Deployment of early diagnosis and mefloquine-artesunate treatment of falciparum malaria in Thailand: the Tak Malaria Initiative.
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.


RESULTS
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 mefloquine-artesunate was feasible and reduced the morbidity and mortality of multidrug-resistant P. falciparum.
Carrara
Verena Ilona
VI
Shoklo Malaria Research Unit, Tak, Thailand.
Sirilak
Supakit
S
Thonglairuam
Janjira
J
Rojanawatsirivet
Chaiporn
C
Proux
Stephane
S
Gilbos
Valery
V
Brockman
Al
A
Ashley
Elizabeth A
EA
McGready
Rose
R
Krudsood
Srivicha
S
Leemingsawat
Somjai
S
Looareesuwan
Sornchai
S
Singhasivanon
Pratap
P
White
Nicholas
N
Nosten
François
F
D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D000077332:Artesunate; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D042241:Early Diagnosis; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D016780:Malaria, Vivax / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use*; D008875:Middle Aged; D009313:National Health Programs; D021261:Parasitic Sensitivity Tests; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000175:diagnosis / Q000188:drug therapy*; D015995:Prevalence; D012036:Refugees; D012717:Sesquiterpenes / Q000627:therapeutic use*; D013785:Thailand / Q000453:epidemiology; D014329:Tropical Climate
D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D000077332:Artesunate; D015767:Mefloquine