Malaria profiles and challenges in artemisinin resistance containment in Myanmar

Background:This study examined evolving malaria profiles from January,2010 to December,2014 to evaluate achievements and challenges of implementing measures to prevent and control spread of artemisinin resistance in Myanmar.Methods:Using National Malaria Control Programme(NMCP)data,a cross-sectional descriptive study of 52 townships in artemisinin-resistant containment areas in Myanmar was conducted.Annual program data were analysed,and trends over time are graphically presented.Results:In the 52 study townships populated by 8.7 million inhabitants,malaria incidence showed a decreasing trend from 10.54 per 1000 population in 2010 to 2.53 in 2014,and malaria mortalities also decreased from 1.83 per 100000 population in 2010 to 0.17 in 2014.The proportion of confirmed to total tested malaria cases also decreased from 6 to 1%,while identification of cases improved.All cases from all parasites species,including Plasmodium falciparum,decreased.Coverage of LLIN(long-lasting insecticidal net)/ITN(insecticide-treated mosquito nets)and indoor residual spraying(IRS)was high in targeted areas with at-risk persons,even though the total population was not covered.In addition to passive case detection(PCD),active case detection(ACD)was conducted in hard-to-reach areas and worksites where mobile migrant populations were present.ACD improved in most areas from 2012 to 2014,but continues to need to be strengthened.Conclusions:The findings provide useful data on the malaria situation in artemisinin-resistant initiative areas,which may be useful for the NMCP to meet its elimination goal.These profiles could contribute to better planning,implementation,and evaluation of intervention activities.

Mapping and modelling the impact of mass drug adminstration on filariasis prevalence in Myanmar

Background:Lymphatic filariasis(LF)is endemic in Myanmar and targeted for elimination.To highlight the National Programme to Eliminate Lymphatic Filariasis(NPELF)progress between 2000 and 2014,this paper describes the geographical distribution of LF,the scale-up and impact of mass drug administration(MDA)implementation,and the first evidence of the decline in transmission in five districts.Methods:The LF distribution was determined by mapping historical and baseline prevalence data collected by NPELF.Data on the MDA implementation,reported coverage rates and sentinel site surveillance were summarized.A statistical model was developed from the available prevalence data to predict prevalence at township level by year of measurement.Transmission assessment survey(TAS)methods,measuring antigenemia(Ag)prevalence in children,were used to determine whether prevalence was below a level where recrudescence is unlikely to occur.Results:The highest baseline LF prevalence was found in the Central Valley region.The MDA implementation activities scaled up to cover 45 districts,representing the majority of the endemic population,with drug coverage rates ranging from 60.0%to 98.5%.Challenges related to drug supply and local conflict were reported,and interrupted MDA in some districts.Overall,significant reductions in LF prevalence were found,especially after the first 2 to 3 rounds of MDA,which was supported by the corresponding model.The TAS activities in five districts found only two Ag positive children,resulting in all districts passing the critical threshold.Conclusion:Overall,the Myanmar NPELF has made positive steps forward in the elimination of LF despite several challenges,however,it needs to maintain momentum,drawing on international stakeholder support,to aim towards the national and global goals of elimination.