Abstract
BackgroundThe spread of artemisinin-resistant Plasmodium falciparum is a global health concern. Myanmar stands at the frontier of artemisinin-resistant P. falciparum. Myanmar also has the highest reported malaria burden in Southeast Asia; it is integral in the World Health Organization’s plan to eliminate malaria in Southeast Asia, yet few epidemiological data exist for the general population in Myanmar.MethodsThis cross-sectional, probability household survey was conducted in Phyu township, Bago Region (central Myanmar), during the wet season of 2013. Interviewers collected clinical and behavioural data, recorded tympanic temperature and obtained dried blood spots for malaria PCR and serology. Plasmodium falciparum positive samples were tested for genetic mutations in the K13 region that may confer artemisinin resistance. Estimated type-specific malaria PCR prevalence and seroprevalence were calculated, with regression analysis to identify risk factors for seropositivity to P. falciparum. Data were weighted to account for unequal selection probabilities.Results1638 participants were sampled (500 households). Weighted PCR prevalence was low (n = 41, 2.5%) and most cases were afebrile (93%). Plasmodium falciparum was the most common species (n = 19. 1.1%) and five (26%) P. falciparum samples harboured K13 mutations. Plasmodium knowlesi was detected in 1.0% (n = 16) and Plasmodium vivax was detected in 0.4% (n = 7). Seroprevalence was 9.4% for P. falciparum and 3.1% for P. vivax. Seroconversion to P. falciparum was 0.003/year in the whole population, but 16-fold higher in men over 23 years old (LR test p = 0.016).DiscussionThis is the first population-based seroprevalence study from central Myanmar. Low overall prevalence was discovered. However, these data suggest endemic transmission continues, probably associated with behavioural risk factors amongst working-age men. Genetic mutations associated with P. falciparum artemisinin resistance, the presence of P. knowlesi and discrete demographic risk groups present opportunities and challenges for malaria control. Responses targeted to working-age men, capable of detecting sub-clinical infections, and considering all species will facilitate malaria elimination in this setting.
Highlights
The spread of artemisinin-resistant Plasmodium falciparum is a global health concern
Whilst transmission is relatively well documented in border areas [13], few data exist from central Myanmar and the burden and drivers of infection in this area remain poorly understood
This study found P. knowlesi [29] in more than 35% of positive samples
Summary
The spread of artemisinin-resistant Plasmodium falciparum is a global health concern. Myanmar has the highest reported malaria burden in Southeast Asia; it is integral in the World Health Organization’s plan to eliminate malaria in Southeast Asia, yet few epidemiological data exist for the general population in Myanmar. The last decade has seen global progress in malaria control [1, 2]. This is threatened by the emergence of Plasmodium falciparum resistant to artemisinin, the world’s front-line anti-malarial [3]. The emergence of the zoonotic primate malaria Plasmodium knowlesi as a Ghinai et al Malar J (2017) 16:16 parasite of significant public health importance in Malaysian Borneo complicates elimination [8, 9]; the distribution and prevalence of this species in other countries in the region remains uncertain. Whilst transmission is relatively well documented in border areas [13], few data exist from central Myanmar and the burden and drivers of infection in this area remain poorly understood
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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 call
