Browsing by Author "Pratap Singhasivanon"
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Publication Metadata only Adherence and efficacy of supervised versus non-supervised treatment with artemether/lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Bangladesh: a randomised controlled trial(2008-09-01) Md Mushfiqur Rahman; Arjen M. Dondorp; Nicholas P.J. Day; Niklas Lindegardh; Mallika Imwong; M. A. Faiz; A. Mannan Bangali; A. T.M.Mustafa Kamal; Jahirul Karim; Jaranit Kaewkungwal; Pratap Singhasivanon; Mahidol University; Nuffield Department of Clinical Medicine; Dhaka Medical College; Organisation Mondiale de la Sante; Directorate General of Family PlanningAs artemether/lumefantrine is now deployed as the first-line treatment for uncomplicated falciparum malaria in Bangladesh, information on its efficacy and adherence to its use is important. A randomised controlled non-inferiority trial comparing directly observed treatment (DOT) and non-directly observed treatment (NDOT) was conducted in 320 patients with uncomplicated falciparum malaria in Bandarban Hill Tract District, Bangladesh. Both regimens showed similar high levels of PCR-corrected 42-day parasitological and clinical cure rates (99.3% in the NDOT group and 100% in the DOT group; P = 0.49). Survival analysis for the time to recurrence of infection showed no difference between treatment groups (log rank, P = 0.98). Adherence, as assessed by counting remaining tablets and oral interviews, was 93% in the NDOT group and was confirmed by Day 7 lumefantrine concentrations. Adherence was independent of educational level. Patients with plasma lumefantrine concentrations <280 ng/ml at Day 7 were at greater risk for re-infection (relative risk 5.62; P = 0.027). The efficacy of artemether/lumefantrine for the treatment of uncomplicated falciparum malaria in Bangladesh is high and is similar for DOT and NDOT. Adherence to therapy is high. © 2008 Royal Society of Tropical Medicine and Hygiene.Publication Metadata only Advantages of using voiced questionnaire and image capture application for data collection from a minority group in rural areas along the Thailand-Myanmar border(2014-01-01) Siriporn Monyarit; Wirichada Pan-Ngum; Saranath Lawpoolsri; Surapon Yimsamran; Suporn Pongnumkul; Jaranit Kaewkungwal; Pratap Singhasivanon; Mahidol University; Thailand National Electronics and Computer Technology CenterCopyright © 2014 The Author(s). Aims To compare the quality of data collection via electronic data capture (EDC) with voiced questionnaire (QNN) and data image capture features using a tablet versus standard paper-based QNN, to assess the user's perception of using the EDC tool, and to compare user satisfaction with the two methods.Study design Randomised cross-over study.Study sites This study was conducted in two villages along the Thailand-Myanmar border.Methodology This study included 30 community health volunteers (CHVs) and 120 Karen hill tribe villagers. Employing a cross-over study design, the CHVs were allocated randomly to two groups, in which they performed interviews in different sequences using EDC and QNN.Results Data discrepancies were found between the two data-collection methods, when data from the paper-based and image-capture methods were compared, and when conducting skip pattern questions. More than 90% of the CHVs perceived the EDC to be useful and easy to use. Both interviewers and interviewees were more satisfied with the EDC compared with QNN in terms of format, ease of use, and system speed.Conclusion The EDC can effectively be used as an alternative method to paperbased QNNs for data collection. It produces more accurate data that can be considered evidence-based.Item Metadata only Age-period-cohort analysis and spatial pattern of tuberculosis incidence in Bangladesh / Mohammad Jahirul Karim(Mahidol University. Mahidol University Library and Knowledge Center, 2007) Mohammad, Jahirul Karim, 1967-; Pratap SinghasivanonPublication Metadata only An analysis of health system resources in relation to pandemic response capacity in the Greater Mekong Subregion(2012-12-14) Piya Hanvoravongchai; Irwin Chavez; James W. Rudge; Sok Touch; Weerasak Putthasri; Pham Ngoc Chau; Bounlay Phommasack; Pratap Singhasivanon; Richard Coker; Chulalongkorn University; Mahidol University; Cambodia Ministry of Health; International Health Policy Program, Thailand; Vietnam Military Medical University; National Emerging Infectious Diseases Coordination OfficeBackground: There is increasing perception that countries cannot work in isolation to militate against the threat of pandemic influenza. In the Greater Mekong Subregion (GMS) of Asia, high socio-economic diversity and fertile conditions for the emergence and spread of infectious diseases underscore the importance of transnational cooperation. Investigation of healthcare resource distribution and inequalities can help determine the need for, and inform decisions regarding, resource sharing and mobilisation. Methods: We collected data on healthcare resources deemed important for responding to pandemic influenza through surveys of hospitals and district health offices across four countries of the GMS (Cambodia, Lao PDR, Thailand, Vietnam). Focusing on four key resource types (oseltamivir, hospital beds, ventilators, and health workers), we mapped and analysed resource distributions at province level to identify relative shortages, mismatches, and clustering of resources. We analysed inequalities in resource distribution using the Gini coefficient and Theil index.Results: Three quarters of the Cambodian population and two thirds of the Laotian population live in relatively underserved provinces (those with resource densities in the lowest quintile across the region) in relation to health workers, ventilators, and hospital beds. More than a quarter of the Thai population is relatively underserved for health workers and oseltamivir. Approximately one fifth of the Vietnamese population is underserved for beds and ventilators. All Cambodian provinces are underserved for at least one resource. In Lao PDR, 11 percent of the population is underserved by all four resource items. Of the four resources, ventilators and oseltamivir were most unequally distributed. Cambodia generally showed higher levels of inequalities in resource distribution compared to other countries. Decomposition of the Theil index suggests that inequalities result principally from differences within, rather than between, countries. Conclusions: There is considerable heterogeneity in healthcare resource distribution within and across countries of the GMS. Most inequalities result from within countries. Given the inequalities, mismatches, and clustering of resources observed here, resource sharing and mobilization in a pandemic scenario could be crucial for more effective and equitable use of the resources that are available in the GMS. © 2012 Hanvoravongchai et al.; licensee BioMed Central Ltd.Publication Open Access Application of mobile-technology for disease and treatment monitoring of malaria in the "Better Border Healthcare Programme"(2010-08) Pongthep Meankaew; พงษ์เทพ เมียนแก้ว; Jaranit Kaewkungwal; จรณิต แก้วกังวาล; Amnat Khamsiriwatchara; อำนาจ คำศิริวัชรา; Podjadeach Khunthong; พจเดช ขุนทอง; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Wichai Satimai; Jaranit Kaewkungwal; Mahidol University. Faculty of Tropical Medicine. Department of Tropical HygieneBACKGROUND: The main objective of this study was to assess the effectiveness of integrating the use of cell-phones into a routine malaria prevention and control programme, to improve the management of malaria cases among an under-served population in a border area. The module for disease and treatment monitoring of malaria (DTMM) consisted of case investigation and case follow-up for treatment compliance and patients' symptoms. METHODS: The module combining web-based and mobile technologies was developed as a proof of concept, in an attempt to replace the existing manual, paper-based activities that malaria staff used in treating and caring for malaria patients in the villages for which they were responsible. After a patient was detected and registered onto the system, case-investigation and treatment details were recorded into the malaria database. A follow-up schedule was generated, and the patient's status was updated when the malaria staff conducted their routine home visits, using mobile phones loaded with the follow-up application module. The module also generated text and graph messages for a summary of malaria cases and basic statistics, and automatically fed to predetermined malaria personnel for situation analysis. Following standard public-health practices, access to the patient database was strictly limited to authorized personnel in charge of patient case management. RESULTS: The DTMM module was developed and implemented at the trial site in late November 2008, and was fully functioning in 2009. The system captured 534 malaria patients in 2009. Compared to paper-based data in 2004-2008, the mobile-phone-based case follow-up rates by malaria staff improved significantly. The follow-up rates for both Thai and migrant patients were about 94-99% on Day 7 (Plasmodium falciparum) and Day 14 (Plasmodium vivax) and maintained at 84-93% on Day 90. Adherence to anti-malarial drug therapy, based on self-reporting, showed high completion rate for P. falciparum-infected cases, but lower rate for P. vivax cases. Patients' symptoms were captured onto the mobile phone during each follow-up visit, either during the home visit or at Malaria Clinic; most patients had headache, muscle pain, and fatigue, and some had fever within the first follow-up day (day 7/14) after the first anti-malarial drug dose. CONCLUSIONS: The module was successfully integrated and functioned as part of the malaria prevention and control programme. Despite the bias inherent in sensitizing malaria workers to perform active case follow-up using the mobile device, the study proved for its feasibility and the extent to which community healthcare personnel in the low resource settings could potentially utilize it efficiently to perform routine duties, even in remote areas. The DTMM has been modified and is currently functioning in seven provinces in a project supported by the WHO and the Bill & Melinda Gates Foundation, to contain multi-drug resistant malaria on the Thai-Cambodian border.Publication Metadata only Application of mobile-technology for disease and treatment monitoring of malaria in the "Better Border Healthcare Programme"(2010-08-23) Pongthep Meankaew; Jaranit Kaewkungwal; Amnat Khamsiriwatchara; Podjadeach Khunthong; Pratap Singhasivanon; Wichai Satimai; Mahidol University; Thailand Ministry of Public HealthBackground: The main objective of this study was to assess the effectiveness of integrating the use of cell-phones into a routine malaria prevention and control programme, to improve the management of malaria cases among an under-served population in a border area. The module for disease and treatment monitoring of malaria (DTMM) consisted of case investigation and case follow-up for treatment compliance and patients' symptoms. Methods: The module combining web-based and mobile technologies was developed as a proof of concept, in an attempt to replace the existing manual, paper-based activities that malaria staff used in treating and caring for malaria patients in the villages for which they were responsible. After a patient was detected and registered onto the system, case-investigation and treatment details were recorded into the malaria database. A follow-up schedule was generated, and the patient's status was updated when the malaria staff conducted their routine home visits, using mobile phones loaded with the follow-up application module. The module also generated text and graph messages for a summary of malaria cases and basic statistics, and automatically fed to predetermined malaria personnel for situation analysis. Following standard public-health practices, access to the patient database was strictly limited to authorized personnel in charge of patient case management. Results: The DTMM module was developed and implemented at the trial site in late November 2008, and was fully functioning in 2009. The system captured 534 malaria patients in 2009. Compared to paper-based data in 2004-2008, the mobile-phone-based case follow-up rates by malaria staff improved significantly. The follow-up rates for both Thai and migrant patients were about 94-99% on Day 7 (Plasmodium falciparum) and Day 14 (Plasmodium vivax) and maintained at 84-93% on Day 90. Adherence to anti-malarial drug therapy, based on self-reporting, showed high completion rate for P. falciparum-infected cases, but lower rate for P. vivax cases. Patients' symptoms were captured onto the mobile phone during each follow-up visit, either during the home visit or at Malaria Clinic; most patients had headache, muscle pain, and fatigue, and some had fever within the first follow-up day (day7/14) after the first anti-malarial drug dose. Conclusions: The module was successfully integrated and functioned as part of the malaria prevention and control programme. Despite the bias inherent in sensitizing malaria workers to perform active case follow-up using the mobile device, the study proved for its feasibility and the extent to which community healthcare personnel in the low resource settings could potentially utilize it efficiently to perform routine duties, even in remote areas. The DTMM has been modified and is currently functioning in seven provinces in a project supported by the WHO and the Bill & Melinda Gates Foundation, to contain multi-drug resistant malaria on the Thai-Cambodian border. © 2010 Meankaew et al; licensee BioMed Central Ltd.Publication Metadata only Application of smart phone in "better Border Healthcare Program": A module for mother and child care(2010-11-05) Jaranit Kaewkungwal; Pratap Singhasivanon; Amnat Khamsiriwatchara; Surasak Sawang; Pongthep Meankaew; Apisit Wechsart; Mahidol University; Suan PhungBackground. To assess the application of cell phone integrating into the healthcare system to improve antenatal care (ANC) and expanded programme on immunization (EPI) services for the under-served population in border area. Methods. A module combining web-based and mobile technology was developed to generate ANC/EPI visit schedule dates in which the healthcare personnel can cross-check, identify and update the mother's ANC and child's EPI status at the healthcare facility or at the household location when performing home visit; with additional feature of sending appointment reminder directly to the scheduled mother in the community. Results. The module improved ANC/EPI coverage in the study area along the country border including for both Thai and non-Thai mothers and children who were either permanent resident or migrants; numbers of ANC and EPI visit on-time as per schedule significantly increased; there was less delay of antenatal visits and immunizations. Conclusions. The module integrated and functioned successfully as part of the healthcare system; it is proved for its feasibility and the extent to which community healthcare personnel in the low resource setting could efficiently utilize it to perform their duties. © 2010 Kaewkungwal et al; licensee BioMed Central Ltd.Publication Open Access Application of smart phone in "Better Border Healthcare Program": a module for mother and child care(2010-11) Jaranit Kaewkungwal; จรณิต แก้วกังวาล; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Amnat Khamsiriwatchara; อำนาจ คำศิริวัชรา; Surasak Sawang; Pongthep Meankaew; พงษ์เทพ เมียนแก้ว; Apisit Wechsart; Jaranit Kaewkungwal; Mahidol University. Faculty of Tropical Mediicine. Department of Tropical HygieneBACKGROUND: To assess the application of cell phone integrating into the healthcare system to improve antenatal care (ANC) and expanded programme on immunization (EPI) services for the under-served population in border area. METHODS: A module combining web-based and mobile technology was developed to generate ANC/EPI visit schedule dates in which the healthcare personnel can cross-check, identify and update the mother's ANC and child's EPI status at the healthcare facility or at the household location when performing home visit; with additional feature of sending appointment reminder directly to the scheduled mother in the community. RESULTS: The module improved ANC/EPI coverage in the study area along the country border including for both Thai and non-Thai mothers and children who were either permanent resident or migrants; numbers of ANC and EPI visit on-time as per schedule significantly increased; there was less delay of antenatal visits and immunizations. CONCLUSIONS: The module integrated and functioned successfully as part of the healthcare system; it is proved for its feasibility and the extent to which community healthcare personnel in the low resource setting could efficiently utilize it to perform their duties.Publication Metadata only Are extensive T cell epitope polymorphisms in the Plasmodium falciparum circumsporozoite antigen, a leading sporozoite vaccine candidate, selected by immune pressure(2005-09-15) Chutima Kumkhaek; Kooruethai Phra-Ek; Laurent Rénia; Pratap Singhasivanon; Sornchai Looareesuwan; Chakrit Hirunpetcharat; Nicholas J. White; Alan Brockman; Anne Charlotte Grüner; Nicolas Lebrun; Ali Alloueche; François Nosten; Srisin Khusmith; Georges Snounou; Mahidol University; Shoklo Malaria Research Unit; Universite Paris Descartes; Churchill Hospital; Novartis Immunobiological Research Institute; Institut Pasteur, Paris; Museum National d'Histoire Naturelle; CNRS Centre National de la Recherche ScientifiqueProtective cellular immune responses depend on MHC presentation of pathogen-derived Ag fragments. MHC diversity renders this process sensitive to point mutations coding for altered amino acid sequence of the short target Ag-derived peptides epitopes. Thus, in a given host, a pathogen with an altered epitope sequence will be more likely to escape detection and elimination by the immune system. At a population level, selection by immune pressure will increase the likelihood of polymorphism in important pathogen antigenic epitopes. This mechanism of immune evasion is found in viruses and other pathogens. The detection of polymorphic hot spots in an Ag is often taken as a strong indication of its role in protective immunity. We provide evidence that polymorphisms in the T cell epitopes of a malaria vaccine candidate are unlikely to have been selected by immune pressure in the human host. Copyright © 2005 by The American Association of Immunologists, Inc.Publication Open Access Are there any changes in burden and management of communicable diseases in areas affected by Cyclone Nargis?(2011-06-28) Myint, Nyan Win; Jaranit Kaewkungwal; จรณิต แก้วกังวาล; Pratap Singhasivanon; ประตาป สิงหศิวานนท์; Kamron Chaisiri; Pornpet Panjapiyakul; Pichit Siriwan; Mallik, Arun K.; Nyein, Soe Lwin; Mu, Thet Thet; Jaranit Kaewkungwal; Mahidol University. Faculty of Tropical MedicineBACKGROUND: This study aims to assess the situation of communicable diseases under national surveillance in the Cyclone Nargis-affected areas in Myanmar (Burma) before and after the incident. METHODS: Monthly data during 2007, 2008 and 2009 from the routine reporting system for disease surveillance of the Myanmar Ministry of Health (MMOH) were reviewed and compared with weekly reporting from the Early Warning and Rapid Response (EWAR) system. Data from some UN agencies, NGOs and Tri-Partite Core Group (TCG) periodic reviews were also extracted for comparisons with indicators from Sphere and the Inter-Agency Standing Committee. RESULTS: Compared to 2007 and 2009, large and atypical increases in diarrheal disease and especially dysentery cases occurred in 2008 following Cyclone Nargis. A seasonal increase in ARI reached levels higher than usual in the months of 2008 post-Nargis. The number of malaria cases post-Nargis also increased, but it was less clear if this reflected normal seasonal patterns or was specifically associated with the disaster event. There was no significant change in the occurrence of other communicable diseases in Nargis-affected areas. Except for a small decrease in mortality for diarrheal diseases and ARI in 2008 in Nargis-affected areas, population-based mortality rates for all other communicable diseases showed no significant change in 2008 in these areas, compared to 2007 and 2009. Tuberculosis control programs reached their targets of 70% case detection and 85% treatment success rates in 2007 and 2008. Vaccination coverage rates for DPT 3rd dose and measles remained at high though measles coverage still did not reach the Sphere target of 95% even by 2009. Sanitary latrine coverage in the Nargis-affected area dropped sharply to 50% in the months of 2008 following the incident but then rose to 72% in 2009. CONCLUSION: While the incidence of diarrhea, dysentery and ARI increased post-Nargis in areas affected by the incident, the incidence rate for other diseases and mortality rates did not increase, and normal disease patterns resumed by 2009. This suggests that health services as well as prevention and control measures provided to the Nargis-affected population mitigated what could have been a far more severe health impact.Publication Metadata only Are there any changes in burden and management of communicable diseases in areas affected by Cyclone Nargis?(2011-07-20) Nyan Win Myint; Jaranit Kaewkungwal; Pratap Singhasivanon; Kamron Chaisiri; Pornpet Panjapiyakul; Pichit Siriwan; Arun K. Mallik; Soe Lwin Nyein; Thet Thet Mu; Ministry of Health; Mahidol University; Thailand Ministry of Public Health; Red Cross Society; Inter-Agency Coordination and Emergency and Humanitrian ActionBackground: This study aims to assess the situation of communicable diseases under national surveillance in the Cyclone Nargis-affected areas in Myanmar (Burma) before and after the incident. Methods. Monthly data during 2007, 2008 and 2009 from the routine reporting system for disease surveillance of the Myanmar Ministry of Health (MMOH) were reviewed and compared with weekly reporting from the Early Warning and Rapid Response (EWAR) system. Data from some UN agencies, NGOs and Tri-Partite Core Group (TCG) periodic reviews were also extracted for comparisons with indicators from Sphere and the Inter-Agency Standing Committee. Results: Compared to 2007 and 2009, large and atypical increases in diarrheal disease and especially dysentery cases occurred in 2008 following Cyclone Nargis. A seasonal increase in ARI reached levels highe r than usual in the months of 2008 post-Nargis. The number of malaria cases post-Nargis also increased, but it was less clear if this reflected normal seasonal patterns or was specifically associated with the disaster event. There was no significant change in the occurrence of other communicable diseases in Nargis-affected areas. Except for a small decrease in mortality for diarrheal diseases and ARI in 2008 in Nargis-affected areas, population-based mortality rates for all other communicable diseases showed no significant change in 2008 in these areas, compared to 2007 and 2009. Tuberculosis control programs reached their targets of 70% case detection and 85% treatment success rates in 2007 and 2008. Vaccination coverage rates for DPT 3 rd dose and measles remained at high though measles coverage still did not reach the Sphere target of 95% even by 2009. Sanitary latrine coverage in the Nargis-affected area dropped sharply to 50% in the months of 2008 following the incident but then rose to 72% in 2009. Conclusion: While the incidence of diarrhea, dysentery and ARI increased post-Nargis in areas affected by the incident, the incidence rate for other diseases and mortality rates did not increase, and normal disease patterns resumed by 2009. This suggests that health services as well as prevention and control measures provided to the Nargis-affected population mitigated what could have been a far more severe health impact. © 2011 Myint et al; licensee BioMed Central Ltd.Publication Open 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.Publication Metadata only 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(2012-07-31) Amnat Khamsiriwatchara; Prayuth Sudathip; Surasak Sawang; Saowanit Vijakadge; Thanapon Potithavoranan; Aumnuyphan Sangvichean; Wichai Satimai; Charles Delacollette; Pratap Singhasivanon; Saranath Lawpoolsri; Jaranit Kaewkungwal; Mahidol University; Thailand Ministry of Public HealthBackground: 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 20082011 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 20092011; 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. © 2012 Khamsiriwatchara et al.; licensee BioMed Central Ltd.Publication Open 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 projectPublication Metadata only Artemisinin resistance containment project in Thailand. II: Responses to mefloquine-artesunate combination therapy among falciparum malaria patients in provinces bordering Cambodia(2012-08-30) Wichai Satimai; Prayuth Sudathip; Saowanit Vijaykadga; Amnat Khamsiriwatchara; Surasak Sawang; Thanapon Potithavoranan; Aumnuyphan Sangvichean; Charles Delacollette; Pratap Singhasivanon; Jaranit Kaewkungwal; Saranath Lawpoolsri; Thailand Ministry of Public Health; Mahidol UniversityBackground: 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. © 2012 Satimai et al.; licensee BioMed Central Ltd.Publication Metadata only Artemisinin resistance in Plasmodium falciparum malaria(2009-07-30) Arjen M. Dondorp; François Nosten; Poravuth Yi; Debashish Das; Aung Phae Phyo; Joel Tarning; Khin Maung Lwin; Frederic Ariey; Warunee Hanpithakpong; Sue J. Lee; Pascal Ringwald; Kamolrat Silamut; Mallika Imwong; Kesinee Chotivanich; Pharath Lim; Trent Herdman; Sen Sam An; Shunmay Yeung; Pratap Singhasivanon; Nicholas P.J. Day; Niklas Lindegardh; Duong Socheat; Nicholas J. White; Mahidol University; Shoklo Malaria Research Unit; Family Health International, Thailand; Churchill Hospital; National Center for Parasitology, Entomology and Malaria Control; Institut Pasteur du Cambodge; Organisation Mondiale de la SanteBACKGROUND: Artemisinin-based combination therapies are the recommended first-line treatments of falciparum malaria in all countries with endemic disease. There are recent concerns that the efficacy of such therapies has declined on the Thai - Cambodian border, historically a site of emerging antimalarial-drug resistance. METHODS: In two open-label, randomized trials, we compared the efficacies of two treatments for uncomplicated falciparum malaria in Pailin, western Cambodia, and Wang Pha, northwestern Thailand: oral artesunate given at a dose of 2 mg per kilogram of body weight per day, for 7 days, and artesunate given at a dose of 4 mg per kilogram per day, for 3 days, followed by mefloquine at two doses totaling 25 mg per kilogram. We assessed in vitro and in vivo Plasmodium falciparum susceptibility, artesunate pharmaco kinetics, and molecular markers of resistance. RESULTS: We studied 40 patients in each of the two locations. The overall median parasite clearance times were 84 hours (interquartile range, 60 to 96) in Pailin and 48 hours (interquartile range, 36 to 66) in Wang Pha (P<0.001). Recrudescence confirmed by means of polymerase-chain-reaction assay occurred in 6 of 20 patients (30%) receiving artesunate monotherapy and 1 of 20 (5%) receiving artesunate-mefloquine therapy in Pailin, as compared with 2 of 20 (10%) and 1 of 20 (5%), respectively, in Wang Pha (P = 0.31). These markedly different parasitologic responses were not explained by differences in age, artesunate or dihydroartemisinin pharmacokinetics, results of isotopic in vitro sensitivity tests, or putative molecular correlates of P. falciparum drug resistance (mutations or amplifications of the gene encoding a multidrug resistance protein [PfMDR1] or mutations in the gene encoding sarco-endoplasmic reticulum calcium ATPase6 [PfSERCA]). Adverse events were mild and did not differ significantly between the two treatment groups. CONCLUSIONS: P. falciparum has reduced in vivo susceptibility to artesunate in western Cambodia as compared with northwestern Thailand. Resistance is characterized by slow parasite clearance in vivo without corresponding reductions on conventional in vitro susceptibility testing. Containment measures are urgently needed. (ClinicalTrials.gov number, NCT00493363, and Current Controlled Trials number, ISRCTN64835265.) Copyright © 2009 Massachusetts Medical Society.Publication Metadata only Artesunate/dihydroartemisinin pharmacokinetics in acute falciparum malaria in pregnancy: Absorption, bioavailability, disposition and disease effects(2012-03-01) Rose Mcgready; Aung Pyae Phyo; Marcus J. Rijken; Joel Tarning; Niklas Lindegardh; Warunee Hanpithakpon; Hla Hla Than; Nathar Hlaing; Naw Thida Zin; Pratap Singhasivanon; Nicholas J. White; François Nosten; Shoklo Malaria Research Unit; Mahidol University; Nuffield Department of Clinical MedicineAim: To determine if reported lower plasma concentrations of artemisinin derivatives for malaria in pregnancy result from reduced oral bioavailability, expanded volume of distribution or increased clearance. Methods: In a sequentially assigned crossover treatment study, pregnant women with uncomplicated falciparum malaria received i.v. artesunate (i.v. ARS) (4mgkg -1 ) on the first day and oral ARS (4mgkg -1 ) on the second, or, oral on the first and i.v. on the second, in both groups followed by oral ARS (4mgkg -1 day -1 ) for 5 days. Plasma concentrations of ARS and dihyroartemisinin (DHA) were measured by liquid chromatography-mass-spectrometry on days 0, 1, 2 and 6. Controls were the same women restudied when healthy (3 months post partum). Results: I.v. ARS administration resulted in similar ARS and DHA pharmacokinetics in pregnant women with malaria (n= 20) and in controls (n= 14). Oral administration resulted in higher total drug exposure in pregnancy [AUC (95% CI) in (ngml -1 h)/(mgkg -1 )] of 55.1 (30.1, 100.0) vs. 26.5 (12.2, 54.3) for ARS, P= 0.002 and 673 (386, 1130) vs. 523 (351, 724) for DHA, P= 0.007. The corresponding median absolute oral bioavailability (F%) was 21.7 (12.6, 75.1) vs. 9.9 (6.0, 36.81) for ARS (P= 0.046) and 77.0 (42.2, 129) vs. 72.7 (42.0, 87.7) for DHA, P= 0.033. Total DHA exposure was lower at day 6 in pregnant women with malaria (P < 0.001) compared with day 0 or 1, but not in the controls (P= 0.084). Conclusions: This study demonstrates the effects of malaria on oral ARS drug disposition are greater than those of pregnancy. This probably results from a disease related reduction in first pass metabolism. The data are reassuring regarding current dosing recommendations. © 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.Publication Metadata only Arthropod borne disease: The leading cause of fever in pregnancy on the thai-burmese border(2010-11-01) Rose Mcgready; Elizabeth A. Ashley; Vanaporn Wuthiekanun; Saw Oo Tan; Mupawjay Pimanpanarak; Samuel Jacher Viladpai-Nguen; Wilarat Jesadapanpong; Stuart D. Blacksell; Sharon J. Peacock; Daniel H. Paris; Nicholas P. Day; Pratap Singhasivanon; Nicholas J. White; François Nosten; Shoklo Malaria Research Unit; Mahidol University; Churchill Hospital; Imperial College Healthcare NHS Trust; University of CambridgeBackground: Fever in pregnancy is dangerous for both mother and foetus. In the 1980's malaria was the leading cause of death in pregnant women in refugee camps on the Thai-Burmese border. Artemisinin combination therapy has significantly reduced the incidence of malaria in the population. The remaining causes of fever in pregnancy are not well documented. Methodology: Pregnant women attending antenatal care, where weekly screening for malaria is routine, were invited to have a comprehensive clinical and laboratory screen if they had fever. Women were admitted to hospital, treated and followed up weekly until delivery. A convalescent serum was collected on day 21. Delivery outcomes were recorded. Principal Findings: Febrile episodes (n = 438) occurred in 5.0% (409/8,117) of pregnant women attending antenatal clinics from 7-Jan-2004 to 17-May-2006. The main cause was malaria in 55.5% (227/409). A cohort of 203 (49.6% of 409) women had detailed fever investigations and follow up. Arthropod-borne (malaria, rickettsial infections, and dengue) and zoonotic disease (leptospirosis) accounted for nearly half of all febrile illnesses, 47.3% (96/203). Coinfection was observed in 3.9% (8/ 203) of women, mostly malaria and rickettsia. Pyelonephritis, 19.7% (40/203), was also a common cause of fever. Once malaria, pyelonephritis and acute respiratory illness are excluded by microscopy and/or clinical findings, one-third of the remaining febrile infections will be caused by rickettsia or leptospirosis. Scrub and murine typhus were associated with poor pregnancy outcomes including stillbirth and low birth weight. One woman died (no positive laboratory tests). Conclusion/Significance: Malaria remains the leading cause of fever in pregnancy on the Thai-Burmese border. Scrub and murine typhus were also important causes of fever associated with poor pregnancy outcomes. Febrile pregnant women on the Thai-Burmese border who do not have malaria, pyelonephritis or respiratory tract infection should be treated with azithromycin, effective for typhus and leptospirosis. © 2010 McGready et al.Publication Metadata only The Asian center of international parasite control (ACIPAC): five years of achievement. I. Introduction.(2005-12-01) Somei Kojima; Sornchai Looareesuwan; Pratap Singhasivanon; Tsutomu Takeuchi; Mahidol UniversityACIPAC has made an effort to promote the concept of the school-based approach to malaria and STH control, mainly through human resource development, which could be eventually extended to any other health promotion program. Implementation of SSPP resulted in the establishment of national policies on parasite control and/or school health in some partner countries. It also provides a good opportunity for the formulation of partnerships among health and education sectors and international partners, although it did cause some problems concerning the enrollment of persons of authority from partner countries, and the staff of JICA resident offices as well. As described in the Joint Evaluation Report, ACIPAC is expected to further contribute to human resource development and to strengthening human resource and information networking at regional and global levels.Publication Metadata only The Asian Center of International Parasite Control (ACIPAC): five years of achievement. II. ACIPAC human resources development.(2005-12-01) Jitra Waikagul; Pratap Singhasivanon; Suvanee Supavej; Wichit Rojekittikhun; Waraporn Suphadtanaphongs; Somjai Leemingswat; Wijitr Fungladda; Mahidol University