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The Battle Against Drug-Resistant Malaria in Thailand



Maeo, 6, a Karen ethnic minority group tested for malaria at a malaria clinic in Tai Muang, in Kanchanaburi province, on Oct 26, Maeo tested positive for malaria one month ago


CHIANGRAI TIMES – Maeo, 6, bravely held out her forefinger for a quick jab at the Malaria Post in Tai Muang, 10kilometres from the Myanmar border, in Thailand’s Kanchanaburi province. A month ago, Maeo, whose family is from Myanmar’s Karen ethnic minority group and lacks Thai citizenship, tested positive for malaria.

She was back for a follow-up test after a combined treatment of the anti-malarial drugs artemisinin and mafloquine.

“She has tested negative,” Malaria Post worker Laksanna Kaewleresaid, after checking Maeo’s blood sample in a test kit.

Had Maeo tested positive, she would have joined the growing ranks of patients for whom the most recent drug against the malaria parasite – artemisinin – has failed. Artemisinin is usually used in combination with other anti-malarial drugs, such as mafloquine.

The number of artemisinin/mafloquine-resistant cases is on the rise along the Thai-Myanmar border, according to Kanchanaburi healthworkers.

“This year, 41 out of 207 cases of malaria proved resistant to artemisinin/mafloquine treatment,” said Wittaya Saiphromsud, head of the Vector Borne Disease Centre in Sai Yok district, Kanchanaburi,125 kilometres west of Bangkok.

Wittaya asks patients with a resistant strain of malaria to go for follow-up treatment at Sai Yok Hospital, but not all do.

“Some people don’t want to pay the bus fare to the hospital. Others don’t have Thai identity papers so they are afraid of being harassed by police if they leave their village, and others are just disobedient,” Wittaya said.

By refusing follow-up treatment, malaria carriers increase the risk of transmitting via mosquitos their drug-resilient malaria parasites to others, including across the border in Myanmar, where health services are rudimentary after decades of neglect.

The rise in drug-resistant malaria is also due to counterfeit or sub-standard anti-malaria drugs, usually made in India or China, in the remote border regions of Myanmar and Cambodia.

Sub-standard, or weaker artemisinin, allows the parasite to buildup resistance, as it has to previous anti-malaria drugs including chloroquine, sulfadoxin-pyrimethamine and quinine-tetracycline, all of which have lost their effectiveness over the past six decades.

There are now growing fears among international health agencies that artemisinin, still widely used and effective in Africa, is loosing its punch.

The porous border regions of Thailand, Myanmar and Cambodia, have a long history as the cradle of anti-malarial resistance, and have nowbecome the breeding ground for artemisinin-resistant parasites.

“The problem is still located in the western part of Cambodia andwestern part of Thailand,” said Charles Delacollet, Thailand director for the World Health Organization. “These are the only two confirmed hot spots for artemisinin-resistant malaria.”

The fear is that these artemisinin-resistant malarial strains will migrate across Myanmar to India and eventually Africa, which accounts for about 90 per cent of the world’s annual death toll of 650,000malaria victims.

“Our country is the gateway for the spread of drug-resistant parasites westward, down to Africa,” said Saw Lwin, deputy director-general of Maynmar’s Health Department.

“If we can’t contain the problem at the source of the infection, it can spread to other regions, so this is a global issue,” he told a recent seminar in Kanchanaburi.

The issue of artemisinin-resistant malaria is expected to be a key focal point at the Malaria 2012 ministerial meeting to be held inSydney, Australia, Wednesday to Friday.

The appearance of artemisinin-resistant malaria comes at a time when the Global Fund, which contributes 60 per cent of the 3 billion dollars spent annually on internationally financed anti-malarial campaigns worldwide, is experiencing a budget crunch.

The Global Fund will decide on its new malaria budget next month. The Roll Back Malaria Partnership, set up in 1998 to coordinate international efforts to wipe out malaria, is hoping that new funding will be focused on the hot spots on Thailand’s borders to nip artemisinin-resistant malaria in the bud.

“The opportunity to deal with this resistance is relatively short,” said Roll Back Malaria’s executive director Fatoumata Nafo-Traore. “So what needs to be done is to say now that we have a small window of opportunity to contain the resistance, so let’s contain it.”

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