The online version of this article (doi:10.1186/1475-2875-11-300) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests. Development of the eMIS was supported by the malaria containment initiative of the WHO and the Bill & Melinda Gates Foundation.
SL, PS(1), WS, JK designed the study. SL, JK performed statistical analysis. PS(1), AK, SS, TP, AS worked on the design of eMIS and the applications module, and monitored and maintained the module’s implementation, and extracted data for analysis. PS(1), WS, SV were responsible for managing and supervising the overall malaria control programmer’s activities. AK, JK, DC were in charge of monitoring the progress of eMIS applications. SL, JK, WS, DC, PS(2) drafted the manuscript. All authors read and approved the final manuscript.
The area along the Thai-Cambodian border is considered an epicenter of anti-malarial drug resistance. Recently, parasite resistance to artemisinin-based therapies has been reported in the area. The artemisinin resistance containment project was initiated in November 2008, with the aim to limit resistant parasites and eliminate malaria in this region. This study describes the response to artemisinin-based therapy among falciparum malaria patients in the area, using data from the malaria surveillance programmed under the containment project.
The study was conducted in seven provinces of Thailand along the Thai-Cambodian border. Data of Plasmodium falciparum-positive patients during January 2009 to December 2011 were obtained from the electronic malaria information system (eMIS) Web-based reporting system. All P. falciparum cases were followed for 42 days, as the routine case follow-up protocol. The demographic characteristics of the patients were described. Statistical analysis was performed to determine the cure rate of the current standard anti-malarial drug regimen--mefloquine-artesunate combination therapy (MAS). The proportion of patients who remained parasite-positive at each follow-up day was calculated. In addition, factors related to the delayed parasite clearance on day-3 post-treatment, were explored.
A total of 1,709 P. falciparum-positive cases were reported during the study period. Almost 70% of falciparum cases received MAS therapy (n = 1,174). The majority of cases were males, aged between 31 and 50 years. The overall MAS cure rate was >90% over the three-year period. Almost all patients were able to clear the parasite within 7 to 14 days post-treatment. Approximately 14% of patients undergoing MAS remained parasite-positive on day-3. Delayed parasite clearance was not significantly associated with patient gender, age, or citizenship. However, delayed parasite clearance varied across the study area.
Anti-malarial drug-resistant parasites should be closely monitored in the area along the Thai-Cambodian border. Although the MAS cure rate in this study area was above 90%, an increasing trend of treatment failure has been reported in neighboring parts. Effective malaria surveillance is an important component to monitor drug-resistance in the malaria containment project.
World Health Organization: Containment of malaria multi-drug resistance on the Cambodia-Thailand border. Report of an Informal Consultation. 2007, WHO-Mekong Malaria Programme, Phnom Penh, Cambodia
World Health Organization: Guidelines for the treatment of malaria - 2nd edition. 2010, World Health Organization, Geneva
Carrara VI, Zwang J, Ashley EA, Price RN, Stepniewska K, Barends M, Brockman A, Anderson T, McGready R, Phaiphun L, Proux S, van Vugt M, Hutagalung R, Lwin KM, Phyo AP, Preechapornkul P, Imwong M, Pukrittayakamee S, Singhasivanon P, White NJ, Nosten F: Changes in the treatment responses to artesunate-mefloquine on the northwestern border of Thailand during 13 years of continuous deployment. PLoS One. 2009, 4: e4551-10.1371/journal.pone.0004551. PubMedCentralCrossRefPubMed
Vijaykadga S, Rojanawatsirivej C, Cholpol S, Phoungmanee D, Nakavej A, Wongsrichanalai C: In vivo sensitivity monitoring of mefloquine monotherapy and artesunate-mefloquine combinations for the treatment of uncomplicated falciparum malaria in Thailand in 2003. Trop Med Int Health. 2006, 11: 211-219. 10.1111/j.1365-3156.2005.01557.x. CrossRefPubMed
Dondorp AM, Nosten F, Yi P, Das D, Phyo AP, Tarning J, Lwin KM, Ariey F, Hanpithakpong W, Lee SJ, Ringwald P, Silamut K, Imwong M, Chotivanich K, Lim P, Herdman T, An SS, Yeung S, Singhasivanon P, Day NP, Lindegardh N, Socheat D, White NJ: Artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med. 2009, 361: 455-467. 10.1056/NEJMoa0808859. PubMedCentralCrossRefPubMed
World Health Organization: Global report on antimalarial drug efficacy and drug resistance: 2000–2010. 2010, World Health Organization, Geneva
World Health Organization: Methods for surveillance of antimalarial drug efficacy. 2009, World Health Organization, Geneva
World Health Organization: Strategic Plan to Strengthen Malaria Control and Elimination in the Greater Mekong Sub region: 2010–2014. A Mekong Malaria Programme Partnership Initiative - Working Document. 2009, World Health Organization
World Health Organization: Progress on the Containment of Artemisinin Tolerant Malaria Parasites in South-East Asia (ARCE) Initiative. 2010, World Health Organization, Geneva
Khamsiriwatchara A, Sudathip P, Sawang S, Vijakadge S, Potithavoranan T, Sangvichean A, Satimai W, Delacollette C, Singhasivanon P, Lawpoolsri S, Kaewkungwal J: Artemisinin resistance containment project in Thailand. I: implementation of electronic-based malaria information system for early case detection and individual case management in provinces along the Thai-Cambodian border. Malar J. 2012, 11: 247-10.1186/1475-2875-11-247. PubMedCentralCrossRefPubMed
Noedl H, Se Y, Sriwichai S, Schaecher K, Teja-Isavadharm P, Smith B, Rutvisuttinunt W, Bethell D, Surasri S, Fukuda MM, Socheat D, Chan Thap L: Artemisinin resistance in Cambodia: a clinical trial designed to address an emerging problem in Southeast Asia. Clin Infect Dis. 2010, 51: e82-89. 10.1086/657120. CrossRefPubMed
- Artemisinin resistance containment project in Thailand. II: responses to mefloquine-artesunate combination therapy among falciparum malaria patients in provinces bordering Cambodia
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
e.Med Kampagnen-Visual, Mail Icon II