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The Department of Medical Research (Lower Myanmar), in
collaboration with WHO, successfully concluded a Technical Meeting on Anti-malarial
Drug Resistance in Myanmar on 13 March 2009. Experts on malaria from national
and international organizations and representatives from Food and Drug
Administration and the pharmaceutical companies in Myanmar participated. They
concluded that treatment failure rates to artemisinin-based
combination treatments (ACTs) is high, and the
prolonged parasite clearance time documented in seven cases is a concern. However,
it was not clear if the treatment failures and the prolonged parasite
clearance time were due to Plasmodium falciparum
resistance to artemisinins since pharmacokinetic
studies were not done and Polymerase Chain Reaction (PCR) analysis was only
done for studies carried out in 2007.
Previous report on two cases of P. vivax
malaria resistant to chloroquine was noted. Further studies are needed to validate
resistance of P. vivax to chloroquine
and to determine the magnitude.
The experts identified key factors that may contribute to
the emergence and spread of resistance to anti-malarial drugs in Myanmar. They recommended the following strategic
actions to address them:
1. Scale up
rapidly nationwide, both in the public and private sectors, the provision of
early diagnosis and appropriate treatment of malaria in line with the current
national malaria treatment policy. Quality
assured diagnostic tests and ACTs should be widely
available, preferably free of charge. It
should be supported with effective supportive interventions such as: (a) training,
continuing medical education of health care providers, and dissemination of
the national malaria treatment guidelines to target users, (b) behavior
change communications for both the health providers, patients and the
populations at risk of malaria, (c) surveillance system, (d) supervision, monitoring
and evaluation
2. Prioritize
the implementation of preventive measures such as Insecticide treated net (ITNs)/ Long lasting insecticide net (LLINs)
and Indoor Residual Spray (IRS) in areas where treatment failures were
detected or in areas where there is high risk of emergence and spread of drug
resistance.
3. Further
strengthen and expand the Malaria Technical and Strategy Group. It should
serve as a coordination body to monitor and provide recommendations to scale
up the implementation of the national malaria treatment policy.
4. Review the
available anti-malarial drugs in the country. Ineffective anti-malarial drugs,
those that do not comply with registration and national standards and those
that are not in line with the national malaria treatment policy should be
recommended for de-listing. The Food and Drug Administration (FDA), in
collaboration with other concerned government agencies, WHO and other key
stakeholders, should consider this as a priority activity to be done as soon
as possible.
5. Strengthen
the capacity of FDA to detect fake, sub-standard drugs and counterfeit drugs.
This will include, among others, human resource development, and provision of
equipment and supplies. The capacities
of other agencies (e.g., CMSD, VBDC, DMRs, NGOs, etc)
for effective malaria prevention and control should be further improved.
6. Advocate to
the pharmaceutical companies and drug vendors to adhere to the national
malaria treatment policy.
7. Carry out
operational research to improve rational use of and access to Rapid
diagnostic test (RDTs) and ACTs.
8. Continue
monitoring the therapeutic efficacy of anti-malarial drugs and further
improved it to ensure quality and timely availability of data. PCR analyses
and pharmacokinetic studies should be done.
9. Strengthen
the collaboration with countries in the Greater Mekong Sub-region, Bangladesh and India to address the emergence
and spread of drug resistance.
10. Mobilize more
resources (e.g., from Three Diseases Fund, GFATM and other donors) for
effective malaria prevention and control.
In her opening remarks, Prof Adik Wibowo, WHO
Representative to Myanmar,
emphasized that “the emergence and spread of resistance to artemisinin-based drugs will have serious consequences
not just in Myanmar
but also globally. I encourage the national health authorities and the
international community to jointly invest massive financial and technical resources
to prevent a catastrophe”. Indeed, enormous
resources would be needed to carry out the strategic actions recommended to
prevent the emergence and spread of antimalarial
drugs resistance in Myanmar.
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