Deployment of early diagnosis and mefloquine-artesunate treatment of falciparum malaria in Thailand: The Tak Malaria Initiative
Background: Early diagnosis and treatment with artesunate-mefloquine combination therapy (MAS) have reduced the transmission of falciparum malaria dramatically and halted the progression of mefloquine resistance in camps for displaced persons along the Thai-Burmese border, an area of low and seasona...
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th-mahidol.236972018-08-20T14:14:57Z Deployment of early diagnosis and mefloquine-artesunate treatment of falciparum malaria in Thailand: The Tak Malaria Initiative Verena Ilona Carrara Supakit Sirilak Janjira Thonglairuam Chaiporn Rojanawatsirivet Stephane Proux Valery Gilbos Al Brockman Elizabeth A. Ashley Rose McGready Srivicha Krudsood Somjai Leemingsawat Sornchai Looareesuwan Pratap Singhasivanon Nicholas White François Nosten Shoklo Malaria Research Unit Mahidol University Public Health Office Thailand Ministry of Public Health Churchill Hospital Medicine Background: Early diagnosis and treatment with artesunate-mefloquine combination therapy (MAS) have reduced the transmission of falciparum malaria dramatically and halted the progression of mefloquine resistance in camps for displaced persons along the Thai-Burmese border, an area of low and seasonal transmission of multidrug-resistant Plasmodium falciparum. We extended the same combination drug strategy to all other communities (estimated population 450,000) living in five border districts of Tak province in northwestern Thailand. Methods and Findings: Existing health structures were reinforced. Village volunteers were trained to use rapid diagnostic tests and to treat positive cases with MAS. Cases of malaria, hospitalizations, and malaria-related deaths were recorded in the 6 y before, during, and after the Tak Malaria Initiative (TMI) intervention. Cross-sectional surveys were conducted before and during the TMI period. P. falciparum malaria cases fell by 34% (95% confidence interval [CI], 33.5-34.4) and hospitalisations for falciparum malaria fell by 39% (95% CI, 37.0-39.9) during the TMI period, while hospitalisations for P. vivax malaria remained constant. There were 32 deaths attributed to malaria during, and 22 after the TMI, a 51.5% (95% CI, 39.0-63.9) reduction compared to the average of the previous 3 y. Cross-sectional surveys indicated that P. vivax had become the predominant species in Thai villages, but not in populations living on the Myanmar side of the border. In the displaced persons population, where the original deployment took place 7 y before the TMI, the transmission of P. falciparum continued to be suppressed, the incidence of falciparum malaria remained low, and the in vivo efficacy of the 3-d MAS remained high. Conclusions: In the remote malarious north western border area of Thailand, the early detection of malaria by trained village volunteers, using rapid diagnostic tests and treatment with mefloquineartesunate was feasible and reduced the morbidity and mortality of multidrug-resistant P. falciparum. © 2006 Carrara et al. 2018-08-20T07:14:57Z 2018-08-20T07:14:57Z 2006-07-10 Article PLoS Medicine. Vol.3, No.6 (2006), 0856-0864 10.1371/journal.pmed.0030183 15491676 15491277 2-s2.0-33745630654 https://repository.li.mahidol.ac.th/handle/123456789/23697 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=33745630654&origin=inward |
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Medicine Verena Ilona Carrara Supakit Sirilak Janjira Thonglairuam Chaiporn Rojanawatsirivet Stephane Proux Valery Gilbos Al Brockman Elizabeth A. Ashley Rose McGready Srivicha Krudsood Somjai Leemingsawat Sornchai Looareesuwan Pratap Singhasivanon Nicholas White François Nosten Deployment of early diagnosis and mefloquine-artesunate treatment of falciparum malaria in Thailand: The Tak Malaria Initiative |
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Background: Early diagnosis and treatment with artesunate-mefloquine combination therapy (MAS) have reduced the transmission of falciparum malaria dramatically and halted the progression of mefloquine resistance in camps for displaced persons along the Thai-Burmese border, an area of low and seasonal transmission of multidrug-resistant Plasmodium falciparum. We extended the same combination drug strategy to all other communities (estimated population 450,000) living in five border districts of Tak province in northwestern Thailand. Methods and Findings: Existing health structures were reinforced. Village volunteers were trained to use rapid diagnostic tests and to treat positive cases with MAS. Cases of malaria, hospitalizations, and malaria-related deaths were recorded in the 6 y before, during, and after the Tak Malaria Initiative (TMI) intervention. Cross-sectional surveys were conducted before and during the TMI period. P. falciparum malaria cases fell by 34% (95% confidence interval [CI], 33.5-34.4) and hospitalisations for falciparum malaria fell by 39% (95% CI, 37.0-39.9) during the TMI period, while hospitalisations for P. vivax malaria remained constant. There were 32 deaths attributed to malaria during, and 22 after the TMI, a 51.5% (95% CI, 39.0-63.9) reduction compared to the average of the previous 3 y. Cross-sectional surveys indicated that P. vivax had become the predominant species in Thai villages, but not in populations living on the Myanmar side of the border. In the displaced persons population, where the original deployment took place 7 y before the TMI, the transmission of P. falciparum continued to be suppressed, the incidence of falciparum malaria remained low, and the in vivo efficacy of the 3-d MAS remained high. Conclusions: In the remote malarious north western border area of Thailand, the early detection of malaria by trained village volunteers, using rapid diagnostic tests and treatment with mefloquineartesunate was feasible and reduced the morbidity and mortality of multidrug-resistant P. falciparum. © 2006 Carrara et al. |
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Shoklo Malaria Research Unit |
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Shoklo Malaria Research Unit Verena Ilona Carrara Supakit Sirilak Janjira Thonglairuam Chaiporn Rojanawatsirivet Stephane Proux Valery Gilbos Al Brockman Elizabeth A. Ashley Rose McGready Srivicha Krudsood Somjai Leemingsawat Sornchai Looareesuwan Pratap Singhasivanon Nicholas White François Nosten |
format |
Article |
author |
Verena Ilona Carrara Supakit Sirilak Janjira Thonglairuam Chaiporn Rojanawatsirivet Stephane Proux Valery Gilbos Al Brockman Elizabeth A. Ashley Rose McGready Srivicha Krudsood Somjai Leemingsawat Sornchai Looareesuwan Pratap Singhasivanon Nicholas White François Nosten |
author_sort |
Verena Ilona Carrara |
title |
Deployment of early diagnosis and mefloquine-artesunate treatment of falciparum malaria in Thailand: The Tak Malaria Initiative |
title_short |
Deployment of early diagnosis and mefloquine-artesunate treatment of falciparum malaria in Thailand: The Tak Malaria Initiative |
title_full |
Deployment of early diagnosis and mefloquine-artesunate treatment of falciparum malaria in Thailand: The Tak Malaria Initiative |
title_fullStr |
Deployment of early diagnosis and mefloquine-artesunate treatment of falciparum malaria in Thailand: The Tak Malaria Initiative |
title_full_unstemmed |
Deployment of early diagnosis and mefloquine-artesunate treatment of falciparum malaria in Thailand: The Tak Malaria Initiative |
title_sort |
deployment of early diagnosis and mefloquine-artesunate treatment of falciparum malaria in thailand: the tak malaria initiative |
publishDate |
2018 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/23697 |
_version_ |
1763495135801245696 |