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Up until now, Myanmar has spent little on heathcare and receive little assistance from rich countries. Prevention is difficult, which leaves diagnosis and treatment. MOCRU has set up a network of community health workers, trained and supplied with diagnostics and treatments, to help improve access to healthcare for remote communities.

Q: Why is Malaria such a problem in Myanmar?

Frank Smithuis: There are several reasons. For the last decade Myanmar government has spent very little on healthcare, including malaria. The previous regime did not have a priority in healthcare, it seems. Unfortunately, the First World that provides assistance to poor countries decided to boycott Myanmar. The Myanmar people were unfortunately hit double: by their government not taking care of them and also by the international community not taking care of them.

Q: How can we reduce the burden of malaria in Myanmar?

FS: There are several ways: we can try to prevent malaria and we can treat it. Treatment on itself will lead to prevention because there is less malaria that will be transmitted. Prevention is usually mainly done by mosquito nets. Unfortunately, in Myanmar and South East Asia, mosquito nets are not very effective because the vector, the mosquito, bites very early in the evening and when they do that we are not protected because we are not sleeping yet. It has a little more of an effect of children but even there it is usually too early. So that leaves diagnosis and treatment as the mainstay of malaria control, and we must make sure that people who have malaria have access to good diagnosis and treatment. That is most difficult in remote areas because there are very few healthcare services in these areas and that is what we have to focus on.

Q: How can we tackle increased resistance to antimalarial drugs?

FS: First of all, we have to reduce malaria. We want that the resistant parasite can not transmit easily, spreading over vast areas. If you decrease malaria drastically then that would be an enormous benefit. Second, we have to keep up the treatments that we develop because the parasite changes and adapts to our treatment, it selects the most resistant types. We must make sure that we can treat these most resistant types. For this we need new treatment regimens or new drugs, new molecules but they are very difficult to find. Otherwise we can have new treatment combinations, for example, previously we used one drug, or two drugs, and now we can give a combination of maybe three drugs.

Q: What are the most important lines of research that have developed in the last 5-10 years?

FS: It focuses on good diagnosis and good treatment, and how the treatment is delivered, how we can make sure that most people with malaria get the right diagnosis and treatment. The diagnosis is a bit problematic: the diagnostics we have been using for the past decade are not very sensitive. We can identify people with a high number of parasites, but we cannot identify people with a low number of parasites. If we keep this same diagnostic tool that there will always be people who walk around with low parasite counts, people that we do not treat and keep the transmission up. Secondly, we have to make sure we keep the good effective drugs and that need continuous research.

Q: Why does your line of research matter and why should we put money into it?

FS: Malaria is an important disease. It kills many people; it makes many people sick. That is a very clear reason. Secondly, over the past decade or so we have achieved a very impressive decrease of malaria; we are winning. The problem is that now the parasite is becoming resistant to the existing drugs. If we do not invent new ideas, new ways to kill the parasite, then all the gain we have made over the last decade will be lost and the parasite will increase again, more people will get sick again and more people will die. I would say this is the moment to keep up the momentum, to make sure we can diagnose and treat the parasites effectively.

Q: How does your research fit into translational medicine within the department?

FS: Our research focuses on the interaction between the people, the community and the first line healthcare provider. This is usually a village health worker, a person we have identified in the village, a person we have trained and supplied with diagnostics and treatment. I think that is very focused on the community and particularly a community that did not have access to healthcare before. Usually the healthcare system is in larger towns, where by the way there is also less malaria. We do this research over the whole region: it is not only MOCRU (Myanmar Oxford Clinical Research Unit), it is together with the whole network of MORU (Mahidol Oxford Tropical Medicine Research Unit). In the whole region we are looking at which drugs can be used, which drugs can be effective, and how we can improve diagnostics, how we can improve access to these services.

Frank Smithuis

MOCRU

Professor Frank Smithuis is the director of MOCRU, our Myanmar Oxford Clinical Research Unit. MOCRU involves a network of 6 clinics and 650 community health workers in remote areas.
Most research questions originate from the day to day health issues in this network. Research interests include the epidemiology and management of malaria, and the management of tuberculosis, HIV and opportunistic infections.

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