Drug-Resistant Malaria
Southeast Asia
While improved access to prompt diagnosis
and treatment has contributed to a gradual decrease in the
number of malaria deaths in Southeast Asia, the recent emergence
of multi-drug-resistant (MDR) malaria threatens to reverse
these gains. Factors contributing to the emergence and spread
of drug-resistant malaria in Southeast Asia include:
- Drug management and quality. Fueling the emergence
of drug-resistant malaria are various drug-use behaviors
by both prescribers/dispensers and consumers that exposure
malaria parasites to sub-lethal doses of antimalarial
drugs.
- Economic pressures. Financial constraints on
health services which have been exacerbated by the recent
Asian financial crisis have resulted in budget reductions
for malaria monitoring and control, operational research,
and training. At the same time, decreasing economic opportunities
have led to increasing population incursions into forest
areas for informal income generating activities (e.g.
hunting, gathering of forest products, clearing of land
for agriculture).
- Population movement. Mobile populations and expansion
of areas under human habitation, especially encroachment
upon forested land, have contributed to the spread of
drug-resistant malaria from western Cambodia, where it
emerged in the late 1980s, to other locations in Southeast
Asia including Burma and Thailand. In recent years, increasing
levels of drug-resistant malaria have been observed in
several other countries in the region where similar conditions
(e.g. widespread and inappropriate drug use, economic
migration) exist.
Considering the cross-border nature of
the MDR-malaria problem and the limited scientific and surveillance
capacity in Southeast Asia, a coordinated, regional approach
is urgently needed to: (1) immediately contain the spread
of MDR malaria; and (2) limit future emergence and spread
of drug-resistant malaria. In order to improve national
capacity to monitor and respond to drug-resistant malaria,
USAID is working with host-country malaria programs, the
World Health Organization (WHO), and other partners in both
Cambodia and Thailand . (USAID restrictions currently prohibit
direct support being provided in Burma.) Specific activities
include: improving the diagnosis of P. falciparum, including
the use of dipsticks, so that the newer and more-costly
drugs are used judiciously; providing effective combination
therapies to vulnerable populations; monitoring drug resistance
and drug-use practices; and developing/testing/delivering
interventions to limit the emergence and spread of drug
resistance.
USAID has also addressed poor antimalarial drug quality
in Africa and Southeast Asia by supporting assessments
and analyses of drugs available through the public sector
and in both formal and
informal private facilities. The findings demonstrated
that both substandard and counterfeit antimalarial drugs
are widespread. Interventions
and training to help countries monitor and respond to
this problem will take place in the coming year.
At the regional level, USAID is also supporting
the WHO Regional Offices in New Delhi (SEARO)
and Manila (WPRO),
the Centers
for Disease Control and Prevention (CDC) in Atlanta,
and the Rational
Pharmaceutical Management (RPMplus) as part of
the Mekong Roll Back Malaria Initiative . These partners
will be providing technical assistance related to strengthening
local capacity for monitoring drug-resistant malaria in
the region and developing/implementing control measures
where appropriate. In the near future,
USAID will explore the possibility of expanding the surveillance
network for drug-resistant malaria to also include countries
in South Asia (i.e. Bangladesh,
India, and Nepal).
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