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Rotejanaprasert C, Malaphone V, Mayxay M, Chindavongsa K, Banouvong V, Khamlome B, Vilay P, Vanisavaeth V, Maude RJ. Malaria epidemiology, surveillance and response for elimination in Lao PDR. Infect Dis Poverty 2024; 13:35. [PMID: 38783374 PMCID: PMC11112833 DOI: 10.1186/s40249-024-01202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Lao PDR has made significant progress in malaria control. The National Strategic Plans outline ambitious targets, aiming for the elimination of Plasmodium falciparum and P. vivax malaria from all northern provinces by 2025 and national elimination by 2030. This article presents an overview of malaria epidemiology, surveillance, and response systems in Lao PDR, emphasizing experiences and achievements in transmission reduction. METHODS Data on surveillance, monitoring and evaluation systems, human resources, infrastructure, and community malaria knowledge during 2010-2020 were systematically gathered from the national program and relevant documents. The collected information was synthesized, and discussions on challenges and future prospects were provided. RESULTS Malaria control and elimination activities in Lao PDR were implemented at various levels, with a focus on health facility catchment areas. There has been significant progress in reducing malaria transmission throughout the country. Targeted interventions, such as case management, vector control, and community engagement, using stratification of control interventions by catchment areas have contributed to the decline in malaria cases. In elimination areas, active surveillance strategies, including case and foci investigation, are implemented to identify and stop transmission. The surveillance system has facilitated timely detection and response to malaria cases, enabling these targeted interventions in higher-risk areas. CONCLUSIONS The malaria surveillance and response system in Lao PDR has played a crucial role in reducing transmission and advancing the country towards elimination. Challenges such as importation, drug resistance, and sustaining support require ongoing efforts. Further strengthening surveillance, improving access to services, and addressing transmission determinants are key areas of focus to achieve malaria elimination and enhance population health in Lao PDR.
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Affiliation(s)
- Chawarat Rotejanaprasert
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Vilayvone Malaphone
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Vientiane, Laos
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Virasack Banouvong
- Center of Malariology, Parasitology, and Entomology, Vientiane, Lao PDR, Laos
| | - Boualam Khamlome
- Center of Malariology, Parasitology, and Entomology, Vientiane, Lao PDR, Laos
| | - Phoutnalong Vilay
- Center of Malariology, Parasitology, and Entomology, Vientiane, Lao PDR, Laos
| | | | - Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The Open University, Milton Keynes, UK
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Multidrug-Resistant Plasmodium falciparum Parasites in the Central Highlands of Vietnam Jeopardize Malaria Control and Elimination Strategies. Antimicrob Agents Chemother 2021; 65:AAC.01639-20. [PMID: 33526483 DOI: 10.1128/aac.01639-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/10/2021] [Indexed: 11/20/2022] Open
Abstract
Plasmodium falciparum resistance to dihydroartemisinin-piperaquine has spread through the Greater Mekong Subregion to southwestern Vietnam. In 2018 to 2019, we collected 127 P. falciparum isolates from Dak Nong (36), Dak Lak (55), Gia Lai (13), and Kon Tum (23) provinces in Vietnam's Central Highlands and found parasites bearing the Pfkelch13 C580Y mutation and multiple plasmepsin 2/3 genes (mean prevalence, 17.9%; range, 4.3% to 27.8%), conferring resistance to dihydroartemisinin-piperaquine. This information is important for drug policy decisions in Vietnam.
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Mpimbaza A, Nayiga S, Ndeezi G, Rosenthal PJ, Karamagi C, Katahoire A. Understanding the context of delays in seeking appropriate care for children with symptoms of severe malaria in Uganda. PLoS One 2019; 14:e0217262. [PMID: 31166968 PMCID: PMC6550380 DOI: 10.1371/journal.pone.0217262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/08/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction A large proportion of children with uncomplicated malaria receive appropriate treatment late, contributing to progression of illness to severe disease. We explored contexts of caregiver delays in seeking appropriate care for children with severe malaria. Methods This qualitative study was conducted at the Children’s Ward of Jinja Hospital, where children with severe malaria were hospitalized. A total of 22in-depth interviews were conducted with caregivers of children hospitalized with severe malaria. Issues explored were formulated based on the Partners for Applied Social Sciences (PASS) model, focusing on facilitators and barriersto caregivers’promptseeking and accessing ofappropriate care. The data were coded deductively using ATLAS.ti (version 7.5). Codes were then grouped into families based on emerging themes. Results Caregivers’ rating of initial symptoms as mild illness lead to delays in response. Use of home initiated interventions with presumably ineffective herbs or medicines was common, leading to further delay. When care was sought outside the home, drug shops were preferred over public health facilities for reasons of convenience. Drug shops often provided sub-optimal care, and thus contributed to delays in access to appropriate care. Public facilities were often a last resort when illness was perceived to be progressing to severe disease. Further delays occurred at health facilities due to inadequate referral systems. Conclusion Communities living in endemic areas need to be sensitized about the significance of fever, even if mild, as an indicator of malaria. Additionally, amidst ongoing efforts at bringing antimalarial treatment services closer to communities, the value of drug shops as providers ofrationalantimalarialtreatment needs to be reviewed.
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Affiliation(s)
- Arthur Mpimbaza
- Child Health & Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Grace Ndeezi
- Department of Pediatrics & Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Philip J. Rosenthal
- Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Charles Karamagi
- Department of Pediatrics & Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
- Clinical Epidemiology Unit, Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Anne Katahoire
- Child Health & Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
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Iwagami M, Nakatsu M, Khattignavong P, Soundala P, Keomalaphet S, Lorpachan L, Xangsayalath P, Matsumoto-Takahashi E, Pommelet V, Hongvanthong B, Brey PT, Kano S. Heterogeneous distribution of k13 mutations in Plasmodium falciparum in Laos. Malar J 2018; 17:483. [PMID: 30587196 PMCID: PMC6307170 DOI: 10.1186/s12936-018-2625-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 12/11/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The emergence and transnational spread of artemisinin resistance in Plasmodium falciparum in the Greater Mekong Sub-region (GMS) is a serious threat to malaria elimination in the region and could present a threat to malaria control in Africa. Recently, the Lao Government adopted the goal of malaria elimination by 2030, for which monitoring of artemisinin-resistant malaria within the country is indispensable. This study's objectives were to assess the distribution of k13 mutations in Laos. METHODS Plasmodium falciparum isolates (n = 1151) were collected from five southern provinces in Laos between 2015 and 2016, and three isolates from the northernmost province bordering China in 2017. Polymorphisms of the k13 gene and two flanking regions were analysed to estimate relationship among the isolates. RESULTS In the five southern provinces, overall 55.5% of the isolates possessed artemisinin-resistant mutations of the k13 gene (C580Y, P574L, R539T, Y493H). The C580Y was the predominant mutation (87.2%). The frequencies of the k13 mutations were heterogeneous in the five southern provinces, but with a clear tendency showing the highest frequency in the south (72.5%) and to a lower degree when moving northward (28.0%). The three isolates from the Lao-Chinese border also possessed the C580Y mutation. Analysis of the flanking loci demonstrated that these three isolates were genetically very close to resistant strains originating from western Cambodia. CONCLUSIONS Artemisinin resistance was observed to be rapidly increasing and spreading northwards through Laos and has now reached the Chinese border. The Lao and Chinese governments, as well as the international community, should make dedicated efforts to contain the spread of k13 mutations within Laos and in the GMS.
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Affiliation(s)
- Moritoshi Iwagami
- Department of Tropical Medicine and Malaria, Research Institute, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan.,SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,Institut Pasteur du Laos, Ministry of Health, Sansenthai Road, Ban Kao-Gnot, Sisattanak District, P.O. Box 3560, Vientiane, Lao People's Democratic Republic
| | - Masami Nakatsu
- Department of Tropical Medicine and Malaria, Research Institute, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan.,SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic
| | - Phonepadith Khattignavong
- SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,Institut Pasteur du Laos, Ministry of Health, Sansenthai Road, Ban Kao-Gnot, Sisattanak District, P.O. Box 3560, Vientiane, Lao People's Democratic Republic
| | - Pheovaly Soundala
- SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,Institut Pasteur du Laos, Ministry of Health, Sansenthai Road, Ban Kao-Gnot, Sisattanak District, P.O. Box 3560, Vientiane, Lao People's Democratic Republic
| | - Sengdeuane Keomalaphet
- SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,Institut Pasteur du Laos, Ministry of Health, Sansenthai Road, Ban Kao-Gnot, Sisattanak District, P.O. Box 3560, Vientiane, Lao People's Democratic Republic
| | - Lavy Lorpachan
- SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,Institut Pasteur du Laos, Ministry of Health, Sansenthai Road, Ban Kao-Gnot, Sisattanak District, P.O. Box 3560, Vientiane, Lao People's Democratic Republic
| | - Phonepadith Xangsayalath
- SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Emilie Matsumoto-Takahashi
- Department of Tropical Medicine and Malaria, Research Institute, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan.,SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic
| | - Virginie Pommelet
- Institut Pasteur du Laos, Ministry of Health, Sansenthai Road, Ban Kao-Gnot, Sisattanak District, P.O. Box 3560, Vientiane, Lao People's Democratic Republic
| | - Bouasy Hongvanthong
- SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Paul T Brey
- SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic. .,Institut Pasteur du Laos, Ministry of Health, Sansenthai Road, Ban Kao-Gnot, Sisattanak District, P.O. Box 3560, Vientiane, Lao People's Democratic Republic.
| | - Shigeyuki Kano
- Department of Tropical Medicine and Malaria, Research Institute, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan. .,SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic. .,Institut Pasteur du Laos, Ministry of Health, Sansenthai Road, Ban Kao-Gnot, Sisattanak District, P.O. Box 3560, Vientiane, Lao People's Democratic Republic.
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Yang H, Zhang Y, Wang J, Wu T, Liu S, Xu Y, Shang D. Global view of a drug-sensitivity gene network. Oncotarget 2018; 9:3254-3266. [PMID: 29423044 PMCID: PMC5790461 DOI: 10.18632/oncotarget.23229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/16/2017] [Indexed: 01/25/2023] Open
Abstract
An important challenge in drug development is to gain insight into the mechanism of drug sensitivity. Looking for insights into the global relationships between drugs and their sensitivity genes would be expected to reveal mechanism of drug sensitivity. Here we constructed a drug-sensitivity gene network (DSGN) based on the relationships between drugs and their sensitivity genes, using drug screened genomic data from the NCI-60 cell line panel, including 181 drugs and 1057 sensitivity genes, and 1646 associations between them. Through network analysis, we found that two drugs that share the same sensitivity genes tend to share the same Anatomical Therapeutic Chemical classification and side effects. We then found that the sensitivity genes of same drugs tend to cluster together in the human interactome and participate in the same biological function modules (pathways). Finally, we noticed that the sensitivity genes and target genes of the same drug have a significant dense distance in the human interactome network and they were functionally related. For example, target genes such as epidermal growth factor receptor gene can activate downstream sensitivity genes of the same drug in the PI3K/Akt pathway. Thus, the DSGN would provide great insights into the mechanism of drug sensitivity.
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Affiliation(s)
- Haixiu Yang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Yunpeng Zhang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Jiasheng Wang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Tan Wu
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Siyao Liu
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Yanjun Xu
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Desi Shang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
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Musuva A, Ejersa W, Kiptui R, Memusi D, Abwao E. The malaria testing and treatment landscape in Kenya: results from a nationally representative survey among the public and private sector in 2016. Malar J 2017; 16:494. [PMID: 29268789 PMCID: PMC5740898 DOI: 10.1186/s12936-017-2089-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/27/2017] [Indexed: 11/15/2022] Open
Abstract
Background Since 2004, Kenya’s national malaria treatment guidelines have stipulated artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria, and since 2014, confirmatory diagnosis of malaria in all cases before treatment has been recommended. A number of strategies to support national guidelines have been implemented in the public and private sectors in recent years. A nationally-representative malaria outlet survey, implemented across four epidemiological zones, was conducted between June and August 2016 to provide practical evidence to inform strategies and policies in Kenya towards achieving national malaria control goals. Results A total of 17,852 outlets were screened and 2271 outlets were eligible and interviewed. 78.3% of all screened public health facilities stocked both malaria diagnostic testing and quality-assured ACT (QAACT). Sulfadoxine–pyrimethamine (SP) for intermittent preventive treatment in pregnancy was available in 70% of public health facilities in endemic areas where it is recommended for treatment. SP was rarely found in the public sector outside of the endemic areas (< 0.5%). The anti-malaria stocking private sector had lower levels of QAACT (46.7%) and malaria blood testing (20.8%) availability but accounted for majority of anti-malarial distribution (70.6% of the national market share). More than 40% of anti-malarials were distributed by unregistered pharmacies (37.3%) and general retailers (7.1%). QAACT accounted for 58.2% of the total anti-malarial market share, while market share for non-QAACT was 15.8% and for SP, 24.8%. In endemic areas, 74.9% of anti-malarials distributed were QAACT. Elsewhere, QAACT market share was 49.4% in the endemic-prone areas, 33.2% in seasonal-transmission areas and 37.9% in low-risk areas. Conclusion Although public sector availability of QAACT and malaria diagnosis is relatively high, there is a gap in availability of both testing and treatment that must be addressed. The private sector in Kenya, where the majority of anti-malarials are distributed, is also critical for achieving universal coverage with appropriate malaria case management. There is need for a renewed commitment and effective strategies to ensure access to affordable QAACT and confirmatory testing in the private sector, and should consider how to address malaria case management among informal providers responsible for a substantial proportion of the anti-malarial market share. Electronic supplementary material The online version of this article (10.1186/s12936-017-2089-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Anne Musuva
- Population Services Kenya (PS/Kenya), 2nd Floor, Wing B, Jumuia Place, Lenana Road, P.O. Box 22591-00400, Nairobi, Kenya
| | - Waqo Ejersa
- National Malaria Control Programme, Kenya KNH Grounds, P.O. Box 20750, Nairobi, Kenya
| | - Rebecca Kiptui
- National Malaria Control Programme, Kenya KNH Grounds, P.O. Box 20750, Nairobi, Kenya
| | - Dorothy Memusi
- National Malaria Control Programme, Kenya KNH Grounds, P.O. Box 20750, Nairobi, Kenya
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Guo S, Kyaw MP, He L, Min M, Ning X, Zhang W, Wang B, Cui L. Quality Testing of Artemisinin-Based Antimalarial Drugs in Myanmar. Am J Trop Med Hyg 2017; 97:1198-1203. [PMID: 28820713 DOI: 10.4269/ajtmh.17-0305] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Artemisinin-based combination therapies are the frontline treatment of Plasmodium falciparum malaria. The circulation of falsified and substandard artemisinin-based antimalarials in Southeast Asia has been a major predicament for the malaria elimination campaign. To provide an update of this situation, we purchased 153 artemisinin-containing antimalarials, as convenience samples, in private drug stores from different regions of Myanmar. The quality of these drugs in terms of their artemisinin derivative content was tested using specific dipsticks for these artemisinin derivatives, as point-of-care devices. A subset of these samples was further tested by high-performance liquid chromatography (HPLC). This survey identified that > 35% of the collected drugs were oral artesunate and artemether monotherapies. When tested with the dipsticks, all but one sample passed the assays, indicating that the detected artemisinin derivative content corresponded approximately to the labeled contents. However, one artesunate injection sample was found to contain no active ingredient at all by the dipstick assay and subsequent HPLC analysis. The continued circulation of oral monotherapies and the description, for the first time, of falsified parenteral artesunate provides a worrisome picture of the antimalarial drug quality in Myanmar during the malaria elimination phase, a situation that deserves more oversight from regulatory authorities.
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Affiliation(s)
- Suqin Guo
- College of Agronomy and Biotechnology, China Agricultural University, Beijing, China
| | | | - Lishan He
- Breeding Base of Guangxi Key Laboratory of Agri-Environment and Agri-Products Safety, Nanning, Guangxi, China.,College of Agriculture, Guangxi University, Nanning, Guangxi, China
| | - Myo Min
- Myanmar Medical Association, Yangon, Myanmar
| | - Xiangxue Ning
- College of Agronomy and Biotechnology, China Agricultural University, Beijing, China
| | - Wei Zhang
- College of Agronomy and Biotechnology, China Agricultural University, Beijing, China
| | - Baomin Wang
- College of Agronomy and Biotechnology, China Agricultural University, Beijing, China
| | - Liwang Cui
- Department of Entomology, Pennsylvania State University, University Park, Pennsylvania
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