% [24] | Not required | Started SLD PQ policy as DOT since 2014 | No policy |
| Botswana | >3%–7% [24] | Not required | Started SLD PQ policy as DOT in 2015 | 0.25 mg/kg/day for 14 days since 2015 |
| Eritrea | >3%–7% [24] | Not required | SLD PQ policy since 2015 (not implemented) | 0.25 mg/kg/day for 14 days since 2002 as DOT |
| Rwanda, Somalia | >3%–7% [24] | Not required | Not used | No policy |
| Niger | >3%–7% [24] | No policy | Not used | No policy |
| Angola | >13%–17% [24] | Required since 2006 | Not used | 0.25 mg/kg/day for 14 days |
| South Africa | >3%–7% [24] | Yes | Not used | Uses DOT with PQ for Pv, regimen not specified; PQ is no longer registered in the country and is only available for compassionate use, for the few cases of Pv and P. ovale (14-day course) |
| Algeria | ND | Not required | Single dose | 0.25 mg/kg/day for 14 days (with CQ) as DOT |
| Cabo Verde | From 176 individuals, only G6PD A- was found at a low frequency of slightly under 1% [61] | Required | Single dose (DOT) | There is no Pv in the country, but 2015 modified policy indicates PQ for Pv (not implemented currently) |
Abbreviations: Pv, Plasmodium vivax; Pf, Plasmodium falciparum; PQ, primaquine; G6PD, Glucose-6-phosphate dehydrogenase; G6PDd, G6PD deficient; FST, fluorescent spot test; DOT, directly observed treatment; SLD, single low dose (0.25 mg/kg); CQ, chloroquine; ND, no data.
* Prevalences shown from reference [24] correspond to modelled national-level allele frequencies; other estimates shown are mostly from G6PD deficiency quantitative surveys.
** Policies from the WHO World Malaria Report (2016) were updated with the WHO 2017 report after this paper was reviewed [28]. Primaquine is currently contraindicated in infants and pregnant and breastfeeding women; ‘single dose’ refers to a dose of either 0.25 mg/kg or 0.75 mg/kg, and SLD refers to 0.25 mg/kg dose only. The predominant G6PD variant across the African region is G6PD A-; however, there are occasional reports of other variants, e.g., Mediterranean (South Africa, Sudan, Comoros) and Santamaria (Senegal, The Gambia) [24].
° Policies from the WHO 2016 report were checked with sources in these countries; corresponding updates are shown in italics.
Cells shaded in grey indicate countries are in the elimination phase.