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Malaria Adds to Myanmar’s Woes

BANGKOK, Apr 27 2012 (IPS) - Political reforms unfolding in Myanmar (or Burma) are giving health workers a chance to address a resurgence of drug-resistant falciparum malaria in the war-torn ethnic minority enclaves along the country’s eastern borders.

Carrying medical aid in backpacks they have been dodging bullets and avoiding mines to deliver healthcare to villagers in the remote border areas that are home to ethnic minorities such as the Karen, Shan and Kachin.

“Due to recent political changes, our health workers have more freedom to access areas formerly restricted by the Burmese army,” Mahn Mahn, secretary of the Back Pack Health Worker Team (BPHWT), a non-profit that has been attending to the health needs of nearly 200,000 ethnic minority people in Myanmar for over a decade, told IPS.

Improved healthcare along eastern Myanmar could not have been timed better because of emerging concern over possible genetic mutation of the Plasmodium falciparum that makes the deadly parasite resistant to artemisinin, the most effective anti-malaria drug.

Researchers from the Shoklo Malaria Research Unit, on the Thai-Myanmar border, which is supported by the Tropical Medicine Research Programme of Oxford University and the Bangkok-based Mahidol University, have concluded that there is now a resurgence of the deadly strain of falciparum malaria.

The researchers arrived at that conclusion after studying 3,202 patients with falciparum malaria who were on oral artesunate (an artemisinin derivate). The study, conducted along the Thailand-Myanmar border, spanned a 10-year period that ended in 2010.

According to a study published in the British medical journal ‘Lancet’ in April, the longer time taken for oral anti-malaria drugs to act on parasites in the bloodstream suggested increasing resistance.

The World Health Organisation (WHO) has called for more attention to be paid to Myanmar – in addition to Cambodia, Thailand and Vietnam that are under watch – to manage resistance to artemisinin and its derivates.

WHO stated its concerns ahead of World Malaria Day, on Apr. 25. “The four countries most affected by resistance to artemisinin resistance are Cambodia, Thailand, Vietnam and Myanmar. Of these Myanmar has by far the greatest malaria burden.”

“Given its extensive migrant population, the widespread use of oral artemisinin-based mono therapies and its close geographical proximity to India, Myanmar is critical to the success of efforts to prevent the emergence of artemisinin resistance globally,” the WHO adds.

But programmes to combat the spread of malaria in remote ethnic areas – often among the most vulnerable – need to address the link between disease prevalence and human rights violations in Myanmar, says Bill Davis, Burma project director for Physicians for Human Rights, a United States-based global campaigner for health and rights.

“Research done in the Karen state a few years ago showed that people who had experienced human rights violations were more likely to be positive with malaria than those who did not experience rights abuse,” he told IPS of a region where government troops and Karen rebels have been locked in an ethnic conflict spanning 60 years.

“Human rights abuses have a direct impact on public health,” he asserted. “Forced labour, having food stolen, forced displacement, all have negative effects on health.”

According to the WHO, there were 2.4 million malaria cases reported in 2010 in South and Southeast Asia, of which three countries accounted for over 90 percent of the confirmed cases. India accounted for 66 percent, Myanmar 18 percent and Indonesia 10 percent.

WHO studies reveal that close to 40 million people, nearly 69 percent of the population, live in malaria endemic zones in Myanmar. Of that, some 24 million people live in high-transmission areas – where BPHT operates.

In 2010, Myanmar reported 650,000 cases and 788 malaria-related deaths, according the WHO.

Myanmar dominated the other two Asian countries in the spike in malaria cases over a 10-year period, from 2000 to 2010, according to the ‘World Malaria Report 2011’. It recorded the highest increase in cases – 250 percent – because of “the changes associated with a large increase in the external diagnostic testing,” the report adds.

The spectre of artemisinin resistance in this corner of Southeast Asia affirms why it has been labelled the “epicentre of drug-resistant malaria in the world.”

The battle to contain the malaria parasite’s resistance to chloroquinine, once the drug of choice, was lost in these parts. Malaria resistance to chloroquinine was first detected in Pailin, a war-torn corner along the Thai-Cambodian border, from where it spread around the world.

“The threat of drug resistance must be taken seriously,” Shin Young-soo, regional director for the WHO’s Western Pacific division, said this week in a message to mark Malaria Day. “A particular concern is that artemisinin resistance will also develop in Africa, which has the world’s greatest malaria burden.”

“Our task is to prevent and to protect the gains that have been achieved by continuing artemisinin resistance containment efforts in the affected areas, and by preventing the development of resistance in other areas,” he added. “In the countries with detected artemisinin resistance, elimination of resistant parasites is vital.”

Mahn Mahn hopes that the government will give border-based organisations like the BPHWT, that have been providing much needed humanitarian assistance for many years, recognition, “so that we can improve our healthcare programmes and activities in remote areas.”

“We are unable to purchase medicines and supplies inside Burma because we are not an organisation registered with the government,” he said.

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