Abstract
Even though malaria continues to cause high morbidity and mortality in most of the malaria endemic countries in the world, it is currently not a major health problem in Sri Lanka. Despite the low malaria incidence, the development and spread of anti-malarial drug resistance, combined with a recent increase in the armed conflict hindering provision of effective health services will make it difficult to control malaria in Sri Lanka. Since chloroquine (CQ) resistant Plasmodium falciparum was first reported from Dambulla area in 1984, the number has increased to more than 50% observed in vivo from various endemic areas. In concordance with this, single nucleotide polymorphisms (SNPs) in genes of P. falciparum responsible for CQ resistance are present. A limited number of trials have investigated the efficacy of the second line drug, sulfadoxine/ pyrimethamine (SP) against P. falciparum and a few cases of resistance have been reported. Moreover, SNPs in P. falciparum genes responsible for SP resistance are present and may constitute a sign of evolving SP resistance development. For P. vivax, drug resistance is not yet recorded as a problem in Sri Lanka, however the prevalence of SP resistant SNPs in P. vivax populations seems high and may pose a risk despite that SP is not used directly against P. vivax infections. Continuous monitoring of drug efficacy in vivo, as well by measuring the prevalence of SNPs related to drug resistance are major issues to be addressed. doi: 10.4038/cjsbs.v37i1.493 Cey. J. Sci. (Bio. Sci.) 37 (1): 15-22, 2008
Highlights
Malaria is a major public health problem deeply rooted in poor communities, impeding the economic growth and development of the malaria endemic countries in the world
The situation varies from country to country depending on malaria epidemiology and the effectiveness of control programmes where one of the key strategies has been the promotion of early diagnosis and treatment with effective antimalarials (WHO 2001)
On a regional level there is a slight increase in reported cases during 2005, but the same decreased at a country level for DPR Korea, Sri Lanka, Bhutan, Bangladesh, India and Myanmar
Summary
Malaria is a major public health problem deeply rooted in poor communities, impeding the economic growth and development of the malaria endemic countries in the world. As identified by the World Health Organization (WHO), the South-East Asian countries with endemic malaria are Bangladesh, Bhutan, India, DPR Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste. On a regional level there is a slight increase in reported cases during 2005, but the same decreased at a country level for DPR Korea, Sri Lanka, Bhutan, Bangladesh, India and Myanmar. While frequent epidemics are being observed in many countries in the region, Bhutan, Bangladesh, Sri Lanka and Nepal have not reported any recent major epidemics since 2000. Considering the low island-wide incidence, malaria cannot be considered a major public health problem currently in Sri Lanka. Briet et al.,, (2005) attributed the decrease in the overall malaria incidences in the country since 2000 to the reduced incidences in the districts in the conflict affected areas, especially Vavuniya and Kilinochchi. Surveillance of drug resistance The efficacy of anti-malarial drugs is assessed by performing routine in vivo efficacy trials as well as in vitro drug susceptibility tests on parasite populations according to WHO guidelines and providing warning of rising drug resistance in vivo (Shretta et al, 2000; Brockman et al, 2000; WHO 2001)
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