Browsing by Author "สารนาถ ล้อพูลศรี"

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    PublicationOpen Access
    Artemisinin resistance containment project in Thailand. (I): Implementation of electronic-based malaria information system for early case detection and individual case management in provinces along the Thai-Cambodian border
    (2012-07-29) Amnat Khamsiriwatchara; Prayuth Sudathip; Surasak Sawang; Saowanit Vijakadge; Thanapon Potithavoranan; Aumnuyphan Sangvichean; Wichai Satimai; Delacollette, Charles; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Saranath Lawpoolsri; สารนาถ ล้อพูลศรี; Jaranit Kaewkungwal; จรณิต แก้วกังวาล; Jaranit Kaewkungwal; Mahidol University. Faculty of Tropical Medicine. Department of Tropical Hygiene; Mahidol University. Faculty of Tropical Medicine. Center of Excellence for Biomedical and Public Health Informatics.
    BACKGROUND: The Bureau of Vector-borne Diseases, Ministry of Public Health, Thailand, has implemented an electronic Malaria Information System (eMIS) as part of a strategy to contain artemisinin resistance. The attempt corresponds to the WHO initiative, funded by the Bill & Melinda Gates Foundation, to contain anti-malarial drug resistance in Southeast Asia. The main objective of this study was to demonstrate the eMIS' functionality and outputs after implementation for use in the Thailand artemisinin-resistance containment project. METHODS: The eMIS had been functioning since 2009 in seven Thai-Cambodian border provinces. The eMIS has covered 61 malaria posts/clinics, 27 Vector-borne Disease Units covering 12,508 hamlets at risk of malaria infections. The eMIS was designed as an evidence-based and near real-time system to capture data for early case detection, intensive case investigation, monitoring drug compliance and on/off-site tracking of malarial patients, as well as collecting data indicating potential drug resistance among patients. Data captured by the eMIS in 2008-2011 were extracted and presented. RESULTS: The core functionalities of the eMIS have been utilized by malaria staff at all levels, from local operational units to ministerial management. The eMIS case detection module suggested decreasing trends during 2009-2011; the number of malaria cases detected in the project areas over the years studied were 3818, 2695, and 2566, with sero-positive rates of 1.24, 0.98, and 1.16%, respectively. The eMIS case investigation module revealed different trends in weekly Plasmodium falciparum case numbers, when classified by responsible operational unit, local and migrant status, and case-detection type. It was shown that most Thai patients were infected within their own residential district, while migrants were infected either at their working village or from across the border. The data mapped in the system suggested that P. falciparum-infected cases and potential drug-resistant cases were scattered mostly along the border villages. The mobile technology application has detected different follow-up rates, with particularly low rates among seasonal and cross-border migrants. CONCLUSION: The eMIS demonstrated that it could capture essential data from individual malaria cases at local operational units, while effectively being used for situation and trend analysis at upper-management levels. The system provides evidence-based information that could contribute to the control and containment of resistant parasites. Currently, the eMIS is expanding beyond the Thai-Cambodian project areas to the provinces that lie along the Thai-Myanmar border.
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    PublicationOpen Access
    Artemisinin resistance containment project in Thailand. II: Responses to mefloquine-artesunate combination therapy among falciparum malaria patients in provinces bordering Cambodia
    (2012-08-28) Wichai Satimai; Prayuth Sudathip; Saowanit Vijaykadga; Amnat Khamsiriwatchara; อำนาจ คำศิริวัชรา; Surasak Sawang; Thanapon Potithavoranan; Aumnuyphan Sangvichean; Delacollette, Charles; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Jaranit Kaewkungwal; จรณิต แก้วกังวาล; Saranath Lawpoolsri; สารนาถ ล้อพูลศรี; Saranath Lawpoolsri; Mahidol University. Faculty of Tropical Medicine. Department of Tropical Hygiene; Mahidol University. Faculty of Tropical Medicine. Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS)
    BACKGROUND: The area along the Thai-Cambodian border is considered an epicenter of anti-malarial drug resistance. Recently, parasite resistance to artemisinin-based therapies has been reported in the area. The artemisinin resistance containment project was initiated in November 2008, with the aim to limit resistant parasites and eliminate malaria in this region. This study describes the response to artemisinin-based therapy among falciparum malaria patients in the area, using data from the malaria surveillance programmed under the containment project. METHODS: The study was conducted in seven provinces of Thailand along the Thai-Cambodian border. Data of Plasmodium falciparum-positive patients during January 2009 to December 2011 were obtained from the electronic malaria information system (eMIS) Web-based reporting system. All P. falciparum cases were followed for 42 days, as the routine case follow-up protocol. The demographic characteristics of the patients were described. Statistical analysis was performed to determine the cure rate of the current standard anti-malarial drug regimen--mefloquine-artesunate combination therapy (MAS). The proportion of patients who remained parasite-positive at each follow-up day was calculated. In addition, factors related to the delayed parasite clearance on day-3 post-treatment, were explored. RESULTS: A total of 1,709 P. falciparum-positive cases were reported during the study period. Almost 70% of falciparum cases received MAS therapy (n = 1,174). The majority of cases were males, aged between 31 and 50 years. The overall MAS cure rate was > 90% over the three-year period. Almost all patients were able to clear the parasite within 7 to 14 days post-treatment. Approximately 14% of patients undergoing MAS remained parasite-positive on day-3. Delayed parasite clearance was not significantly associated with patient gender, age, or citizenship. However, delayed parasite clearance varied across the study area. CONCLUSION: Anti-malarial drug-resistant parasites should be closely monitored in the area along the Thai-Cambodian border. Although the MAS cure rate in this study area was above 90%, an increasing trend of treatment failure has been reported in neighboring parts. Effective malaria surveillance is an important component to monitor drug-resistance in the malaria containment project
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    Assessment of adherence to a three day course of artemether-lumefantrine treatment in rakhine state, Myanmar
    (2014) Wai Yan Aung; Arjen M. Dondorp; Myo Min; Thar Tun Kyaw; Saranath Lawpoolsri; สารนาถ ล้อพูลศรี; Srivicha Krudsood; ศรีวิชา ครุฑสูตร; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Mahidol University. Faculty of Tropical Medicine. Department of Tropical Hygiene
    Background: The development and spread of drug-resistant strains of malaria parasites has been identified as a key factor in malaria resurgence and is one of the greatest challenges to malaria control today. It is important to prevent or delay significantly the spread of artemisinin resistant parasites within the country and beyond its borders. Efforts to prevent deterioration of this problem are, therefore, at present directed towards finding novel ways of intervening to improve adherence and prevent the irrational use of currently available multi-dose anti-malarial drugs. The primary objective of this study was to access the level of patient adherence to artemether-lumefantrine under routine conditions of prescription. Method and Technique: Patients who consulted the fixed clinic or mobile clinic were routinely examined and screened for eligibility of inclusion in the study. The malaria positive P. falciparum malaria cases were treated with six doses of artemetherlumefantrine. Patient adherence was conducted by questionnaire and counting remaining pills on day 3 of anti-malaria treatment at their home. The adherence level was classified into three categories: definitely non-adherent, probably non-adherent and probably adherent. Reasons for being definitely non-adherent were also assessed. Results: Out of the total initially enrolled 175 patients, 161 (92%) patients completed the follow-up. Out of these, 138 (85.7%) were classified as probably adherent, 8 (5%) as probably non-adherent, and 15(9.3%) were definitely non-adherent. 40% of patients among definitely non-adherent group were age more than 15 years of age while 2-4 years of age compromised 70% of probably non-adherent group.
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    Causes of acute febrile illness among school children in ladkrabang district, Bangkok: cohort study
    (2014) Komchaluch Taweeseneepitch; Jaranit Kaewkungwal; จรณิต แก้วกังวาน; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Wongwat Liulark; Amnat Khamsiriwatchara; อำนาจ คำศิริวัชรา; Sarinya Krongrungroj; Saranath Lawpoolsri; สารนาถ ล้อพูลศรี; Mahidol University. Faculty of Tropical Medicine. Department of Tropical Hygiene; Mahidol University. Faculty of Tropical Medicine. Center of Excellence for Biomedical and Public Health Informatics
    Fever is a common clinical sign of most infectious diseases. School children are a population at risk, and also play an important role as a source of disease outbreak spreading in community. This study aimed to describe and investigate causes of acute febrile illness among school absentees Study was conducted in seven primary schools containing 5000 students from Ladkrabang district, Bangkok between 1 November 2013 and 31 August 2014. School absentees were monitored by an electronic absenteeism system. A list of school children who were sick with fever for 2 consecutive days were extracted and sent to nurses who are responsible for home visits. During home visits, consenting children and their parents were asked to complete a questionnaire. Sick children were also tested for dengue infection using a dengue duo rapid test. Their parents were advised to take their children to see a doctor for further investigation and treatment. One week later, the parents were asked for a final diagnosis of their sick children via phone. 60 % of the 83 investigated sick children received self-medication and recovered without seeing a doctor. The most common clinical signs were headache (64%). No dengue infection results were found. The top cause of acute febrile illness was the common cold (36%). Most parents preferred to give self-medication, maybe due to most students not having serious illnesses. No positive dengue test results were possibly due to the low incidence of infection. Understanding pattern of acute febrile illness in this population would greatly help to prevent disease outbreaks in schools and communities.
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    PublicationOpen Access
    Customized-language voice survey on mobile devices for text and image data collection among ethnic groups in Thailand: a proof-of-concept study.
    (2014-03-06) Kasemsak Jandee; เกษมศักดิ์ จันดี; Saranath Lawpoolsri; สารนาถ ล้อพูลศรี; Pimsurang Taechaboonsermsak; พิมพ์สุรางค์ เตชะบุญเสริมศักดิ์; Amnat Khamsiriwatchara; Peerawat Wansatid; Jaranit Kaewkungwal; จรณิต แก้วกังวาล; Jaranit Kaewkungwal; Mahidol University. Faculty of Tropical Medicine. Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS); Mahidol University. Faculty of Tropical Medicine. Department of Tropical Hygiene.; Mahidol University. Faculty of Public Health. Department of Family Health.
    BACKGROUND: Public health surveys are often conducted using paper-based questionnaires. However, many problems are associated with this method, especially when collecting data among ethnic groups who speak a different language from the survey interviewer. The process can be time-consuming and there is the risk of missing important data due to incomplete surveys. OBJECTIVE: This study was conducted as a proof-of-concept to develop a new electronic tool for data collection, and compare it with standard paper-based questionnaire surveys using the research setting of assessing Knowledge Attitude and Practice (KAP) toward the Expanded Program on Immunization (EPI) among 6 ethnic groups in Chiang Rai Province, Thailand. The two data collection methods were compared on data quality in terms of data completeness and time consumed in collecting the information. In addition, the initiative assessed the participants' satisfaction toward the use of a smartphone customized-language voice-based questionnaire in terms of perceived ease of use and perceived usefulness. METHODS: Following a cross-over design, all study participants were interviewed using two data collection methods after a one-week washout period. Questions in the paper-based questionnaires in Thai language were translated to each ethnic language by the interviewer/translator when interviewing the study participant. The customized-language voice-based questionnaires were programmed to a smartphone tablet in six, selectable dialect languages and used by the trained interviewer when approaching participants. RESULTS: The study revealed positive data quality outcomes when using the smartphone, voice-based questionnaire survey compared with the paper-based questionnaire survey, both in terms of data completeness and time consumed in data collection process. Since the smartphone questionnaire survey was programmed to ask questions in sequence, no data was missing and there were no entry errors. Participants had positive attitudes toward answering the smartphone questionnaire; 69% (48/70) reported they understood the questions easily, 71% (50/70) found it convenient, and 66% (46/70) reported a reduced time in data collection. The smartphone data collection method was acceptable by both the interviewers and by the study participants of different ethnicities. CONCLUSIONS: To our knowledge, this is the first study showing that the application of specific features of mobile devices like smartphone tablets (including dropdown choices, capturing pictures, and voiced questions) can be successfully used for data collection. The mobile device can be effectively used for capturing photos of secondary data and collecting primary data with customized-language and voiced questionnaire survey. Using smartphone questionnaires can minimize or eliminate missing data and reduce the time consumed during the data collection process. Smartphone customized-language, voice-based questionnaires for data collection can be an alternative and better approach than standard translated paper-based questionnaires for public health surveys, especially when collecting data among ethnic and hard-to-reach groups residing in multilanguage-speaking settings.
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    PublicationOpen Access
    Development of temporal modelling for forecasting and prediction of malaria infections using time-series and ARIMAX analyses: a case study in endemic districts of Bhutan
    (2010-09-03) Wangdi, Kinley; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Tassanee Silawan; Saranath Lawpoolsri; สารนาถ ล้อพูลศรี; White, Nicholas J.; Jaranit Kaewkungwal; จรณิต แก้วกังวาล; Jaranit Kaewkungwal; Mahidol University. Faculty of Tropical Medicine. Department of Tropical Hygiene; Mahidol University. Faculty of Tropical Medicine. Mahidol-Oxford Unit; Mahidol University. Faculty of Public Health. Rural Health Training and Research Centre
    BACKGROUND: Malaria still remains a public health problem in some districts of Bhutan despite marked reduction of cases in last few years. To strengthen the country's prevention and control measures, this study was carried out to develop forecasting and prediction models of malaria incidence in the endemic districts of Bhutan using time series and ARIMAX. METHODS: This study was carried out retrospectively using the monthly reported malaria cases from the health centres to Vector-borne Disease Control Programme (VDCP) and the meteorological data from Meteorological Unit, Department of Energy, Ministry of Economic Affairs. Time series analysis was performed on monthly malaria cases, from 1994 to 2008, in seven malaria endemic districts. The time series models derived from a multiplicative seasonal autoregressive integrated moving average (ARIMA) was deployed to identify the best model using data from 1994 to 2006. The best-fit model was selected for each individual district and for the overall endemic area was developed and the monthly cases from January to December 2009 and 2010 were forecasted. In developing the prediction model, the monthly reported malaria cases and the meteorological factors from 1996 to 2008 of the seven districts were analysed. The method of ARIMAX modelling was employed to determine predictors of malaria of the subsequent month. RESULTS: It was found that the ARIMA (p, d, q) (P, D, Q)s model (p and P representing the auto regressive and seasonal autoregressive; d and D representing the non-seasonal differences and seasonal differencing; and q and Q the moving average parameters and seasonal moving average parameters, respectively and s representing the length of the seasonal period) for the overall endemic districts was (2,1,1)(0,1,1)12; the modelling data from each district revealed two most common ARIMA models including (2,1,1)(0,1,1)12 and (1,1,1)(0,1,1)12. The forecasted monthly malaria cases from January to December 2009 and 2010 varied from 15 to 82 cases in 2009 and 67 to 149 cases in 2010, where population in 2009 was 285,375 and the expected population of 2010 to be 289,085. The ARIMAX model of monthly cases and climatic factors showed considerable variations among the different districts. In general, the mean maximum temperature lagged at one month was a strong positive predictor of an increased malaria cases for four districts. The monthly number of cases of the previous month was also a significant predictor in one district, whereas no variable could predict malaria cases for two districts. CONCLUSIONS: The ARIMA models of time-series analysis were useful in forecasting the number of cases in the endemic areas of Bhutan. There was no consistency in the predictors of malaria cases when using ARIMAX model with selected lag times and climatic predictors. The ARIMA forecasting models could be employed for planning and managing malaria prevention and control programme in Bhutan.
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    PublicationOpen Access
    Directly-observed therapy (DOT) for the radical 14-day primaquine treatment of Plasmodium vivax malaria on the Thai-Myanmar border
    (2010-11-01) Takeuchi, Rie; Saranath Lawpoolsri; สารนาถ ล้อพูลศรี; Mallika Imwong; มัลลิกา อิ่มวงศ์; Kobayashi, Jun; Jaranit Kaewkungwal; จรณิต แก้วกังวาล; Sasithon Pukrittayakamee; ศศิธร ผู้กฤตยาคามี; Supalap Puangsa-art; ศุภลาภ พวงสอาด; Nipon Thanyavanich; นิพนธ์ ธัญญวานิช; Wanchai Maneeboonyang; วรรณไชย มณีบุญยัง; Day, Nicholas P.J.; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Pratap Singhasivanon; Mahidol University. Faculty of Tropical Medicine. Department of Clinical Tropical Medicine; Mahidol University. Faculty of Tropical Medicine. Mahidol-Oxford Tropical Medicine Research Unit (MORU); Mahidol University. Faculty of Tropical Medicine. Department of Tropical Hygiene.
    BACKGROUND: Plasmodium vivax has a dormant hepatic stage, called the hypnozoite, which can cause relapse months after the initial attack. For 50 years, primaquine has been used as a hypnozoitocide to radically cure P. vivax infection, but major concerns remain regarding the side-effects of the drug and adherence to the 14-day regimen. This study examined the effectiveness of using the directly-observed therapy (DOT) method for the radical treatment of P. vivax malaria infection, to prevent reappearance of the parasite within the 90-day follow-up period. Other potential risk factors for the reappearance of P. vivax were also explored. METHODS: A randomized trial was conducted from May 2007 to January 2009 in a low malaria transmission area along the Thai-Myanmar border. Patients aged ≥ 3 years diagnosed with P. vivax by microscopy, were recruited. All patients were treated with the national standard regimen of chloroquine for three days followed by primaquine for 14 days. Patients were randomized to receive DOT or self-administered therapy (SAT). All patients were followed for three months to check for any reappearance of P. vivax. RESULTS: Of the 216 patients enrolled, 109 were randomized to DOT and 107 to SAT. All patients recovered without serious adverse effects. The vivax reappearance rate was significantly lower in the DOT group than the SAT group (3.4/10,000 person-days vs. 13.5/10,000 person-days, p = 0.021). Factors related to the reappearance of vivax malaria included inadequate total primaquine dosage received (< 2.75 mg/kg), duration of fever ≤ 2 days before initiation of treatment, parasite count on admission ≥ 10,000/µl, multiple P. vivax-genotype infection, and presence of P. falciparum infection during the follow-up period. CONCLUSIONS: Adherence to the 14-day primaquine regimen is important for the radical cure of P. vivax malaria infection. Implementation of DOT reduces the reappearance rate of the parasite, and may subsequently decrease P. vivax transmission in the area.
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    PublicationOpen Access
    The impact of human reservoir of malaria at a community-level on individual malaria occurrence in a low malaria transmission setting along the Thai-Myanmar border
    (2010-05) Saranath Lawpoolsri; สารนาถ ล้อพูลศรี; Chavez, Irwin F.; Surapon Yimsamran; สุรพล ยิ้มสำราญ; Supalap Puangsa-art; สุภลาภ พวงสอาด; Nipon Thanyavanich; นิพนธ์ ธัญญวานิช; Wanchai Maneeboonyang; Wuthichai Chaimungkun; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Maguire, James H.; Hungerford, Laura L.; Saranath Lawpoolsri; Mahidol University. Faculty of Tropical Medicine. Department of Tropical Hygiene
    BACKGROUND: The probability of contracting malaria in a given individual is determined not only by the individual's characteristics, but also the ecological factors that characterize the level of human-vector contact in the population. Examination of the relationship between "individual" and "supra-individual" variables over time is important for understanding the local malaria epidemiology. This is essential for planning effective intervention strategies specifically for each location. METHODS: A retrospective cohort study was conducted, which followed a community-cohort of about 3,500 residents in seven hamlets along the Thai-Myanmar border between 1999 and 2006. Potential malaria determinants measured at different levels (temporal variables, individual variables, and hamlet variables) were incorporated into multilevel models to estimate their effects on an individual's risk of malaria attack. RESULTS: The monthly minimum temperature was significantly associated with the seasonal variation of malaria risk. An individual risk of malaria attack decreased by about 50% during the period that active surveillance was conducted; an additional 15% and 25% reduction of Plasmodium falciparum and Plasmodium vivax incidence, respectively, was observed after the use of artesunate-mefloquine combination therapy (ACT) for treatment of P. falciparum. Male children (age < 16 years old) were at highest risk of both P. falciparum and P. vivax attack. An increase in the hamlet's incidence of P. falciparum and P. vivax by 1 per 100 persons in a previous month resulted in 1.14 and 1.34 times increase in the risk of P. falciparum and P. vivax, respectively, among individuals in a particular hamlet. CONCLUSION: In a small area with low malaria transmission intensity, the variation in mosquito abundance is relatively similar across the residential areas; incidence of malaria between hamlets, which reflects the community level of human infectious reservoirs, is an important predictor for the malaria risk among individuals within these hamlets. Therefore, local malaria control strategies should focus on interventions that aim to reduce the gametocyte carriage in the population, such as early detection and treatment programmes and the use of ACT for P. falciparum.
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    PublicationOpen Access
    Spatio-temporal patterns of malaria infection in Bhutan: a country embarking on malaria elimination
    (2011-04-16) Wangdi, Kinley; Jaranit Kaewkungwal; จรณิต แก้วกังวาล; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Tassanee Silawan; Saranath Lawpoolsri; สารนาถ ล้อพูลศรี; White, Nicholas J.; Wangdi, Kinley; Mahidol University. Faculty of Tropical Medicine. Department of Tropical Hygiene.
    BACKGROUND: At the verge of elimination of malaria in Bhutan, this study was carried out to analyse the trend of malaria in the endemic districts of Bhutan and to identify malaria clusters at the sub-districts. The findings would aid in implementing the control activities. Poisson regression was performed to study the trend of malaria incidences at district level from 1994 to 2008. Spatial Empirical Bayesian smoothing was deployed to identify clusters of malaria at the sub-district level from 2004 to 2008. RESULTS: Trend of the overall districts and most of the endemic districts have decreased except Pemagatshel, which has an increase in the trend. Spatial cluster-outlier analysis showed that malaria clusters were mostly concentrated in the central and eastern Bhutan in three districts of Dagana, Samdrup Jongkhar and Sarpang. The disease clusters were reported throughout the year. Clusters extended to the non-transmission areas in the eastern Bhutan. CONCLUSIONS: There is significant decrease in the trend of malaria with the elimination at the sight. The decrease in the trend can be attributed to the success of the control and preventive measures. In order to realize the target of elimination of malaria, the control measure needs to be prioritized in these high-risk clusters of malaria.