title: Characterization of "Yaa Chud" Medicine on the Thailand-Myanmar border: selecting for drug-resistant malaria and threatening public health.
abstract: Multidrug-resistant Plasmodium falciparum malaria is a severe public health problem on the Thailand-Myanmar border. Many villagers buy packets of 4-5 mixed medicines ("yaa chud") from shops without medical assessment as their first-line malaria treatment. In 2000-2001 a local researcher purchased 50 yaa chud from 44 shops around Mae Sot, Thailand and Myawaddy, Myanmar (Burma), for his wife who was said to be pregnant with fever and drowsiness. The tablets/capsules were provisionally identified by appearance and active ingredients determined in a subset by using mass and atomic spectrometry. The most frequently detected active ingredients were acetaminophen (22%), chlorpheniramine (13.4%), chloroquine (12.6%), tetracycline/doxycycline (11.4%), and quinine (5.1%). Only seven bags contained potentially curative medicine for malaria. A total of 82% of the bags contained medicines contraindicated in pregnancy. Inappropriate, ineffective antimalarial drugs on the Thailand-Myanmar border are likely to increase malaria morbidity, mortality and health costs and engender the emergence and spread of antimalarial drug resistance.
authors.affiliation: Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Newton
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Hampton
authors.forename: Krystyn
authors.initials: K
authors.lastname: Alter-Hall
authors.forename: Thanongsak
authors.initials: T
authors.lastname: Teerwarakulpana
authors.forename: Sompol
authors.initials: S
authors.lastname: Prakongpan
authors.forename: Ronnatrai
authors.initials: R
authors.lastname: Ruangveerayuth
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Mabel B
authors.initials: MB
authors.lastname: Tudino
authors.forename: Natalia
authors.initials: N
authors.lastname: Mancuso
authors.forename: Facundo M
authors.initials: FM
authors.lastname: Fernández
mesh_terms: D002853:Chromatography, Liquid; D004351:Drug Resistance; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology*; D013058:Mass Spectrometry; D008519:Medicine, Traditional; D002052:Myanmar / Q000453:epidemiology; D004364:Pharmaceutical Preparations / Q000737:chemistry*; D013054:Spectrophotometry, Atomic; D013785:Thailand / Q000453:epidemiology
chemical_list: D004364:Pharmaceutical Preparations