Health experts had barely finished one project to contain anti-malarial drug resistance along the Thai-Cambodia border when their attention was drawn to Myanmar, where early warning signs suggest a waning influence of the anti-malarial drug Artemisinin.
Malaria is a leading cause of morbidity and mortality in Myanmar and a leading cause of deaths in children under five, says the UN World Health Organization (WHO).
Resistance to the previous standard treatment for malaria, chloroquine, was first reported in the 1950s along the Thai-Cambodia border. By the 1980s it had spread to sub-Saharan Africa, which has the world's highest rate of malaria mortality.
Evidence of resistance emerged from Southeast Asia once again in 2007, this time to Artemisinin, one component of the combination therapies used worldwide to control malaria. Donors, starting with the Bill & Melinda Gates Foundation, pumped US$22 million into the border from 2009.
Charles Delacollette, coordinator of the Bangkok-based Mekong Malaria Programme with WHO, said while those huge multi-country efforts have worked to bring down reports of malaria infections, "what we are seeing along the Thai-Myanmar border seems equally serious ... to what we had at the Thai-Cambodian one".
He continued: "Myanmar is still struggling to get needed funds and support to scale up malaria control operations. The situation is not good in some areas of eastern Myanmar, with hundreds of thousands of people displaced [due to ethnic conflict].
"In some areas, there is still limited access to quality co-formulated anti-malarial drugs - Artemisinin monotherapies are still in use despite efforts of the Ministry of Health and NGOs to make [more effective combination] drugs available. And you have substandard drugs floating around."
On-going security concerns and access problems to remote communities are two weaknesses in the country's fight against malaria, according to the government's most recent funding proposal to The Global Fund to Fight AIDS, Tuberculosis and Malaria.
Health facilities are poor - if not non-existent - in eastern Myanmar, said Amnat Khamsiriwatchara, a Bangkok-based deputy director of a malaria surveillance informatics project funded by Gates Foundation along the Thai-Cambodia border.
"Most - if not all - patients of not just malaria cross over into Thailand for care where they know the health facilities are far better."
Khamsiriwatchara said his project would expand in October to record health data from Burmese migrants crossing into Thailand for healthcare with funding to Myanmar from The Global Fund.
The Global Fund recently committed $19 million to fight malaria in Myanmar.
The government's vector-borne disease control programme and the Department of Medical Research for upper Myanmar are expected to set up a new sentinel site close to the Chinese border to monitor drug efficacy. There are seven sites under government supervision in the divisions of Thanitharyi and Bago, and the states of Mon, Kayin, Eastern Shan, and Kachin, which border Thailand and China, as well as Rakhine, which borders Bangladesh.
The multi-donor consortium Three Diseases Fund and the Gates Foundation have pledged an additional $12 million to fund the country's recently adopted Artemisinin-resistance containment strategy.
At a meeting earlier this month in Myanmar, health experts and donors identified three tiers of "hotspots", with the highest priority being all 10 townships in Thanitharyi Division and Shwe Kyin township in Eastern Bago Division. Tier 2 includes all townships in Kayin, Kayah, Mon and Shan States and all townships in Eastern Bago Division except Shwe Kyin. Tier 3 is the rest of the country. Interventions are expected to begin in part of Tier 1 townships in April.
According to WHO, in 2008, there were 247 million cases of malaria and nearly one million deaths - mostly among children living in sub-Saharan Africa where the disease accounts for 20 percent of all childhood deaths.
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