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Title: Deployment of early diagnosis and mefloquine-artesunate treatment of falciparum malaria in Thailand: The Tak Malaria Initiative
Authors: Verena Ilona Carrara
Supakit Sirilak
Janjira Thonglairuam
Chaiporn Rojanawatsirivet
Stephane Proux
Valery Gilbos
Al Brockman
Elizabeth A. Ashley
Rose McGready
Srivicha Krudsood
Somjai Leemingsawat
Sornchai Looareesuwan
Pratap Singhasivanon
Nicholas White
François Nosten
Shoklo Malaria Research Unit
Mahidol University
Public Health Office
Thailand Ministry of Public Health
Churchill Hospital
Keywords: Medicine
Issue Date: 10-Jul-2006
Citation: PLoS Medicine. Vol.3, No.6 (2006), 0856-0864
Abstract: Background: Early diagnosis and treatment with artesunate-mefloquine combination therapy (MAS) have reduced the transmission of falciparum malaria dramatically and halted the progression of mefloquine resistance in camps for displaced persons along the Thai-Burmese border, an area of low and seasonal transmission of multidrug-resistant Plasmodium falciparum. We extended the same combination drug strategy to all other communities (estimated population 450,000) living in five border districts of Tak province in northwestern Thailand. Methods and Findings: Existing health structures were reinforced. Village volunteers were trained to use rapid diagnostic tests and to treat positive cases with MAS. Cases of malaria, hospitalizations, and malaria-related deaths were recorded in the 6 y before, during, and after the Tak Malaria Initiative (TMI) intervention. Cross-sectional surveys were conducted before and during the TMI period. P. falciparum malaria cases fell by 34% (95% confidence interval [CI], 33.5-34.4) and hospitalisations for falciparum malaria fell by 39% (95% CI, 37.0-39.9) during the TMI period, while hospitalisations for P. vivax malaria remained constant. There were 32 deaths attributed to malaria during, and 22 after the TMI, a 51.5% (95% CI, 39.0-63.9) reduction compared to the average of the previous 3 y. Cross-sectional surveys indicated that P. vivax had become the predominant species in Thai villages, but not in populations living on the Myanmar side of the border. In the displaced persons population, where the original deployment took place 7 y before the TMI, the transmission of P. falciparum continued to be suppressed, the incidence of falciparum malaria remained low, and the in vivo efficacy of the 3-d MAS remained high. Conclusions: In the remote malarious north western border area of Thailand, the early detection of malaria by trained village volunteers, using rapid diagnostic tests and treatment with mefloquineartesunate was feasible and reduced the morbidity and mortality of multidrug-resistant P. falciparum. © 2006 Carrara et al.
ISSN: 15491676
Appears in Collections:Scopus 2006-2010

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