title: Malaria incidence in Myanmar 2005-2014: steady but fragile progress towards elimination.
abstract: BACKGROUND
  There has been an impressive recent reduction in the global incidence of malaria, but the development of artemisinin resistance in the Greater Mekong Region threatens this progress. Increasing artemisinin resistance is particularly important in Myanmar, as it is the country in the Greater Mekong Region with the greatest malaria burden. If malaria is to be eliminated in the region, it is essential to define the spatial and temporal epidemiology of the disease in Myanmar to inform control strategies optimally.
  
  
  RESULTS
  Between the years 2005 and 2014 there was an 81.1 % decline in the reported annual incidence of malaria in Myanmar (1341.8 cases per 100,000 population to 253.3 cases per 100,000 population). In the same period, there was a 93.5 % decline in reported annual mortality from malaria (3.79 deaths per 100,000 population to 0.25 deaths per 100,000 population) and a 87.2 % decline in the proportion of hospitalizations due to malaria (7.8 to 1.0 %). Chin State had the highest reported malaria incidence and mortality at the end of the study period, although socio-economic and geographical factors appear a more likely explanation for this finding than artemisinin resistance. The reduced malaria burden coincided with significant upscaling of disease control measures by the national government with support from international partners. These programmes included the training and deployment of over 40,000 community health care workers, the coverage of over 60 % of the at-risk population with insecticide-treated bed nets and significant efforts to improve access to artemesinin-based combination treatment. Beyond these malaria-specific programmes, increased general investment in the health sector, changing population demographics and deforestation are also likely to have contributed to the decline in malaria incidence seen over this time.
  
  
  CONCLUSIONS
  There has been a dramatic fall in the burden of malaria in Myanmar since 2005. However, with the rise of artemisinin resistance, continued political, financial and scientific commitment is required if the ambitious goal of malaria elimination in the country is to be realized.
authors.affiliation: Department of Public Health, Ministry of Health, Nay Pyi Taw, Myanmar.
authors.forename: Thet Thet
authors.initials: TT
authors.lastname: Mu
authors.affiliation: Department of Public Health, Ministry of Health, Nay Pyi Taw, Myanmar.
authors.forename: Aye Aye
authors.initials: AA
authors.lastname: Sein
authors.affiliation: Department of Medical Care, Ministry of Health, Nay Pyi Taw, Myanmar.
authors.forename: Tint Tint
authors.initials: TT
authors.lastname: Kyi
authors.affiliation: Myanmar Medical Association, Yangon, Myanmar.
authors.forename: Myo
authors.initials: M
authors.lastname: Min
authors.affiliation: University of Medicine 2, Yangon, Myanmar.
authors.forename: Ne Myo
authors.initials: NM
authors.lastname: Aung
authors.affiliation: Menzies School of Health Research, Darwin, Australia.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Anstey
authors.affiliation: Department of Medical Research, Yangon, Myanmar.
authors.forename: Myat Phone
authors.initials: MP
authors.lastname: Kyaw
authors.affiliation: University of Medicine 1, Yangon, Myanmar.
authors.forename: Chit
authors.initials: C
authors.lastname: Soe
authors.affiliation: University of Medicine 2, Yangon, Myanmar.
authors.forename: Mar Mar
authors.initials: MM
authors.lastname: Kyi
authors.affiliation: University of Medicine 2, Yangon, Myanmar. drjoshhanson@gmail.com.|Menzies School of Health Research, Darwin, Australia. drjoshhanson@gmail.com.|The Kirby Institute, Sydney, Australia. drjoshhanson@gmail.com.
authors.forename: Josh
authors.identifier: http://orcid.org/0000-0002-1423-3839
authors.initials: J
authors.lastname: Hanson
mesh_terms: D000962:Antimalarials / Q000494:pharmacology; D037621:Artemisinins / Q000494:pharmacology; D004351:Drug Resistance; D006801:Humans; D015994:Incidence; D007783:Lactones / Q000494:pharmacology; D008288:Malaria / Q000453:epidemiology* / Q000401:mortality; D002052:Myanmar / Q000453:epidemiology; D010961:Plasmodium / Q000187:drug effects; D016019:Survival Analysis
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D007783:Lactones; C075875:artemisin
keywords: Artemisinin resistance; Epidemiology; Greater Mekong Region; Malaria; Myanmar; Public health