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      Malaria profiles and challenges in artemisinin resistance containment in Myanmar

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          Abstract

          Background

          This study examined evolving malaria profiles from January, 2010 to December, 2014 to evaluate achievements and challenges of implementing measures to prevent and control spread of artemisinin resistance in Myanmar.

          Methods

          Using National Malaria Control Programme (NMCP) data, a cross-sectional descriptive study of 52 townships in artemisinin-resistant containment areas in Myanmar was conducted. Annual program data were analysed, and trends over time are graphically presented.

          Results

          In the 52 study townships populated by 8.7 million inhabitants, malaria incidence showed a decreasing trend from 10.54 per 1 000 population in 2010 to 2.53 in 2014, and malaria mortalities also decreased from 1.83 per 100 000 population in 2010 to 0.17 in 2014. The proportion of confirmed to total tested malaria cases also decreased from 6 to 1%, while identification of cases improved. All cases from all parasites species, including Plasmodium falciparum, decreased. Coverage of LLIN (long-lasting insecticidal net)/ITN (insecticide-treated mosquito nets) and indoor residual spraying (IRS) was high in targeted areas with at-risk persons, even though the total population was not covered. In addition to passive case detection (PCD), active case detection (ACD) was conducted in hard-to-reach areas and worksites where mobile migrant populations were present. ACD improved in most areas from 2012 to 2014, but continues to need to be strengthened.

          Conclusions

          The findings provide useful data on the malaria situation in artemisinin-resistant initiative areas, which may be useful for the NMCP to meet its elimination goal. These profiles could contribute to better planning, implementation, and evaluation of intervention activities.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s40249-017-0292-4) contains supplementary material, which is available to authorized users.

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          Most cited references15

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          World malaria report 2015

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            Disease surveillance for malaria elimination: an operational manual.

            (2012)
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              Malaria incidence in Myanmar 2005–2014: steady but fragile progress towards elimination

              Background There has been an impressive recent reduction in the global incidence of malaria, but the development of artemisinin resistance in the Greater Mekong Region threatens this progress. Increasing artemisinin resistance is particularly important in Myanmar, as it is the country in the Greater Mekong Region with the greatest malaria burden. If malaria is to be eliminated in the region, it is essential to define the spatial and temporal epidemiology of the disease in Myanmar to inform control strategies optimally. Results Between the years 2005 and 2014 there was an 81.1 % decline in the reported annual incidence of malaria in Myanmar (1341.8 cases per 100,000 population to 253.3 cases per 100,000 population). In the same period, there was a 93.5 % decline in reported annual mortality from malaria (3.79 deaths per 100,000 population to 0.25 deaths per 100,000 population) and a 87.2 % decline in the proportion of hospitalizations due to malaria (7.8 to 1.0 %). Chin State had the highest reported malaria incidence and mortality at the end of the study period, although socio-economic and geographical factors appear a more likely explanation for this finding than artemisinin resistance. The reduced malaria burden coincided with significant upscaling of disease control measures by the national government with support from international partners. These programmes included the training and deployment of over 40,000 community health care workers, the coverage of over 60 % of the at-risk population with insecticide-treated bed nets and significant efforts to improve access to artemesinin-based combination treatment. Beyond these malaria-specific programmes, increased general investment in the health sector, changing population demographics and deforestation are also likely to have contributed to the decline in malaria incidence seen over this time. Conclusions There has been a dramatic fall in the burden of malaria in Myanmar since 2005. However, with the rise of artemisinin resistance, continued political, financial and scientific commitment is required if the ambitious goal of malaria elimination in the country is to be realized.
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                Author and article information

                Contributors
                (067) 422565 , thetwainwe@gmail.com
                Journal
                Infect Dis Poverty
                Infect Dis Poverty
                Infectious Diseases of Poverty
                BioMed Central (London )
                2049-9957
                25 April 2017
                25 April 2017
                2017
                : 6
                : 76
                Affiliations
                [1 ]GRID grid.415741.2, National Malaria Control Programme, Department of Public Health, , Ministry of Health, ; Zabukyetthayay Road, Nay Pyi Taw, Myanmar
                [2 ]GRID grid.415741.2, Department of Medical Research, , Ministry of Health, ; Nay Pyi Taw, Myanmar
                [3 ]ISNI 0000 0000 8803 2373, GRID grid.198530.6, National Institute of Parasitic Diseases, , Chinese Center for Disease Control and Prevention, ; Beijing, China
                [4 ]ISNI 0000 0001 2153 5088, GRID grid.11505.30, , Institute of Tropical Medicine, ; Antwerp, Belgium
                [5 ]ISNI 0000000417678301, GRID grid.414953.e, , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), ; Puducherry, India
                [6 ]Operational Research Unit (LuxOR), Médecins Sans Frontières – Operational Centre Brussels, Luxembourg City, Luxembourg
                Author information
                http://orcid.org/0000-0002-0132-6366
                Article
                292
                10.1186/s40249-017-0292-4
                5404679
                28438194
                d2710362-06da-4712-a3f4-0bdb84ac6fc1
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 7 October 2016
                : 21 March 2017
                Categories
                Research Article
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                © The Author(s) 2017

                malaria,artemisinin resistance,myanmar
                malaria, artemisinin resistance, myanmar

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