Malaria Situation in SEAR Countries

Myanmar

Malaria is the most important public health problem in Myanmar and is the first priority in health planning.  During pre eradication era, the estimated number of cases were around 0.5 million and estimated malaria mortality were around 11000. In 1974, the reported number of cases was below 9500.  The situation deteriorated thereafter severely.  An analysis of the epidemiological information for mid 70’s shows that the , despite the antimalaria control programme, then parasite reservoir in the country had been increased.  The area under operations other than those covered by drug availability alone, covered population of 71%.  The ABER  declined during 1974 to 1979 and API though fluctuating but had definite upward trend.  SPR too increased from 1.7% in 1967 to 7.7% in 1980.  Up to 1980’s, the ABER remained above 3% after ward it declined and reached to below 1% in 1997.  The reported number of cases increased from 7058 in 1971 to 30,870 in 1980.  It further increased to 135,194 in 1989 and thereafter it start declining and remained static around 100.000 cases per annum from 1995 to 1997.  In 1998, situation start deteriorating with120000 reported cases and became worse in 2003 by registering 177,496 cases. The situation improved a little bit in 2004 when reported cases reduced to 152070 showed a decline of 14.3%.  Due  to financial support received from 3D funds the case finding activities has increased tremendously in 2008 and total number of confirmed cases increased up to 411,494. It is worth noticing to watch the increase in SPR% since 1985 onwards. It increased from 5% in 1985 to 11.6% in 1990 to 20.6% in 1995 and touched it’s peak at 37.0% in 2002. Further, it reduced to 35.2% in 2004 but again slightly increased to 35.7% in 2005 and finally reached to 43.4% in 2008.   The Pf% increased from 60% in 1965 to 82.3% in 1980 to 85.6% in 1985 and touched its peak at 89% in 1988 and stabilised around 82% till 2000 after that it keep on decreasing and reached up to 73.8% in 2002.  The decrease in Pf% was short lived and it touches 78.1% again in 2004 and finally, it reaches upto 87% in 2008.  The reported malaria mortality is always highest from Myanmar. From 1718 malaria deaths in 1981 it increased 2,856 in 1985 to 5231 in 1991 then it declined to 3,526 in 1995 and 2,476 in 2003 and upto 1088 deaths in 2008. 

Myanmar has reported an increase in the number of cases confirmed by microscopy from 120,029 in 2000 to 224,205 in 2008.  This is associated with a 20% increase in the number of patients receiving slide examination and an increase in the slide positivity rate from 31% to 45%. (the SPR (including RDT )was between 35-42%).  The introduction of RDTs added a further 187,289 confirmed cases in 2008.   The percentage of cases due to P. falciparum has shown a increase from 80% in 2000 to 87% in 2008 (as almost all RDT used to detect Pf cases only).  The number of malaria admissions has declined since 2000 from 85,409 to 47,553 in 2008 as has the number of deaths from 2756 to 1088.  Malaria represented 6% of all admissions in 2008 compared to 16% in 2000 and 11% of recorded deaths in  2008 compared to 19% in 2000.  While these latter observations may suggest some improvements in the malaria situation, the reasons behind these trends, such as improved diagnostic practices or the effect of increased use of ACTs, are not clear.   1.5 million ITNs were delivered between 2006 and 2008 enough to cover 12% of the population classified as living at high risk of malaria.  An additional 11,000 people benefited from IRS.  Overall the evidence suggests that there has been little change in the malaria situation since 2000.

About 60% of the total malaria cases are reported from forest areas.  The main vectors in forest areas and in forest fringes are A. dirus and A. minimus. While susceptible to DDT, they are exophilic and exophagic and thus indoor residual sprays have little impact on their populations.  A. annularis is DDT resistant in the Rakhine State on the west coast.

Goals and Targets:

To reduce malaria morbidity and mortality until the disease is no longer a public health problem in the country.

Control strategy

     Malaria control is integrated with the general health services.

     Passive Case Detection, Clinical diagnosis and treatment.

     Active Case Detection in limited area.

     Malaria diagnosis is done on the basis of history and clinical diagnosis. Laboratory services are   available.

   Introduction of ACT and rapid diagnostic test for case management as case detection.

     Focal spraying on highly selective basis and in outbreaks, regular spraying only in project areas.

     Insecticide (Permethin) treated bednets are being used in few areas.

Issues and challenges:

     Multidrug resistance is spreading i.e.  P.falciparum resistance to chloroquine and SP is wide spread, while resistance to mefloquine and quinine  also spreading very fast specially Thai-Myanmar border.

     Uncontrolled population movement possibly leading to epidemic prone situation or epidemics and accelerates the spread of drug resistant P.falciparum along with them. 

     An. annularis is resistant to DDT, An. minimus and An. dirus are exophilic and exophagic.

     Lack of resources and health infrastructure in high endemic and inaccessible area.

     Laboratory services and treatment facilities are often inadequate, particularly in the remote areas because of under equipped and under supplied health facilities resulting in inadequate quality of disease management.

     The behavior of disease vectors is presenting some changes, which are creating control problems

     Although communication is better in this decade, some remote, isolated territories are still left and are difficult to access terrain. Mortality is rising in forested and hilly areas, due to poor accessibility to health services

     Indiscriminate use of antimalarials by private practitioners and by the drug sellers leading to drug resistance problems.

     Delay in reporting from periphery to the central VBDC

Other Related Information:-

     Country profile – World Malaria report 2008

     Reported Malaria Morbidity (/1000) and Mortality Rate (/100000) in Myanmar, 2000-2008 [PDF 67 KB]

     State-wise Malaria Situation in Myanmar, 2006