Acceptance of short course artesunate plus mefloquine drug combination by malaria patients in rural Myanmar.

A cross sectional study was carried out in a rural area of Myanmar to identify malaria patients' acceptance of artesunate plus mefloquine drug combination and to determine the cost borne by patients. The majority (88.5%) preferred this new regimen rather than the other ones they had used before; conviction of drug efficacy was the reason given for the preference by most of them. Traveling on foot to rural health centers or a health assistant's residence for getting the drugs was found to be the main route. Average cost incurred by a patient to get the drug was found to be 274.22 Kyats. Among the cost items, drug cost was the highest item that they had used.

The use of personal protective measures in control of malaria in a defined community.

Malaria is one of the main health problems in the non-immune immigrant workers and army personnel of the malaria endemic areas in Myanmar. Due to changes in the vector bionomics and multiresistant strains of P. falciparum, chemoprophylaxis alone is not an effective means of control of malaria in them. So it is envisaged that the combined used of personal protective measures (deltamethrin impregnated bed-nets, scalves and hand-bands) and the chemoprophylaxis will be an effective means of control of malaria in the define group of people. The study also intended to find out the side effects of the deltamethrin and feasibility and acceptability of methods by the users. The study was conducted in Theini Township, Northern Shan State, from March to November 1993. The study population consisted of all ages of both sexes 554 and 440 persons in the test and control groups respectively. At the initial phase of the study, malaria infected persons from both the groups were treated. The experimental group received personal protective measures with impregnation of bed-nets using 25 mg ai/m2 of deltamethrin at 4 monthly intervals and the scarves and hand-bands at twice the concentration of the insecticides at monthly intervals. Chemoprophylaxis was given to both the groups at weekly intervals using age adjusted dosage of Pyrixine tablet (sulfadoxine-pyrimethamine). The parasitological, entomological, and epidemiological indices were collected at two month intervals in both the groups. The study clearly showed the impact of personal protective measures and chemoprophylaxis on malaria infection in the studied subjects. During the study period, the out patient malaria cases of the test group was 6% to 11.2% and that of the control group was 12% to 21.6% in Theini Hospital. The reinfection rate of the test group (0.9 to 4.7%) was also significantly lower than the control group (6.1 to 14.3%) from July to November. Acceptance of the treated bed-nets, scarves and hand-bands was high and good compliance was found in the follow up. The results of the study clearly showed that malaria can be controlled effectively in the defined group of persons for a malaria transmission season by using chemoprophylaxis and personal protective measures.

A simplified in vivo drug sensitivity test for malaria in the field.

The study was intended to develop a simple and reliable in vivo field test for monitoring of sensitivity of P.falciparum to antimalarials. The test is to be used as a built in sustainable monitoring system and applied at regular frequencies to provide guidance in developing a country-wide antimalarial drug policy. The study was conducted as a hospital based study in Mon State in Mudon, Kamawet and Pa-auk hospitals. The criteria matched malaria patients were treated with standard dosages of chloroquine, sulfadoxine-pyrimethamine and mefloquine and blood films were taken on days 0, 2, 3, 4, 7, 14 and 28. The assessment of the in vivo drug response of P.falciparum on days 2, 3 and 4 were compared with WHO standard 28 days and 7 day tests. The following successful tests were carried out for 7 days with different antimalarials: 171 tests with chloroquine and sulfadoxine-pyrimethamine and 167 tests with mefloquine. Tests were also carried out for 28 days: 59 tests with chloroquine, 77 tests with sulfadoxine-pyrimethamine and 78 tests with mefloquine. The results found that 3 day tests, taking blood films on days 0 and 3, can be reliably used as an adjunct to 28-day tests. Since the test is simple and can be used extensively and sustainably throughout the country and the results are applicable to be used for epidemiological purposes, the method is suggested for use as a built-in monitoring method for the malaria control program.

Urinary fibrin (-ogen) degradation products in Russell's viper (Daboia russelii siamensis) bite victims.

Serum and urine concentrations of fibrin (-ogen) degradation products (FDP) were estimated in 20 proven Russell's viper bite (RVB) cases with severe defribination. All patients had similar degrees of high serum FDP levels. However, the ten who developed into acute renal failure (ARF) had significantly (p < 0.001) higher urinary FDP levels than those who did not. The urinary FDP levels of ARF cases increased correspondingly with high serum FDP levels but not in cases without ARF. Serial comparison of serum and urinary FDP levels in RVB cases with severe defibrination may be of value in predicting the likelihood of developing ARF. The present study favored disseminated intravascular coagulation as the main cause of ARF in Myanmar RVB cases.

Renal histopathology following Russell's viper (Vipera russelli) bite.

Renal lesions in ten patients following Russell's viper bite were studied. Renal biopsies were available in six and autopsies in four patients. Autopsied tissues from two cases of traumatic death served as controls. Both qualitative and quantitative changes in the glomeruli, tubules, interstitium and blood vessels were evaluated. Tubular necrosis was detected in five, tubular degeneration in nine, glomerular changes in nine and interstitial changes in four cases. Generally tissues from expired cases had more severe and extensive renal lesions than those that survived.

In vitro sensitivity of Plasmodium falciparum isolates from Burma to chloroquine quinine and mefloquine.

The in vitro sensitivity of 26 isolates of Plasmodium falciparum from Rangoon and Tharrawaddy areas in Burma were studied on chloroquine, mefloquine and quinine. The results indicated that the parasites were highly resistant to chloroquine but sensitive to mefloquine and quinine. The existence of correlation of sensitivity to mefloquine and quinine was detected and discussed. No correlation between the parasite sensitivity to chloroquine and mefloquine and or chloroquine and quinine was detected.

The in vivo and in vitro sensitivity of Plasmodium falciparum to quinine.

The in vivo and in vitro sensitivity of P. falciparum to quinine were studied simultaneously on 20 isolates of P. falciparum from infected patients in Rangoon and in Tharrawaddy Township. The in vivo study showed 85% sensitive and 5% resistance at RI level. The peak plasma quinine level in all the cases were above mean MIC on days 1, 3, 5 and 7. Schizont maturation was inhibited at 128 p.mol/well in 15% of the cases but the rest were at or below 64 p.mol/well in vitro test. However, no relationship was detected between the in vivo and in vitro sensitivity of quinine.