The World Health Organisation has called on malaria-endemic countries to strengthen monitoring of drug efficacy, citing the Thai-Cambodian border as an area with high levels of anti-malarial resistance, in a report released yesterday.
The Global Report on Anti-Malarial Drug Efficacy and Drug Resistance: 2000-2010” estimates that only 34 percent of malaria-endemic countries are complying with WHO recommendations for monitoring anti-malarial medicine efficacy, which they say is crucial to halting the spread of drug resistance.
However, a WHO official in Phnom Penh said that Cambodia was among the 34 percent of malaria-endemic countries that were rigorously monitoring the issue.
“In a place like Cambodia where there’s anti-malarial resistance, it becomes more of a priority to track drug efficacy, and you tend to pay more attention to it,” said Najid Babib, a project manager for the WHO’s artesunate resistant malaria containment project.
People are vigilant to find out whether resistance is increasing or decreasing.
“People are vigilant to find out whether resistance is increasing or decreasing,” he said. “Other countries haven’t reached that standard.”
The report delves into the resistance of artemisinin – a group of drugs that treats malaria caused by Plasmodium falciparum, a parasite – along the Thai-Cambodian border, which was initially confirmed by the WHO in early 2009.
“The emergence to artemisinin resistance on the ... border has been a wake-up call to the world to prevent its spread, increase monitoring and preserve ACTs [artemisinin combination therapies] as the only effective treatment we have for falciparum malaria,” said Robert Newman, director of WHO’s Global Malaria Programme, in a press release.
The report said the strongest evidence of resistance to artesunate – a water-soluble derivative of artemisinin that can be injected into patients – was in northwest Cambodia. The proportion of patients that are parasitaemic, a condition in which parasites are present in blood, is the highest recorded for patients that have received three days of ACTs.
The Thai-Cambodian border area has also been the first to show signs of resistance to three other types of anti-malarial drugs, two of which have since been identified in India and Africa.
“No one knows for sure why anti-malarial drug resistance seems to crop up often on the border, though it may deal with lack of development and health services access, since this was an ex-Khmer Rouge stronghold,” said Najid Babib. “In Pailin they use a lot of monotherapies, just artesunates, and just using that over time will promote resistance.”
Najid Babib said the National Center for Parasitology, Entomology, and Malaria Control was instrumental in establishing a containment project with the WHO in Pailin province.
The project is attempting to eliminate artemisinin-resistant parasites and the spread of those parasites by migrant populations.