Southeast Myanmar Research Articles

Geospatial joint modeling of vector and parasite serology to microstratify malaria transmission

The World Health Organization identifies a strong surveillance system for malaria and its mosquito vector as an essential pillar of the malaria elimination agenda. Anopheles salivary antibodies are emerging biomarkers of exposure to mosquito bites that potentially overcome sensitivity and logistical constraints of traditional entomological surveys. Using samples collected by a village health volunteer network in 104 villages in Southeast Myanmar during routine surveillance, the present study employs a Bayesian geostatistical modeling framework, incorporating climatic and environmental variables together with Anopheles salivary antigen serology, to generate spatially continuous predictive maps of Anopheles biting exposure. Our maps quantify fine-scale spatial and temporal heterogeneity in Anopheles salivary antibody seroprevalence (ranging from 9 to 99%) that serves as a proxy of exposure to Anopheles bites and advances current static maps of only Anopheles occurrence. We also developed an innovative framework to perform surveillance of malaria transmission. By incorporating antibodies against the vector and the transmissible form of malaria (sporozoite) in a joint Bayesian geostatistical model, we predict several foci of ongoing transmission. In our study, we demonstrate that antibodies specific for Anopheles salivary and sporozoite antigens are a logistically feasible metric with which to quantify and characterize heterogeneity in exposure to vector bites and malaria transmission. These approaches could readily be scaled up into existing village health volunteer surveillance networks to identify foci of residual malaria transmission, which could be targeted with supplementary interventions to accelerate progress toward elimination.

Malaria in the crossfire? Donor and provider attitudes across a momentous decade of peace, conflict and growth in Southeast Myanmar

Malaria in the crossfire? Donor and provider attitudes across a momentous decade of peace, conflict and growth in Southeast Myanmar

Moveable Gardens: Itineraries and Sanctuaries of Memory ed. by Virginia D. Nazarea and Terese V. Gagnon

Reviewed by: Moveable Gardens: Itineraries and Sanctuaries of Memory ed. by Virginia D. Nazarea and Terese V. Gagnon Pierrette Hondagneu-Sotelo Virginia D. Nazarea and Terese V. Gagnon (Eds.) Moveable Gardens: Itineraries and Sanctuaries of Memory. Tucson: University of Arizona Press, 2021, pp. 301. (ISBN-13: 978-0-8165-4221-5 paperback) This edited book represents the latest efforts of anthropologists to understand how a wide variety of displacements (war, migration, precarity, late capitalist modernity and so on) lead people to re-engage with plant life in ways that create meaning and sustain biodiversity. The book offers a series of examinations into how quotidian practices of gardening, seed saving, and cooking serve as ways to restore a sense of social and cultural continuity, and to connect the lost past with newly found lives and places. The introductory chapter, written by the editors Virginia D. Nazarea and Terese V. [End Page 215] Gagnon, offers a beautifully written overview of the approach. They remind us that biodiversity “thrives best in marginal places, those small out-of-the way spaces where a sense of identity can be drawn from assemblages of plants and other cohabitants” (p. 3). What happens when this sort of life is disrupted? The book tackles this question in two sections, one with a series of chapters exploring “itineraries,” which is about plant-human engagements in movement, and one focused on Sanctuaries, more emplaced efforts of belonging. The volume is firmly rooted in anthropology and began as a session at the 2017 American Anthropological Association meetings. Yet this journal has decided to have it reviewed since it will be of interest to geographers and Latin Americanists. Foundational references include debates on the topic of multispecies relationships and ontological challenges, such as those by Ann Lowenhaupt Tsing (2015), and Donna Haraway (2016). Some relevant concepts and phrases that will surely become increasingly relevant emotional anchors for us all in this climate crisis era are “ecological grief,” “global mourning,” and “ecological memory” (p. 11). At this moment, there is probably not a reader who has not personally experienced some semblance of these feelings and practices. Some commentators maintain that edited books are always uneven in content and quality. I think a more accurate rendition of this old saw is that we, as readers, always gravitate to some chapters more than others. Space does not allow me to comment on all of the twelve chapters, so I will just discuss a few of my favorites. The first substantive chapter, by Terese Gagnon offers an excellent close-up ethnographic view of Karen refugees who have fled the mountain regions of southeast Myanmar for upstate New York. Engagement with the “materiality of biodiversity” (p. 19), in the form of tending gardens, preparing and eating homeland foods and foraging for food plants allows them to hold on to identity and collective memory, but it is not seamless, as the Karen refugees want to do this on their own terms. For instance, they refuse to garden in raised beds, a common structure in urban community gardens, but one which they experience as foreign, unnatural and distant from the earth. For various reasons, as Gagnon explains, the refuge is liminal and the sanctuary remains shaky. Another fascinating discussion is provided by Guntra A. Aistara’s chapter, Tomatoes Out of Time. Here the focus shifts to how post-socialist European governments establish biopolitical regimes to regulate tomatoes, which can be seen as “alien invaders” and carriers of disease. In this scenario, “multi-species biopolitics” is under state jurisdiction and clashes with cultural memory and traditional seed and plant practices. The section on emplaced sanctuaries includes fascinating looks at particular food, kitchen and eating practices, but a notable chapter is provided by Tracey Heatherington’s examination of the Svalbard Global Seed Vault in Longyearbyen, Norway. The seeds of the world, or more accurately, the secondary back up samples of these seeds, are stored here in air tight packages enveloped in non-descript boxes. Sci-fi futurism is already here, in the form of this seed warehouse located in the middle of a permafrost zone, and this chapter imaginatively includes a [End Page 216] comparative analysis of how two classic...

Mass drug administration for the acceleration of malaria elimination in a region of Myanmar with artemisinin-resistant falciparum malaria: a cluster-randomised trial

To contain multidrug-resistant Plasmodium falciparum, malaria elimination in the Greater Mekong subregion needs to be accelerated while current antimalarials remain effective. We evaluated the safety, effectiveness, and potential resistance selection of dihydroartemisinin-piperaquine mass drug administration (MDA) in a region with artemisinin resistance in Myanmar. We did a cluster-randomised controlled trial in rural community clusters in Kayin (Karen) state in southeast Myanmar. Malaria prevalence was assessed using ultrasensitive quantitative PCR (uPCR) in villages that were operationally suitable for MDA (villages with community willingness, no other malaria control campaigns, and a population of 50-1200). Villages were eligible to participate if the prevalence of malaria (all species) in adults was greater than 30% or P falciparum prevalence was greater than 10% (or both). Contiguous villages were combined into clusters. Eligible clusters were paired based on P falciparum prevalence (estimates within 10%) and proximity. Community health workers provided routine malaria case management and distributed long-lasting insecticidal bed-nets (LLINs) in all clusters. Randomisation of clusters (1:1) to the MDA intervention group or control group was by public coin-flip. Group allocations were not concealed. Three MDA rounds (3 days of supervised dihydroartemisinin-piperaquine [target total dose 7 mg/kg dihydroartemisinin and 55 mg/kg piperaquine] and single low-dose primaquine [target dose 0·25 mg base per kg]) were delivered to intervention clusters. Parasitaemia prevalence was assessed at 3, 5, 10, 15, 21, 27, and 33 months. The primary outcomes were P falciparum prevalence at months 3 and 10. All clusters were included in the primary analysis. Adverse events were monitored from the first MDA dose until 1 month after the final dose, or until resolution of any adverse event occurring during follow-up. This trial is registered with ClinicalTrials.gov, NCT01872702. Baseline uPCR malaria surveys were done in January, 2015, in 43 villages that were operationally suitable for MDA (2671 individuals). 18 villages met the eligibility criteria. Three villages in close proximity were combined into one cluster because a border between them could not be defined. This gave a total of 16 clusters in eight pairs. In the intervention clusters, MDA was delivered from March 4 to March 17, from March 30 to April 10, and from April 27 to May 10, 2015. The weighted mean absolute difference in P falciparum prevalence in the MDA group relative to the control group was -10·6% (95% CI -15·1 to -6·1; p=0·0008) at month 3 and -4·5% (-10·9 to 1·9; p=0·14) at month 10. At month 3, the weighted P falciparum prevalence was 1·4% (0·6 to 3·6; 12 of 747) in the MDA group and 10·6% (7·0 to 15·6; 56 of 485) in the control group. Corresponding prevalences at month 10 were 3·2% (1·5 to 6·8; 34 of 1013) and 5·8% (2·5 to 12·9; 33 of 515). Adverse events were reported for 151 (3·6%) of 4173 treated individuals. The most common adverse events were dizziness (n=109) and rash or itching (n=20). No treatment-related deaths occurred. In this low-transmission setting, the substantial reduction in P falciparum prevalence resulting from support of community case management was accelerated by MDA. In addition to supporting community health worker case management and LLIN distribution, malaria elimination programmes should consider using MDA to reduce P falciparum prevalence rapidly in foci of higher transmission. The Global Fund to Fight AIDS, Tuberculosis and Malaria.

Community demand for comprehensive primary health care from malaria volunteers in South-East Myanmar: a qualitative study

BackgroundMalaria volunteers have contributed significantly to malaria control achieving a reduction of annual parasite incidence to pre-elimination levels in several townships across Myanmar. However, the volunteers’ role is changing as Myanmar transitions from a malaria control to elimination programme and towards the goal of universal health coverage. The aim of the study is to explore the perspectives of community leaders, members and malaria volunteers in South-East Myanmar on community-delivered models to inform an optimal design that targets malaria elimination in the context of primary health care in Myanmar.MethodsQualitative methods including focus group discussions (FGDs) with community members and current or ex-malaria volunteers, and participatory workshops with community leaders were conducted. All data collection tools were pilot tested with similar participants. The FGDs were stratified into male and female participants in consideration of diverse gender roles among the ethnic groups of Myanmar. Data saturation was the key cut-off point to cease recruitment of participants. Inductive thematic analysis was used.ResultsCommunity members were willing to be tested for malaria because they were concerned about the consequences of malaria although they were aware that malaria prevalence is low in their villages. Malaria volunteers were the main service providers for malaria and other infectious diseases in the community. Apart from malaria, the community identified common health problems such as the flu (fever, sneezing and coughing), diarrhoea, skin infections and tuberculosis as priority diseases in this order. Incorporating preventive, and whenever possible curative, services for those diseases into the current malaria volunteer model was recommended.Discussion and conclusionThere was a gap between the communities’ expectations of health services and the health services currently being delivered by volunteers in the community that highlights the need for reassessment and reform of the volunteer model in the changing context. An evidence-based, community preferred, pragmatic community-delivered integrated model should be constructed based on the context of malaria elimination and progressing towards universal health coverage in Myanmar.

Conservation as counterinsurgency: A case of ceasefire in a rebel forest in southeast Myanmar

We demonstrate how international conservation practices in a rebel forest during ceasefire are shaped by and contribute to legacies of racialized political violence. Nature conservation has been shown in some cases to be implemented by armed forces and directly contribute to acts of “green violence” and the makings of “green war”. Less explored in the critical conservation literature, and the focus of our study, are the ways in which conservation projects can also be implicated in the continuation of counterinsurgency through “softer” non-militarized means. Based on ethnographic field research, interviews, and document analysis conducted by both authors, we present a field case study from the lowland forests of Tanintharyi Region in southeast Myanmar. The proposed Lenya National Park falls within territory contested by an ethnic Karen rebel group, who have been under a tenuous ceasefire since 2012 but who have not yet reached a political settlement to end armed conflict. We find that the mapping of Lenya during ceasefire by foreign conservationists legitimizes past forced displacements of Karen civilians by the Myanmar military during decades of war, and impedes the potential return of refugees and internally displaced persons to their customary lands now zoned for the park. Conservationists working to establish the park invoke and build upon racialized discourses of Karen forest dwellers as criminals, first as dangerous rebel supporters, and now as forest destroyers. The ceasefire has also opened up political space for Karen leaders to challenge the making of state forests, who envision an alternative model of community-led conservation based on indigenous rights.

Resolving an unnoticed diversity within the Schistura robertsi species complex (Teleostei: Nemacheilidae) using molecules and morphology

The Schistura robertsi species complex is a group of freshwater fish inhabiting streams in southeast Myanmar as well as in western and southern Thailand. In southern Thailand, the distribution exceeds the biogeographically important ‘Surat Thani – Krabi line’. The complex is believed to include five described and one undescribed species, but monophyly and systematics of the group have never been studied explicitly. The present study aims to resolve the number of species within the Schistura robertsi group as well as their distribution areas and phylogenetic relations. We analysed mitochondrial and nuclear sequence data of 86 specimens from 47 localities and 18 morphological characters of 193 specimens. The phylogenetic analyses revealed the S. robertsi complex to be monophyletic and to be composed of ten major lineages. Six of them correspond to the known described or undescribed species, but another four newly identified clades reveal the existence of an overlooked diversity within the group. All genetic lineages are statistically highly supported and all are morphologically diagnosable, suggesting that they represent distinct species. The distribution areas of several clades overlap, the cases of direct co-occurrence show no sign of hybridisation.

Fish caught in clear water: encompassed state-making in south-east Myanmar

ABSTRACT This paper explores processes of state-making by the New Mon State Party (NMSP), an ethnic armed organization (EAO) that claims to represent the Mon people in south-east Myanmar, and which has fought the Myanmar military to pursue self-representation for the past 50 years. Based on ethnographic fieldwork, the paper focuses on a specific area that is encompassed by three states in the making: the NMSP, the official Myanmar state and another EAO, the Karen National Union (KNU). The paper shows that NMSP state-making happens neither in parallel to nor through a simple separation from the Myanmar government and the KNU, but through different forms of encompassment. It introduces the concept of ‘encompassed state-making’ to capture the simultaneous mimicry and opposition of the NMSP’s state-making practices in relation to the other two states. A core argument is that Mon villagers – albeit deeply loyal towards the NMSP and considering them the legitimate authority – constantly have to take into account the ongoing political transformation in the country and therefore critically have to engage in managing their lives in this encompassed state in formation.

Enduring Peace: a Case Study of the Opportunities and the Challenges for Engaging in Myanmar’s Peace Process

In 2015, the Myanmar Government, the Myanmar Tatmadaw (military) and eight ethnic armed organisations (eaos) signed the 2015 National Ceasefire Agreement (nca). In 2019, this agreement was signed by three more eaos, and there have been four annual conferences (Union Peace Panglong Conference 2016, 2017, 2018, 2019). The ceasefire arrangements, which are present primarily in Southeast Myanmar, have failed to make significant progress in key areas such as the provision of access to civil documents and land to returning refugees, displaced persons and conflict-affected communities. Violence has escalated in the last two years. It is not an exaggeration to say that Myanmar is at a critical juncture of transition. This article examines how the peace process is being communicated amongst different civil society organisations, international organisations, donor organisations, and government representatives in an area directly affected by the peace process. The article details the experiences of these participants exchanged in workshop in Mon State in July 2018. The exchanges during the workshop reveal a practical obstacles faced by civil society organisations, especially, in their attempt to support returnees. Many reported frustration with the implementation gap between promoting a peace process and providing for local enabling conditions that support peace. Specific barriers faced by civil society organisations, and in turn the communities they are seeking to help were threefold: information and communication barriers concerning the peace process; women’s fear and reluctance to seek services due to personal safety concerns, and the persistence of traditional gender norms which affects access to information.

Ceasefire State-Making and Justice Provision by Ethnic Armed Groups in Southeast Myanmar

Ceasefire State-Making and Justice Provision by Ethnic Armed Groups in Southeast Myanmar

Future-making and frictional mobility in the return of Burmese migrants

This article explores the experiences of recent returnees from Thailand to Southeast Myanmar and the complicated landscape of their future-making. In looking at the arduous journeys of Burmese migrants both in Myanmar and Thailand, I discuss how economic and political developments in reform-era Myanmar have informed Burmese migrants’ idea of return migration. Seeking a better life through coming home, they have encountered factors of friction and traction that either support or impede their plans. Accordingly, I argue that the return of these Burmese workers has become frictional mobility rather than a straightforward return. Ethnic politics and land boom in the region have intensified social inequality and conflicts that eventually make the organization of return more complex. The situation allows migrants to settle in their home country, postpone the return, and continue shuttling at the border while using the pattern of movement as a livelihood.

Fisheries development, labour and working conditions on Myanmar's marine resource frontier

The history of fisheries development in Myanmar is poorly understood. A growing body of evidence suggests that working conditions in some of Myanmar's fisheries are extremely precarious. The treatment of labour in the wider fisheries literature has been fragmented. Drawing together these strands, this paper addresses two central questions through a qualitative analysis of marine fisheries in Mon State in Southeast Myanmar: (1) How have marine fisheries developed in a context of broader political, economic, technological and environmental change? (2) What are the characteristics of labour conditions in Mon's marine fisheries, and how have these been shaped by the context of fisheries development? We show that Mon's fisheries have transformed over the past three decades. Fishing has become more reliant on migrant labour, and a range of unsafe and exploitative labour practices are increasingly apparent. The paper makes several contributions: First, we address gaps in the knowledge on the nature of fisheries in Myanmar. Second, we extend previous research on working conditions in fisheries to show how labour arrangements and exploitation in fisheries emerge in the context of place-specific geographies of environmental, social and economic change. Third, we highlight the need for greater critical attention to labour and working conditions in research on fisheries of all scales.

Negotiating representation: gender, city and nation in South East Asian transnational cinema

ABSTRACTThis paper aims to examine modes of representation in transnational films, which in their production, distribution and exhibition relate to two or more countries in South East Asia, particularly Thailand, Laos, Myanmar and Cambodia. The paper uses the concept of transnational cinema to explain how representations of gender, city and nation are constructed in this type of film. Through a textual analysis, the paper argues that Thailand, particularly Bangkok, is usually represented by male characters, while Laos, Myanmar and Cambodia are depicted by either female characters or male characters that are sentimental, and led by emotion rather than by reason. Masculinity in the films is related to capitalism, working life and public spaces, whereas femininity is connected to cultural tradition, family life and private spaces. Therefore, cities in the films are divided into two contrasting types. The first is a modern city, in which a lack of human intimacy is foregrounded; this is usually represented by Bangkok. The other is a romantic city, intended to evoke nostalgic feelings, typically cities such as Luang Prabang, Pakse and Mandalay. Though such cinema is transnational in terms of film funding, production and distribution, the narrative content itself maintains the motif of the national subject to the same extent as purely national cinema.

Molecular identification and genetic diversity of Gnathostoma spinigerum larvae in freshwater fishes in southern Lao PDR, Cambodia, and Myanmar.

Gnathostomiasis, an emerging food-borne parasitic zoonosis in Asia, is mainly caused by Gnathostoma spinigerum (Nematoda: Gnathostomatidae). Consumption of raw meat or freshwater fishes in endemic areas is the major risk factor. Throughout Southeast Asia, including Thailand, Lao PDR, Cambodia, and Myanmar, freshwater fish are often consumed raw or undercooked. The risk of this practice for gnathostomiasis infection in Lao PDR, Cambodia, and Myanmar has never been evaluated. Here, we identified larvae of Gnathostoma species contaminating freshwater fishes sold at local markets in these three countries. Public health authorities should advise people living in, or travelling to, these areas to avoid eating raw or undercooked freshwater fishes. Identification of larvae was done using molecular methods: DNA was sequenced from Gnathostoma advanced third-stage larvae recovered from snakehead fishes (Channa striata) and freshwater swamp eels (Monopterus albus). Phylogenetic analysis of a portion of the mitochondrial cytochrome c oxidase subunit I gene showed that the G. spinigerum sequences recovered from southern Lao PDR, Cambodia, and Myanmar samples had high similarity to those of G. spinigerum from China. Sequences of the nuclear ribosomal DNA internal transcribed spacer 2 region closely resembled sequences of G. spinigerum from Thailand, Indonesia, the USA, and central Lao PDR. This is the first molecular evidence of G. spinigerum from freshwater fishes in southern Lao PDR, Cambodia, and Myanmar.

Cryptic diversity within the Schistura robertsi species complex (Nemacheilidae).

Event Abstract Back to Event Cryptic diversity within the Schistura robertsi species complex (Nemacheilidae). Tomáš Dvořák1*, Jörg Bohlen1 and Vendula Šlechtová1 1 Laboratory of Fish Genetics, Institute of Animal Physiology and Genetics (ASCR), Czechia The Schistura robertsi species complex is a group of freshwater fish inhabiting streams and rivers in southeast Myanmar and western and southern Thailand. The complex is believed to include five described and one undescribed species, but monophyly, outline and systematics of the complex have never been studies explicitly. The present study aims to resolve the number of species within the Schistura robertsi group as well as their distribution areas and their phylogenetic relations. We analysed mitochondrial and nuclear sequence data of 86 specimens from 47 localities and 18 morphologic characters of about 200 specimens. The phylogenetic analyses revealed the S. robertsi complex to be monophyletic and to be composed of ten major lineages. Six of them correspond to the known described or undescribed species, but another four reveal the existence of a cryptic diversity within the group. All genetic lineages are statistically highly supported, have distinct distribution areas and all are morphologically diagnosable, suggesting that they represent distinct species. Several cases of co-occurrence without sign of hybridisation exist. Acknowledgements The study got financial support from grants 206/08/0637 and 19-18453S of the Grant Agency of the Czech Republic. Keywords: molecular phylogeny, systematics, Biodiversity, freswater fish, South East Asia, Loach, morphology Conference: XVI European Congress of Ichthyology, Lausanne, Switzerland, 2 Sep - 6 Sep, 2019. Presentation Type: Poster Topic: TAXONOMY, PHYLOGENY AND ZOOGEOGRAPHY Citation: Dvořák T, Bohlen J and Šlechtová V (2019). Cryptic diversity within the Schistura robertsi species complex (Nemacheilidae).. Front. Mar. Sci. Conference Abstract: XVI European Congress of Ichthyology. doi: 10.3389/conf.fmars.2019.07.00126 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 May 2019; Published Online: 14 Aug 2019. * Correspondence: Mx. Tomáš Dvořák, Laboratory of Fish Genetics, Institute of Animal Physiology and Genetics (ASCR), Liběchov, Czechia, dvorak@iapg.cas.cz Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Tomáš Dvořák Jörg Bohlen Vendula Šlechtová Google Tomáš Dvořák Jörg Bohlen Vendula Šlechtová Google Scholar Tomáš Dvořák Jörg Bohlen Vendula Šlechtová PubMed Tomáš Dvořák Jörg Bohlen Vendula Šlechtová Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Effectiveness of repellent delivered through village health volunteers on malaria incidence in villages in South-East Myanmar: a stepped-wedge cluster-randomised controlled trial protocol

BackgroundTo combat emerging drug resistance in the Greater Mekong Sub-region (GMS) the World Health Organization and GMS countries have committed to eliminating malaria in the region by 2030. The overall approach includes providing universal access to diagnosis and treatment of malaria, and sustainable preventive measures, including vector control. Topical repellents are an intervention that can be used to target residual malaria transmission not covered by long lasting insecticide nets and indoor residual spraying. Although there is strong evidence that topical repellents protect against mosquito bites, evidence is not well established for the effectiveness of repellents distributed as part of malaria control activities in protecting against episodes of malaria. A common approach to deliver malaria services is to assign Village Health Volunteers (VHVs) to villages, particularly where limited or no services exist. The proposed trial aims to provide evidence for the effectiveness of repellent distributed through VHVs in reducing malaria.MethodsThe study is an open stepped-wedge cluster-randomised controlled trial randomised at the village level. Using this approach, repellent (N,N-diethyl-benzamide – 12% w/w, cream) is distributed by VHVs in villages sequentially throughout the malaria transmission season. Villages will be grouped into blocks, with blocks transitioned monthly from control (no repellent) to intervention states (to receive repellent) across 14 monthly intervals in random order). This follows a 4-week baseline period where all villages do not receive repellent. The primary endpoint is defined as the number of individuals positive for Plasmodium falciparum and Plasmodium vivax infections diagnosed by a rapid diagnostic test. Secondary endpoints include symptomatic malaria, Polymerase Chain Reaction (PCR)-detectable Plasmodium spp. infections, molecular markers of drug resistance and antibodies specific for Plasmodium spp. parasites.DiscussionThis study has been approved by relevant institutional ethics committees in Myanmar and Australia. Results will be disseminated through workshops, conferences and peer-reviewed publications. Findings will contribute to a better understanding of the optimal distribution mechanisms of repellent, context specific effectiveness and inform policy makers and implementers of malaria elimination programs in the GMS.Trial registrationAustralian and New Zealand Clinical Trials Registry (ACTRN12616001434482). Retrospectively registered 14th October 2016.

Effectiveness and safety of 3 and 5\xa0day courses of artemether\u2013lumefantrine for the treatment of uncomplicated falciparum malaria in an area of emerging artemisinin resistance in Myanmar

BackgroundArtemisinin resistance in Plasmodium falciparum has emerged and spread in Southeast Asia. In areas where resistance is established longer courses of artemisinin-based combination therapy have improved cure rates.MethodsThe standard 3-day course of artemether–lumefantrine (AL) was compared with an extended 5-day regimen for the treatment of uncomplicated falciparum malaria in Kayin state in South-East Myanmar, an area of emerging artemisinin resistance. Late parasite clearance dynamics were described by microscopy and quantitative ultra-sensitive PCR. Patients were followed up for 42 days.ResultsOf 154 patients recruited (105 adults and 49 children < 14 years) 78 were randomized to 3 days and 76 to 5 days AL. Mutations in the P. falciparum kelch13 propeller gene (k13) were found in 46% (70/152) of infections, with F446I the most prevalent propeller mutation (29%; 20/70). Both regimens were well-tolerated. Parasite clearance profiles were biphasic with a slower submicroscopic phase which was similar in k13 wild-type and mutant infections. The cure rates were 100% (70/70) and 97% (68/70) in the 3- and 5-day arms respectively. Genotyping of the two recurrences was unsuccessful.ConclusionDespite a high prevalence of k13 mutations, the current first-line treatment, AL, was still highly effective in this area of South-East Myanmar. The extended 5 day regimen was very well tolerated, and would be an option to prolong the useful therapeutic life of AL.Trial registration NCT02020330. Registered 24 December 2013, https://clinicaltrials.gov/NCT02020330

A new section of Lower Palaeozoic rocks in Kayin State (Southeast Myanmar)

Lower Palaeozoic rocks have been mapped in Kayin State in an area previously shown on published maps as either metamorphic or possibly Lower or Upper Palaeozoic rocks. Three new formations, with a total thickness of over 900 m, apparently overlain by an, at least, 100 m thick Upper Palaeozoic formation are mapped along the Salween River and along the road from Yinbaing, in Myanmar, to Tha Song Yang, in Thailand. The Lower Palaeozoic succession consists of the predominantly siliciclastic Kyaukpulu and Kushwe–e–we formations and an overlying, predominantly carbonate Meseik Ashe Formation which contains Middle Ordovician (Darriwilian) conodonts. The older two formations are probable correlates of the Ngwetaung and Lokeypin formations of the southern Shan State of Myanmar and the Lower Ordovician siliciclastics of western Thailand. The overlying, peritidal to shallow subtidal carbonates of the Meseik–Ashe Formation are correlates of the Wunbye and Sitha formations of Shan State, Myanmar. The thick–bedded, quartz arenites of the Nyaungwiang Formation are faulted against the Ordovician carbonates and are probable lithological correlates of the Carboniferous Taungnyo Formation. The folds in the Lower Palaeozoic rocks are overturned to the northeast and deformation was in one major phase between the Tournaisian and the Early Permian. The Lower Palaeozoic strata may probably be followed as a ridge for at least 100 km towards the NNW, close to the western border of the Sibuma Block which is separated by a postulated cryptic suture from the Irrawaddy Block to the west.

Community engagement for malaria elimination in contested areas of the Karen/Kayin State, Myanmar: A case study on the Malaria Elimination Task Force

Background: This study evinces how the community engagement (CE) approach of the Malaria Elimination Task Force (METF) in the Karen/Kayin State of southeast Myanmar contributed to generating participation in program activities, such as early detection and treatment, malaria blood surveys and mass drug administration. Methods: We investigated the CE approach through ethnographic and key-informant unstructured interviews as well as focus group discussions and participant observation with program participants METF team members. Interview transcripts were analysed manually applying inductive content analysis. Results: In the context of the Thai-Myanmar border, CE had two main dimensions: The first was to enable the politically sensitive entry of the program into intervention areas, the second was to create mutual understanding among the METF team and people from the population and gain trust. For the first, the METF needed to acknowledge, get permission and communicate with a complex landscape of governing actors and leaders. For the second, creating mutual understanding meant to spend time learning about villagers’ lifeworlds and adapting engagement accordingly to create understanding of the program in resonance with these lifeworlds. Gaining trust meant to leverage leadership and build trust through informal “horizontal” engagement and acts of caring. Three key dimensions of villagers’ lifeworlds that appeared most crucial for staff to learn about were: villagers’ experience with the outside world; leadership and governing relationships to villagers: authority and distrust; and their perceived need for malaria care. Conclusions: Successful CE is highly context specific. CE success was based on the adaptability of the approach towards the complex political and socio-cultural contexts of the different areas of the Karen/Kayin State. Hence, CE is not a fixed approach or strategy defined before entering the setting, but constantly evolving based on the encounters with stakeholders and people of the population.

Zosteropswhite-eyes in continental South-East Asia. 2: what isZosterops auriventerHume?

An accompanying paper (Wells 2017, this issue) presented reasons for treating the type series of Zosterops auriventer Hume, 1878, type locality Tavoy, south-east Myanmar, as a taxonomic composite, and for re-naming its (distantly allopatric) paratypes. Conventionally classified as a subspecies of Oriental White-eye Z. palpebrosus, the de-coupled auriventer is now known solely from its holotype and one other Myanmar specimen. Among provisional contenders, it is shown to be less convincingly related to Z. palpebrosus (as currently defined) than with the morphology of regionally widespread, inland forest-dwelling Everett's White-eye Z. everetti—and to become the species name of the latter's continental Asian populations should, as suggested, everetti be returned to the status of Philippine endemic. As before, the term ‘continental’ includes islands in South-East Asian shelf waters, i.e., out to the Greater Sundas and their satellites.