Wednesday, April 25, 2018

Improving access to healthcare can usually make malaria go away

Drug resistant malaria has emerged in Southeast Asia several times in history and subsequently spread globally. When there are no other antimalarials to use this has led to public health and humanitarian disasters, especially in high transmission settings (parts of sub-Saharan Africa).

Currently there is a single effective antimalarial left: Artemisinin. But malaria parasites in Southeast Asia are already developing resistance to this antimalarial, leading many in the malaria research community and in public health to worry that we will soon be left with untreatable malaria.

One proposed solution to this problem has been to attempt to eliminate the parasite from regions where drug resistance consistently emerges. The proposed strategy uses a combination of increasing access to health care (so that ill people can be quickly diagnosed and treated, therefore reducing transmission) and targeting asymptomatic reservoirs by asking everyone who lives in a community where there is a large reservoir to take antimalarials, regardless of whether or not they feel ill (mass drug administration).

In Southeast Asia malaria largely persists in areas that are difficult to access and remote. The parasite thrives in conflict zones and in the fringes of society. These are the areas that frequently don’t have strong healthcare or surveillance systems and some have even argued that control or elimination would be impossible in such areas because of these difficulties.

Today on World Malaria Day my colleagues and I published the results after 3 years of an elimination campaign in Karen State of Myanmar.  The job is not complete. But this work has shown that it is feasible to set up a health care system, even in remote and difficult-to-access areas, and that most villages can achieve elimination through beefing up of the health care system alone. In places where there are high proportions of people with asymptomatic malaria, access to health care alone doesn’t suffice and malaria persists for a longer period of time. With high participation in mass drug administration, which requires a large amount of community engagement, these communities are able to quickly eliminate the parasites as well. We are hopeful that similar programs will be expanded throughout Southeast Asia, regardless of the geographic and political characteristics of the regions, so that elimination can be achieved and sustained.

Malaria (P. falciparum) incidence in the target area over three years. The project expanded over the three years, and overall incidence has decreased.

Link to the main paper:
Effect of generalised access to early diagnosis and treatment and targeted mass drug administration on Plasmodium falciparum malaria in Eastern Myanmar: an observational study of a regional elimination programme

Link to a detailed description of the setup of the project:

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