MALARIA: FROM CONTROL TO ELIMINATION IN THE WHO EUROPEAN REGION (1999-2014).

Malaria in the WHO European Region has gone from control to elimination thanks to the great efforts of health services in endemic countries. Locally transmitted malaria cases decreased from 90,000 late in the 20th century to 0 in 2015. Currently, there is a real threat to resurgence of malaria in the south of the European and Asian parts of the Region. Neglecting malaria prevention measures in the countries with high malariogenic potential areas where malaria elimination has been achieved may lead to consequences of imported malaria.

Hospital-based study of severe malaria and associated deaths in Myanmar.

The present study identifies factors that contribute to malaria deaths in township hospitals reporting large numbers of such deaths in Myanmar. Between July and December 1995, we identified a total of 101 patients with severe and complicated malaria by screening the cases admitted to hospital with a primary diagnosis of falciparum malaria. Unrousable coma and less marked impairment of consciousness with or without other severe malaria complications, in contrast to severe malaria anaemia, were associated with all malaria deaths. Adult patients with severe malaria were 2.8 times more likely to die than child patients, with the higher risk of death among adults probably being associated with previous exposure to malaria, delay in seeking treatment and severity of the illness before admission. In view of this, we consider that malaria mortality could be reduced by improving peripheral facilities for the management of severe malaria and providing appropriate education to communities, without stepping up vector control activities.

PIP: Malaria threatens about 60% of Myanmar's population with morbidity and mortality. Factors are identified which contribute to malaria mortality in township hospitals reporting large numbers of such deaths in Myanmar. During July-December 1995, 101 patients with severe and complicated malaria were identified through the screening of cases admitted to hospital with a primary diagnosis of falciparum malaria. Unrousable coma and less marked impairment of consciousness with or without other severe malaria complications, in contrast to severe malaria anemia, were associated with all malaria deaths. Adult patients with severe malaria were 2.8 times more likely to die than child patients, with the higher risk of death among adults probably associated with previous exposure to malaria, delay in seeking treatment, and the severity of illness before admission. The level of malaria mortality could be reduced by improving peripheral facilities for the management of severe malaria and providing appropriate education to communities, without stepping up vector control activities.

Response of falciparum malaria to different antimalarials in Myanmar.

The purpose of the study was to ascertain the therapeutic efficacy of different treatments for uncomplicated falciparum malaria in the hospitals in Sagaing, northern and eastern Shan, to facilitate updating the existing national antimalarial drug policy. The proposed 14-day trial for monitoring the efficacy of treatments of uncomplicated falciparum malaria is an efficient method for identifying treatment failure patterns at the intermediate level (township hospital) in the Union of Myanmar. Minimal clinical and parasitological data for days 0-14 were required to classify treatment failure and success. Clinical and parasitiological responses on day 3 and days 4-14 were used as clear examples of early and late treatment failure, respectively. Mefloquine is five times more likely to be effective than chloroquine and sulfadoxine pyrimethamine (S-P), whereas chloroquine and S-P treatments have nearly identical failure patterns. The alarming frequency of clinical and parasitological failure (failure rate > 50%) following chloroquine treatment was reported in Sagaing and following S-P treatment in Sagaing and eastern Shan.

PIP: Malaria is a major health problem in Myanmar, a country in which the resistance of Plasmodium falciparum to antimalarial drugs frustrates malaria control efforts and impedes success. Chloroquine and sulfadoxine-pyrimethamine (SP) resistance at various levels is now common throughout the country, while mefloquine resistance currently remains limited to the Thai-Myanmar border. Findings are presented from an assessment of the therapeutic efficacy of treating uncomplicated falciparum malaria in hospitals in Sagaing Division and Shan State with a view to updating the existing national antimalarial drug policy. 118 patients aged 1-58 years with acute uncomplicated falciparum malaria were recruited into the study conducted in the township hospitals of Katha, Hsipaw, and Tachileik, an overall area characterized by endemic and seasonal forest-related malaria. The most prevalent parasite species is P. falciparum. Patients were randomly assigned to receive either chloroquine, SP, or mefloquine in 14-day trials. Minimal clinical and parasitological data for days 0-14 were needed to classify treatment failure and success. Clinical and parasitological responses on day 3 and days 4-14 were used as clear examples of early and late treatment failure, respectively. Mefloquine was found to be 5 times more likely to be effective than chloroquine and SP, while chloroquine and SP treatments have almost identical failure patterns. A higher than 50% failure rate following chloroquine treatment was reported in Sagaing and following SP treatment in Sagaing and eastern Shan.