Mekong malaria. II. Update of malaria, multi-drug resistance and economic development in the Mekong region of Southeast Asia.

In an expansion of the first Mekong Malaria monograph published in 1999, this second monograph updates the malaria database in the countries comprising the Mekong region of Southeast Asia. The update adds another 3 years' information to cover cumulative data from the 6 Mekong countries (Cambodia, China/Yunnan, Lao PDR, Myanmar, Thailand, Viet Nam) for the six-year period 1999-2001. The objective is to generate a more comprehensive regional perspective in what is a global epicenter of drug resistant falciparum malaria, in order to improve malaria control on a regional basis in the context of social and economic change. The further application of geographical information systems (GIS) to the analysis has underscored the overall asymmetry of disease patterns in the region, with increased emphasis on population mobility in disease spread. Of great importance is the continuing expansion of resistance of P. falciparum to antimalarial drugs in common use and the increasing employment of differing drug combinations as a result. The variation in drug policy among the 6 countries still represents a major obstacle to the institution of region-wide restrictions on drug misuse. An important step forward has been the establishment of 36 sentinel sites throughout the 6 countries, with the objective of standardizing the drug monitoring process; while not all sentinel sites are fully operational yet, the initial implementation has already given encouraging results in relation to disease monitoring. Some decreases in malaria mortality have been recorded. The disease patterns delineated by GIS are particularly instructive when focused on inter-country distribution, which is where more local collaborative effort can be made to rationalize resource utilization and policy development. Placing disease data in the context of socio-economic trends within and between countries serves to further identify the needs and the potential for placing emphasis on resource rationalization on a regional basis. Despite the difficulties, the 6-year time frame represented in this monograph gives confidence that the now well established collaboration is becoming a major factor in improving malaria control on a regional basis and hopefully redressing to a substantial degree the key problem of spread of drug resistance regionally and eventually globally.

Cost of producing a medical doctor at Chulalongkorn University.

To illustrate the cost of producing a medical doctor through a 6-year curriculum and the analysis of the cost components of the Faculty of Medicine, could be used as key data for future planning, budgeting and preparation for the autonomous university. The cost centers were categorized to be executive, education support and education unit. The simultaneous equation method was employed to allocate all costs from other associated cost centers to the education unit. The unit cost per enrolled student was 2,161,124 baht and 8,217 Baht/Student Credit Hour (SCH), while the unit cost per graduate was 2,174,091 baht and 8,267 Baht/SCH. The labor cost accounted for 69.46 per cent, capital cost, 26.42 per cent and material cost, 4.12 per cent of the total medical doctor production cost. The three most costly departments were,: Department of Medicine (13.24%), Department of Obstetrics and Gynecology (11.73%) and Department of Paediatrics (9.87%). The cost-fee ratio (cost/fee) was 95:5 which suggested that medical students obtain 95 per cent subsidy from the government budget or the society. If the University becomes autonomous and less dependent on public budget, the fee may have to be adjusted higher to cover the cost. The percentage of drop out and repeat students was 0.00-0.88 per cent with a delay duration of about 6 months to one year only. The opportunity cost of six years' study for a student attending the medical school was 544,956 baht which raised the total cost per graduate to 2,719,047 baht from student/societal perspective.