TABLE OF CONTENTS
1. Problem Statement (Background of the Study) 3
2. Objectives of the Research 4
3. Research Design and Methodology 4
4. Measures to Address Ethical Concerns 6
5. Study Audiances and Utilization of Results 6
6. Limitations of the Study 6
7. Process of the Study and Time Table 7
8. Resources Required for the Study 7
1. Problem Statement (Background of the Study)
According to the World Malaria Report produced by World Health Organization in 2008 (WHO, 2008), Malaria morbidity rate in Myanmar was 10.15 per 1,000 population and mortality rate was 2.68 per 100,000 population. There were 4.2 million malaria cases (0.87 to 8.5 million) in 2006 of which approximately 75 percent were caused by Plasmodium falciparum. The report estimated the number of Malaria deaths in 2006 at 9,100 (2,400 to 17,000).
In the last decade, oral artemisinin‐based combination therapies have proved effective in the treatment of falciparum malaria, and play an important role in reducing morbidity and mortality of malaria. Unfortunately, there is growing evidence that artemisinin resistant parasites, which were first detected around the Thai‐Cambodian border, occur also in certain parts of Myanmar.
In 2009, sentinel sites have been established in two townships in Myanmar (Shwe Kyin from Bago Division and Kawthaung from Thanintharyi Division) to monitor anti-malaria drug resistance and the data showed that there is suspected resistance to artimisinin in Myanmar which needs urgent action.
Table 1.1 Efficacy results in Kawthaung at 2009
Coartem (Arthemeter + Lumefenterine) Duocotexin Chloroquine
28 days finished 80 80 61
parasitological failure 6 4 12
% parasitaemia Day1 52 (65.0%) 76 (95.8%) 35 (57.4%)
% parasitaemia Day2 30 (37.5%) 54 (67.5%) 9 (14.1%)
% parasitaemia in Day3 5 (6.25.%) 15 (18.75%) 2 (3.3%)
*** Persistence of P.f parasites on day 3 of treatment. Need to be addressed effectively.
Table 1.2 Morbidity Rate, Mortality Rate, Percentage of Malaria Cases Admitted to Out Patient Department and Case Fatality Fate of Kawthaung Township
Morbidity Rate per 100,000 pop Mortality Rate per 100,000 pop Percentage of Malaria Cases admitted at Out Patient Department Case Fatality Rate
3,934.80 4.30 31.54 2.91
Indiscriminate wide spread use of artemisinin based mono‐therapies (AMTs) for the treatment of falciparum Malaria is likely to create emergence of artemisinin resistant parasites (WHO, 2008). Approximately, 60‐75 percent of people in Myanmar are thought to use the private sector for health care and the vast majority of these are likely to receive AMTs. Both the frequency of use of AMTs and the quantity of fake and substandard drugs in circulation are believed to be high in Myanmar.
In Kawthaung Township, there is the high number of migrants/ mobile populations involving primarily in forestry and plantation work and these population groups can play a key role in the transfer of tolerant/resistant...