The Status of Malaria in Thailand

GHSD 7420 - Fall 2012Presented by M. O. Ishak

Thailand Country ProfilePopulation: 69.5 million (UN, 2011)

Area: 513,115 sq km (198,115 sq miles)

Life expectancy at birth, total (years): 74 years

Main exports: Food including rice, seafood and live animals, office equipment, textiles and clothing, rubber

GNI per capita: US $4,420 (World Bank, 2011)

GDP per capita: increasing gradually since 1992

Literacy: definition = age 15 and over can read and write (92.6%)

Health expenditure, total (% of GDP): 3.9 %

http://www.maps-thailand.com/

Historical context of malaria in Thailand

1950’s: 1960-1975:

1975-1990’s:

1990’s 2000’s:

2000’s to present:

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Increasing incidence of MDR parasites

Parasites being killed off with current line up of anti malarials

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Historical context of malaria in Thailand1) DDT was first used in Chiang Mai Province, northern Thailand from 1949 to 1951,

2) In 1965 malaria eradication was adopted within the framework

3) In 1971, a new malaria control strategy was developed (In response to WHO)

4) 1971-1976, the revised malarial national plan in Thailand because operational.

5) Ministry of public health began to decrease or in some cases eliminate the use of DDT for residual house spraying due to failure to control malaria.

6) 1979, revised anti malaria program was developed to provide a comprehensive control program to all at risk populations of Thailand AND DDT was again reintroduced!

7) 1981, nearly 80% of “eradicated” areas were no longer covered by routine vector control activities using DDT.

8) 1995, partly because of the programs success in malaria reduction, DDT importation for public health use was stopped.

9) 1995-1999 DDT phased out of malaria control programs due to publics perceived environmental and human health issues and report of poor community compliance.

10) 2000’s Primary problems areas are along border regions to other countries (i.e. cambodia-thai border, Myanmar, thai border) these problem areas manifest due to rural living conditions, increase number of cross country migrants, and lack of health care infrastructure, and malaria control infrastructure.

Artemsinie resistant parasites have begun to develop due to medication overuse, misuse, and self treatment. Current challenge is how to stop the spread of these Artemsinie resistant parasites and development of strong

drugs / vaccine for malaria.

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Epidemiology and transmission dynamics over time in Thailand

•Major plasmodium species: P. falciparum (42%), and P. Vivax (58%)

•Major anopheles species: An. Minimus, dirus, maculatus, camestris, philippinensis, sundaicus (WHO study confirming just the presence of An. Minimus, dirus, maculatus as the predominant malaria problem)

•Population Total: 69,518,555

•Transmission: Low transmission (0-1 cases per 1000

population) 42%

High transmission (≥ 1 case per 1000) 8%

•Efficacy: malaria control was effect in Thailand's past up until the 1995. in 1997 / 1998 rates began increasing again. 2000 to present new problem of Artemisinin resistant parasites. World Health Organization. (2011). World Malaria Report 2011 (Publication No. 978 92 4

156440 3). Geneva, Switzerland: WHO Library Cataloguing-in-Publication Data.

Existing prevention and control interventions & policies being used

World Health Organization. (2011). World Malaria Report 2011 (Publication No. 978 92 4 156440 3). Geneva, Switzerland: WHO Library Cataloguing-in-Publication Data.

Existing prevention and control interventions & policies being used (Cont.)

• Current phase in Thailand: Control of malaria parasites

• Coverage: ITNs / LLINs delivered were sufficient enough to protect 25%-50% of the population at high risk (WHO WMR 2011).

• Use: utilization of ITNs / LLINs is very low in Thailand.

• IRS is a popular means of protection (chemical used has been changing).

ITN & IRS Coverage in Thailand

World Health Organization. (2011). World Malaria Report 2011 (Publication No. 978 92 4 156440 3). Geneva, Switzerland: WHO Library Cataloguing-in-Publication Data.

Funding for Malaria Control in Thailand

• Thailand Ministry of Health (Public Health) , World Health Organization (WHO), Roll Back Malaria Program• Global Plan for Artemisinin Resistance Containment (GPARC), Strategic Framework for Artemisinin Resistance

Containment in Myanmar (MARC), Australian Agency for International Development (AusAID)• Department for International Development (DFID – UK), United States Agency for International Development (USAID), • Bill & Melinda Gates Foundation

Government & External Financing for Malaria (Thailand)

World Health Organization. (2011). World Malaria Report 2011 (Publication No. 978 92 4 156440 3). Geneva, Switzerland: WHO Library Cataloguing-in-Publication Data.

Expenditure by Intervention (Thailand 2010)

Funding for Malaria Control in Thailand: (cont.)

•As far as malaria control and resources allocations for it, the Thai government began with paying for most malaria interventions out of pocket year 2000 and has dramatically decreased to present day.

•ITNs and malaria diagnostics account for a 35% of expenditures (WHO WMR 2011).

•Human resources coupled with M & E also account for 60% of expenditures (WHO WMR 2011).

World Health Organization. (2011). World Malaria Report 2011 (Publication No. 978 92 4 156440 3). Geneva, Switzerland: WHO Library Cataloguing-in-Publication Data.

Current Challenges to Malaria Control in Thailand:1) multi-drug resistance (PROBLEM)2) the prevalence of counterfeit and

substandard anti-malarial drugs3) low coverage of malaria control

interventions among remote/ethnic populations and in some countries

4) difficult access to and use of basic health services by migrant workers and ethnic minorities who are not citizens and therefore not afforded the same social benefits.

5) Patient compliance and decreasing self treatment.

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Malaria control scale-up in Thailand

• School-based malaria control has been recognized as a new approach for the control of this disease in the Greater Mekong Sub-region since 2000.

• RDT’s are utilized but only at the community level as of 2008 (WHO WMR 2011).

• ACT is FREE for all ages in the public sector as of 2006 (WHO WMR 2011). http://www.sciencephoto.com/media/259501/view

http://www.sciencephoto.com/media/370258/view

Prospects for elimination in Thailand:• adopt adequate tests to assess

resistance (possible RDT / biomarkers?)

• encourage and sustain development of new drugs

• protect drugs against resistance through use of combinations

• expand access to prompt and effective treatment

• promote evidence-based policies and sensible practices

• Ban or fine counterfeit drugs and their vendors, prevent their use / distribution

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Research studies that have been used to guide policy in Thailand:

Kano, S., Kobayashi, J., Kojima, S., Looareesuwan, S., Okabayashi, H., Tateno, S., Thongthien, P., & Waikagul, J. (2006). Keys to success for a school-based malaria control program in primary schools in Thailand, Parasitology International, 55(1). Retrieved November 21, 2012 from Pubmed search database.

Take Away Points:• School based malaria control has been gaining

popularity in reaching children and their parents.

• Teachers and students themselves are integral parts for this type of intervention to work.

• Once the kids are educated at school, they can then further propagate the message / protect themselves.

www.sciencedirect.com/science/article/pii/S1383576911001334

References• Bangs, M., Chareonviriyaphap, T., & Ratanatham, S. (2000). Summary of Malaria in Thailand. Southeastern

Journal of Tropical Medicine & Public Health, 31(2). Retrieved November 21, 2012 from Pubmed search database.

• Brockman, A., Kuile, F., Looareesuwan, S., Luxemburger, C., McGready, R., Nosten, F., Price, R., Vugt, M., & White, N. (2000). Effect of artesunate-mefloquine combination on incidence of Plasmodium falciparum malaria and mefloquine resistance in western Thailand: a prospective study. The Lancet, 356(1). Retrieved November 20, 2012 from Pubmed search database.

• Congpuong, K., Karwacki, J., Miller, R., Pang, L., Thimasarn, K., Sirichaisinthop, J., & Wongsrichanalai, C. (2001). Drug Resistant Malaria on the Thai-Myanmar and Thai-Cambodain Borders. Southeast Asian Journal of Tropical Medicine and Public Health, 32(1). Retrieved November 12, 2012 from Pubmed search database.

• Kano, S., Kobayashi, J., Kojima, S., Looareesuwan, S., Okabayashi, H., Tateno, S., Thongthien, P., & Waikagul, J. (2006). Keys to success for a school-based malaria control program in primary schools in Thailand. Parasitology International, 55(1). Retrieved November 21, 2012 from Pubmed search database.

• Olliaro, P. (2005). Drug Resistance Hampers Our Capacity to Roll Back Malaria. Clinical Infectious Disease, 41(1). Retrieved November 17, 2012 from Pubmed search database.

• Prudhomme O'Meara W, Smith DL, McKenzie F. (2006). Potential Impact of Intermittent Preventive Treatment (IPT) on Spread of Drug-Resistant Malaria. PLoS Med 3(5): e141. Retrieved November 18, 2012 from Pubmed search database.

• Tatem, A., & Smith, D. (2010). International population movements and regional Plasmodium falciparum malaria elimination strategies. PNAS, 107(27). Retrieved November 18, 2012 from Pubmed search database.

• World Health Organization. (2011). World Malaria Report 2011 (Publication No. 978 92 4 156440 3). Geneva, Switzerland: WHO Library Cataloguing-in-Publication Data.