Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

Although malaria is decreasing in Myanmar, resistance to anti-malarials is on the rise in the region and the focus is now to treat people early, particularly in remote communities. MOCRU has set up a network of community health workers, trained and supplied with diagnostics, bednets and treatments, to help improve access to healthcare as well as produce the evidence to encourage policy changes.

My name is Frank Smithuis, I’m a medical doctor and the director of MOCRU, Myanmar Oxford Clinical Research Unit. We focus mainly on infectious diseases and access to health care in the most remote communities.

The main problem for malaria in Southeast Asia, and therefore also in Myanmar, is falciparum malaria because it is the biggest killer. I estimate very roughly, because there’s not a lot of data available, yearly incidents of 5 to10 millions. However, that has gone down substantially and I don’t know what it is at this moment but I expect it to be maybe 100,000, 200,000 or 300,000 cases a year.

There is of course the problem of resistance: the medicines that are used to treat malaria in this region are gradually not effective any more, and the parasite is becoming more and more resistant. This is particularly a problem in Cambodia, Thailand and Vietnam. Actually in Myanmar artemisinin is still effective, resistance is limited, and the artemisinin combination treatment is still effective. In practice, we focus on treating people early in the community. If you treat people early then they can’t transmit malaria and that is very important.

MOCRU and Medical Action Myanmar, an NGO I am working with, focus on working in the most remote communities. That is where malaria is, and there are no health care activities there. We have trained community health workers, villagers, and we trained them how to used rapid tests for malaria, and then gave them enough treatment. We provide medicines, mosquito nets, tests, but also very importantly we keep on training them. When I studied medicine and I saw my first patient, I didn’t know what to do – I learnt a lot but I didn’t know how to manage a patient, and it was a senior doctor that helped me and guided me along. It’s the same for community health workers: we can train them but at a certain moment they need to see patients together with a senior person. That is what we do: we send a team every month to all of these remote communities, and they see patients together. That programme has been very successful; malaria has decreased on average in the communities that we work with by 70% per year, and that has gone on for 6 to 7 years now.

We have to prove to the world, to the ministry of health, to other players, what works and what doesn’t work, I think that’s very important. I can be convinced of something but if I don’t have proof then it’s very difficult to ask other people to implement the same. That’s why when we do activities we measure the results, we compare it with when we do not do these activities. Then we have something in hand, and with these results we go to the government, we go to the ministry of health and we show the results. That has lead several times to a change to treatment protocol so that’s basically it – we do research and we try to change policy. It is very much related to direct service delivery to the people.

There is not so much malaria anymore, so people say ‘so why focus on malaria?’ well if you want to eliminate it, you have to eliminate the last parasite; that’s actually very difficult. You can see with polio, there is very little polio in the world, but when you drop your activities to contain polio and to eliminate polio, polio will come back. It’s the same with malaria – if we stop now or if we stop in the next few years, malaria will come back, and then it was all for nothing.

Frank Smithuis

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.

More podcasts related to Malaria

Bob Taylor: Primaquine for vivax and falciparum malaria

Malaria

Primaquine can be used both to treat vivax malaria and to prevent the transmission of falciparum malaria from human to mosquito. A shorter and age-based primaquine regimen would reduce the burden of vivax malaria. It would also allow primaquine to be used more widely to block the transmission of falciparum malaria.

Lisa White: Mathematical modelling for tropical diseases

Malaria

Mathematical modelling, particularly when combined with economical modelling, allows researchers and policy makers to determine the most effective interventions to fight infectious diseases such as malaria. We can use those models to explore ‘what ifs’ scenarios, at country or province level, save more lives and limit costs.

Ric Price: Curing Plasmodium vivax malaria

Malaria

Vivax malaria used to be considered benign but is now recognised as an important cause of morbidity and mortality. Resistance to chloroquine (given to treat the parasite blood stage) is growing and ACT (artemisinin-based combination therapy) is becoming common treatment for vivax malaria. New drugs and better public health strategies can help elimination targets, anticipated for 2030.

Olivo Miotto: Genomics and global health

Malaria

Genomics is the study of the complete DNA sequence, for example of a particular parasite, allowing us to analyse its evolution and the impact of human interventions. Alongside clinical date, we use genomics to identify mutations that are markers for drug resistance. Mapping out drug resistance then helps inform elimination programmes.

Andrea Ruecker: Blocking malaria transmission

Malaria

In the falciparum malaria parasite cycle, the gametocyte stages are responsible for the transmission from person to mosquito, then to other persons. A better understanding of how gametocytes respond to malaria treatments would help us block transmission and ultimately eliminate malaria.

Rob van der Pluijm: Tracking antimalarial resistance and treatment of malaria using Triple ACTs

Malaria

Anti-malaria drug resistance is spreading throughout Southeast Asia and we need to find new treatments. Our researchers at MORU use a combination of artemisinin and two partner drugs instead of one. If confirmed safe and tolerable, triple artemisinin combination therapies might be a good option to treat multi-drug resistant malaria, as well as slow down the emergence and spread of anti-malarial resistance.

James Watson: Primaquine and vivax malaria

Malaria

Primaquine is a drug used to eliminate vivax malaria from the liver and prevent relapses. However, it causes anaemia in patients with G6PD deficiency. A new, slightly longer regimen with increasing doses of primaquine could allow to safely treat all patients with vivax malaria.

Xin Hui Chan: Using big data to eliminate malaria

Malaria

Malaria is the most important parasitic infection to still affect humans, and a safe use of antimalarial drugs is paramount. The current explosion of clinical data is causing a jungle of data; making sense of all this data will greatly help us in our fight to eliminate malaria.

Bob Snow: Malaria control in Africa

Malaria

Quality data is vital to design better malaria control programmes. This project helps various African countries gather epidemiological evidence to better control malaria. Professor Bob Snow showed how sub-regional, evidence-based platforms can effectively change malaria treatment policies.

Lorenz von Seidlein: Malaria elimination in the Greater Mekong sub-region

Malaria

Multidrug resistant P. falciparum malaria is now established in parts of Thailand, Laos and Cambodia, causing high treatment failure rates for artemisinin combination therapies, the main falciparum malaria medicines.

Translational Medicine

From Bench to Bedside

Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.