Abstract
BackgroundEarly diagnosis and treatment with artesunate-mefloquine combination therapy (MAS) have reduced the transmission of falciparum malaria dramatically and halted the progression of mefloquine resistance in camps for displaced persons along the Thai-Burmese border, an area of low and seasonal transmission of multidrug-resistant Plasmodium falciparum. We extended the same combination drug strategy to all other communities (estimated population 450,000) living in five border districts of Tak province in northwestern Thailand.Methods and FindingsExisting health structures were reinforced. Village volunteers were trained to use rapid diagnostic tests and to treat positive cases with MAS. Cases of malaria, hospitalizations, and malaria-related deaths were recorded in the 6 y before, during, and after the Tak Malaria Initiative (TMI) intervention. Cross-sectional surveys were conducted before and during the TMI period. P. falciparum malaria cases fell by 34% (95% confidence interval [CI], 33.5–34.4) and hospitalisations for falciparum malaria fell by 39% (95% CI, 37.0–39.9) during the TMI period, while hospitalisations for P. vivax malaria remained constant. There were 32 deaths attributed to malaria during, and 22 after the TMI, a 51.5% (95% CI, 39.0–63.9) reduction compared to the average of the previous 3 y. Cross-sectional surveys indicated that P. vivax had become the predominant species in Thai villages, but not in populations living on the Myanmar side of the border. In the displaced persons population, where the original deployment took place 7 y before the TMI, the transmission of P. falciparum continued to be suppressed, the incidence of falciparum malaria remained low, and the in vivo efficacy of the 3-d MAS remained high.ConclusionsIn the remote malarious north western border area of Thailand, the early detection of malaria by trained village volunteers, using rapid diagnostic tests and treatment with mefloquine-artesunate was feasible and reduced the morbidity and mortality of multidrug-resistant P. falciparum.
Highlights
The development and spread of multidrug-resistant Plasmodium falciparum parasites has impaired decades of efforts to reduce the burden of malaria worldwide
We report the impact of this intervention on malaria morbidity and mortality in the targeted area by comparing epidemiological indicators before (October 1995– September 2001), during (October 2001–September 2002), and after (October 2002–September 2003) the Tak Malaria Initiative (TMI) intervention
Twice as many P. falciparum malaria cases were seen per year among foreign national (FN) than in the Thai population, giving an estimated annual incidence three times higher in FN than in Thais
Summary
The development and spread of multidrug-resistant Plasmodium falciparum parasites has impaired decades of efforts to reduce the burden of malaria worldwide. In 1991–1992, different regimens of mefloquine with artesunate were tested in trials in Bangkok and in Karen refugee camps in Tak province [6,7] This proved to be a highly effective and safe treatment and by 1994, when the failure rate of mefloquine monotherapy reached 60%, a combination of 25 mg/kg of mefloquine and 12 mg/kg of artesunate given over 3 d (MAS3) was deployed as first-line treatment in all refugee camps along the Thai-Myanmar border [8]. Diagnosis and treatment with artesunate-mefloquine combination therapy (MAS) have reduced the transmission of falciparum malaria dramatically and halted the progression of mefloquine resistance in camps for displaced persons along the Thai-Burmese border, an area of low and seasonal transmission of multidrug-resistant Plasmodium falciparum. In a malaria programme for people in the camps, efforts were made to diagnose cases early, and people found to have malaria were treated with a combination pill, containing artesunate (a derivative of artemisinin) and another drug, mefloquine. A study of this programme found that it made a big reduction in the number of cases of the most serious form of malaria, and suppressed the advance of resistance to mefloquine
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
