Malaria burden and treatment targets in Kachin Special Region II, Myanmar from 2008 to 2016: A retrospective analysis

Abstract

Although drug-based treatment is the primary intervention for malaria control and elimination, optimal use of targeted treatments remains unclear. From 2008 to 2016, three targeted programs on treatment were undertaken in Kachin Special Region II (KR2), Myanmar. Program I (2008–2011) treated all confirmed, clinical and suspected cases; program II (2012–2013) treated confirmed and clinical cases; and program III (2014–2016) targeted confirmed cases only. This study aims to evaluate the impacts of the three programs on malaria burden individually based on the annual parasite incidence (API), slide positivity rate (SPR) and their relative values. The API is calculated from original collected data and the incidence rate ratio (IRR) for each year is calculated by using the first-year API as a reference in each program phase across the KR2. Same method is applied to calculate SPR and risk ratio (RR) at the sentinel hospital too. During program I (2008–2011), malaria burden was reduced by 61% (95%CI: 58%-74%) and the actual API decreased from 9.8 (95%CI: 9.6–10.1) per 100 person-years in 2008 to 3.8 (3.6–4.1) per 100 person-years in 2011. Amid program II (2012–2013), the malaria burden increased by 33% (95%CI: 22%-46%) and the actual API increased from 2.1(95%CI: 2.0–2.3) per 100 person-years in 2012 to 2.8 (95%CI: 2.7–2.9) per 100 person-years in 2013. During program III (2014–2016) the malaria burden increased furtherly by 60% (95%CI: 51% - 69%) and the actual API increased from 3.2(95%CI: 3.0–3.3) per 100 person-years in 2014 to 5.1 (95%CI: 4.9–5.2) per 100 person-years in 2016. Results of the slide positivity of the sentinel hospital also confirm these results. Resurgence of malaria was mainly due to Plasmodium vivax during program II and III. This study indicates that strategy adopted in program I (2008–2011) should be more appropriate for the KR2. Quality-assured treatment of all confirmed, clinical and suspected malaria cases may be helpful for the reduction of malaria burden.

Retrospective analysis of risk factors of slide positivity among febrile patients in the Salween river valley of Shan Special Region II, northern Myanmar

“…Border malaria control is still one of the great challenges in the GMS [ 3 – 6 ]. Reducing malaria endemicity of neighbouring countries largely determines the success of malaria elimination [ 15 – 17 ]. Thus, this paper presents slide positivity and associated risk factors before intensive interventions from China’s GFATM in 2009.…”

Spatiotemporal Trends of Malaria in Relation to Economic Development and Cross-Border Movement along the China–Myanmar Border in Yunnan Province

“…Nine townships border Myanmar. KSR II has a land area of about 287 km 2 with a total population of around 60,000; most local residents belong to the Kachin ethnic minority (known as Jinghpaw in China) [ 18 , 33 , 34 ]. Basic health care and malaria control activities have been established by the Kachin Independent Organization, which receives support from several international non-governmental organizations [ 12 ].…”

“…Specifically, the study explored adjacent areas in the 2 countries, Yingjiang County of China and the KSR II of Myanmar (Fig. 1 [18,33,34]. Basic health care and malaria control activities have been established by the Kachin Independent Organization, which receives support from several international non-governmental organizations [12].…”

The health beliefs, dengue knowledge and control behaviors among internally displaced persons versus local residents in Kachin Special Region II, Myanmar

“…As a result, health services provided by the Myanmar central government cannot fully cover these regions, and thereby health services there are somewhat limited [5,12,22]. In the emergency situation, the Kachin people and especially the IDPs faced many health problems such as a high burden of malaria [1,9]. DF might not be regarded as one of the top priority health issues due to the shortage of laboratory tests, which might lower people awareness and sensitivity to dengue.…”

“…DF is still one of the major tropical diseases and an increasing threat to public health in the world [7,8], but the impact of dengue on local public health is still being neglected now. While extensive investigations about malaria have been done in the KSR2, Myanmar [2,3,[9][10][11][12][13][14][15][16][17][18], studies on DF are still unavailable.…”