Sarah Newey
Mon, 3 April 2023
The Moei river, which marks the porous border between Thailand and Myanmar - Sarah Newey
Malaria has surged by more than 1,000 per cent in eastern Myanmar since 2020, a blow in a region pushing to eliminate the deadly parasitic disease by 2030.
Across Kayin state – a mountainous, forested province also known as Karen – 4,510 cases were reported in January 2023, compared to just 399 over the same period in 2020. Last year, roughly 32,000 cases were reported overall – in both 2019 and 2020, that figure hovered at around 8,000.
According to the figures from the Shoklo Malaria Research Unit (SMRU), the recent jump upends years of low and declining transmission in the state – which shares a long, porous border with Thailand.
At a small clinic south of Phop Phra, on the Thai side of the winding Moei River that separates the two countries, health workers told the Telegraph that although the case-load remains far smaller than in the 1990s, they now see malaria cases on an almost daily basis.
“The situation has really changed, it’s not a development we wanted to see,” says Eh Moo, head of the clinic’s antenatal unit, which offers healthcare for migrants and refugees from Myanmar. “It’s not as bad as 30 years ago, when I started working here, but the increase suggests transmission is changing, especially on the Burma side of the border.”
As if to prove her point she walks out to the waiting area, where a dozen women and children are perched on wooden benches, and asks if anyone there was infected. A 21-year-old pregnant woman raises her hand, the team in the lab has just confirmed the fever she’s been suffering from is malaria.
“See, every day we’re confirming new cases,” says Eh Moo. “It’s a worrying trend.”
But it is the situation a few hundred miles away, in Hpapun Township in northern Kayin state, that has most alarmed experts. There, the surge in December has been linked to the spread of the dangerous Plasmodium falciparum malaria parasite.
Not only does this cause more severe infections than the Plasmodium vivax parasite – which makes up the majority of cases in this region – but it is prone to develop resistance to critical treatments.
“Of course, you don’t want to have P. vivax, but it won’t kill you, it’s less dangerous,” said Prof François Nosten, a professor of tropical medicine and director of SMRU. “What we are really concerned about is P. falciparum – it’s more severe, it’s much more drug resistant, and that’s a problem. That’s why we want to eliminate it.”
Myanmar has two annual malaria peaks: during the rainy season between May and September, and a shorter but more intense period in the cold season, between November and December.
In December 2022, 1,413 malaria infections in an area of northern Kayin state were linked to P. falciparum infections, followed by 833 in January. It’s a significant increase: just 213 were detected in December 2022 – falling to 103 at the same point in 2020, and only 39 in 2019.
It’s not exactly clear why P. falciparum has spread more widely in this part of the state, though recent events may have played a role.
Malaria transmission first picked up during the pandemic, when measures to curb the spread of Covid-19 made it harder to access some communities and disrupted supply chains and healthcare services.
Since then, the uncertain security situation in Myanmar has made it more challenging to respond to the increase, and has also pushed many displaced people into the forested areas where mosquitoes thrive.
Malaria is not the only disease where trends are going in the wrong direction. At the sprawling Mae Tao Clinic just outside Mae Sot, which has been providing healthcare for Burmese migrants and refugees since 1989, health workers have also reported an increase in conditions including tuberculosis, severe HIV and malnutrition in new arrivals.
“Overall the situation is getting worse and worse, as access to services are interrupted… we are seeing almost a collapse of the health system [in Myanmar],” said Dr Cynthia Maung, who founded the clinic after fleeing political upheaval in Myanmar in the late 1980s. “So we see more severe cases of HIV, or child malnutrition or other noncommunicable diseases.”
But the jump in malaria cases, especially the increased transmission of the P. falciparum parasite, is a particular blow.
Dr Cynthia Maung, head of the Mae Tao clinic near Mae Sot, which provides healthcare for Burmese migrants and refugees - Sarah Newey
A waiting room at the Mae Tao Clinic - Sarah Newey
Across the Mekong subregion – Myanmar, Thailand, Cambodia, Laos, Vietnam and southern China – cases have fallen dramatically over recent decades, and health officials have been optimistic about hitting targets to eliminate malaria by 2030.
This is considered especially critical because, since the 1950s, parasites resistant to antimalarial drugs have consistently emerged in the Greater Mekong subregion and then been exported to other regions of the world – including Africa.
“Why did we embark on eliminating P. falciparum in this area? It’s not just for the love of humankind, it’s because the parasite in this area is very drug resistant,” said Prof Nosten. “The only way to prevent it becoming more drug resistant is to eliminate it. I think we have to stay focused on that objective.”
He added that, in northern Kayin state, the parasites spreading malaria are already resistant to artemisinin, but there’s no evidence right now that other, newer drugs are becoming less effective.
But that could change at any moment, making it more critical than ever to diagnose and treat the disease rapidly to reduce the risk of onward transmission. This is more important than rolling out bed nets to sleep under, as many of the mosquitos in this area bite during the day or early evening.
“We have to be cautious, because the resistance to artemether-lumefantrine, ACT, [a combination of malaria drugs] which everyone uses in Myanmar, could emerge and it’s difficult to pick up emergence because it’s difficult to do evaluation studies,” said Prof Nosten. “So we have to be careful not to be caught off guard.”
Protect yourself and your family by learning more about Global Health Security
No comments:
Post a Comment