MYANMAR: WHO warns of tolerance to anti-malaria drug

YANGON, 4 February 2010 (IRIN) - Tolerance to artemisinin, the most effective anti-malarial drug available, is emerging in Myanmar and could pose a major challenge to regional malaria control, says the World Health Organization (WHO).

WHO, researchers and health officials are already trying to contain the spread of resistant strains of the plasmodium falciparum parasite along the Thai-Cambodian border.

The parasite causes the most deadly form of malaria .

Preliminary studies in 2008-09 by the Mekong countries of Cambodia, China, Lao PDR, Myanmar, Thailand and Vietnam, show tolerance elsewhere, with the drug proving less effective and taking longer than previously to kill the parasite.

The studies, presented late last year at a WHO regional workshop of health officials, show tolerance may have extended to areas along the Myanmar-Thailand, Myanmar-China and Cambodia-Vietnam borders.

WHO describes the Mekong countries as the epicentre of plasmodium falciparum resistance to anti-malarial drugs in the world, and the findings have prompted further studies over 2010 and 2011 to confirm increasing resistance.

“In this globalized economy, people move from one place to another, so parasite resistance can easily be spread to the rest of the world,” Leonard Ortega, WHO’s acting country representative in Myanmar, told IRIN.

“If those drugs are no longer effective, more people may die of malaria,” he said.

Artemisinin is normally used in combination therapy (ACT) with other drugs, although it can be prescribed on its own.

Ortega said the studies in Myanmar had shown that parasites were still detected in some cases after treatment, taking more than a benchmark three days to be cleared.

“This is an indication that there is resistance, but this year we will try to confirm that,” he said, adding that plans will soon be under way for containment of the parasite, which is spread by mobile populations such as migrant workers.

“We don’t need to wait until we confirm. We know from history - and there is now evidence at the Thai-Cambodia border - that there is resistance to artemisinin, so we believe it is already here,” he said.

Factors in resistance

In Myanmar, evidence of a tolerance to ACTs, with longer times for the parasite to be cleared and decreasing effectiveness, has been seen in Kawthaung town in the southeast, along the border with Thailand, and in southern Mon State, said Ortega.

As with the Thai-Cambodia situation, tolerance may be due to the use of counterfeit or substandard drugs which expose the parasite to lower doses of artemisinin, thereby enabling it to become resistant.

Malaria patients may also not be completing the full three-day ACT courses, while health service providers, such as doctors, are not following the national malaria treatment guidelines recommended by WHO, said Ortega.

“On the part of the service providers, we have evidence that they don’t give the complete treatment,” he said.

Instead of handing over a full course of drugs to patients, private general practitioners are cutting up the medicine packs to dole out drugs by the day, probably to increase their profits, he said.

This, in turn, deters patients from completing drug treatment courses, many of whom are the rural poor and lack the means to travel for repeat practitioner visits.

Containment challenges

Along with diseases such as tuberculosis and HIV/AIDS, malaria is a leading cause of mortality in Myanmar, according to WHO.

Despite this, resources to treat malaria and to control its spread are limited.

“People already own mosquito nets, but they are not treated with insecticide, so it’s not effective in preventing malaria,” said Ortega.

“We estimate that around nine million mosquito nets are available at the household level, but only 6 percent are treated with insecticides,” he said.

In addition, only around 500,000 ACT courses are available annually - a fraction of what is needed to treat an estimated 8.5 million malaria cases.

“There is a huge gap in terms of drugs available and prevention,” he said. Read more!

REFILING: Japan to send SDF ship for U.S. naval medical aid mission in Asia+

Japan will send a Self-Defense Force ship to Vietnam and Cambodia from May to July to take part in the U.S. Navy's annual medical aid mission aimed at enhancing Asia-Pacific countries' capabilities on disaster relief, Defense Minister Toshimi Kitazawa said Thursday.

The move is the first step under Prime Minister Yukio Hatoyama's so- called "fraternity boat" initiative, announced last November, to deploy an SDF vessel that would carry civilians and nongovernmental members as well for extending medical support and carrying out cultural exchanges.

A Maritime Self-Defense Force transport ship with 150 crew members and 30 SDF medical officers will join the Pacific Partnership 2010 program organized by the U.S. Pacific Fleet that involves about 20 countries and civic group members, the Defense Ministry said.

Japan will engage in the mission between May 23 and July 15 and provide free medical support to patients in Vietnam and Cambodia for training. The Foreign Ministry will solicit several dozen NGO participants for the latest annual program begun in 2007, a defense ministry official said.

Kitazawa told reporters he believes Japan's participation in the mission is a "landmark event" as it embodies ideal international contribution advocated by Hatoyama.

The minister said Tokyo should not only take part in the U.S.-led activities, but also explore avenues for further contributing to the international community on its own.

In his Asian policy speech in Singapore last November, Hatoyama vowed to launch his initiative in 2010, saying that within the philosophy of "yu-ai (fraternity)," people respect the freedom and human dignity of each other and that the word signifies coexistence.

Japan had sent only two medical officers each for the previous Pacific Partnership missions. This year, Japan will join the United States and Australia in dispatching a vessel, the official said.

The U.S. Navy hospital ship Mercy, which has a full load displacement of approximately 69,350 tons, and the MSDF's 8,900-ton Osumi-class transport ship will be deployed for the mission, he said.

Other participating countries will include South Korea, Thailand and Malaysia, according to the ministry. Japan will set aside some 200 million yen from the state budget for joining the program, the official said.

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Cambodia to draft new law against acid attacks

By SOPHENG CHEANG


PHNOM PENH, Cambodia -- Cambodia plans to draft a new law in a bid to stop the growing number of attacks in which jealous wives, vengeful businessmen and others have hurled acid at their rivals, a government official said Thursday.

More than 10 people were assaulted with acid in 2009, and three last month alone, according to statistics from a nongovernment group that helps victims of the attacks.

"For the attackers, using acid to attack their opponents is very easy, not hard to keep and hide like guns," said Deputy Minister of Interior Teng Savong.

Acid attackers are currently tried under the general criminal law, and Teng Savong said that due to the increasing number of attacks, specific legislation with heavy punishments was needed to curb such vicious acts.

In recent years, the majority of acid attacks have stemmed from marital and business disputes. Jealous wives have attacked or hired others to attack girlfriends of their husbands and small-time businessmen have used acid to injure and disfigure rivals.

Last month, a market vendor quarreled with a neighbor who then hired two men to douse the vendor's two daughters with acid as they rode a motorcycle through the streets of Phnom Penh.

Pin Damnang of the Cambodian Acid Survivors Charity, a nongovernmental organization that gives free medical treatment to acid victims, said figures gathered by his group show that more than 10 people suffered from attacks last year and at least three were attacked in January. Official figures were not available.

Teng Savong, who is also a chairman of the government committee to draft the law, said the country's legal experts are expected to hold their first meeting at the end of this month and will take several months to complete the task. Read more!

Cambodia looks forward to ATF 2011

Cambodia is gearing up to host the ASEAN Tourism Forum in 2011, officials saying this week the country was ready to welcome ATF delegates for a second time.

Speaking to reporters at ATF 2010 in Brunei this week, ASEAN Cambodia tourism director Thok Sokhom said the event would be held 15-21 January 2011.

The venue t be used will be the US$4 million Diamond Island Convention and Exhibition Center in Phnom Penh.

The hosting of the event will further boost arrivals to the country which received over 2 million international arrivals last year according to Director Thok.

Of those arrivals, 58 percent were by air and 35-42 percent of arrivals were from the Asia-Pacific.

The director said the tourism board has been working hard to attract more international inbound tourists by increasing accessibility through open-sky policies, visa on arrival, e-visas and visa exemptions for ASEAM member countries.

Indonesia confirmed earlier this week that it would host ATF 2012
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Siem Reap Celebrates Cambodian New Year

The Cambodian New Year celebrations take place over three days in April.

(OPENPRESS) February 4, 2010 -- People travelling to Siem Reap this year may like to combine their visit with the Cambodian New Year celebrations.

Spread over three days, the new year festival is one of the country's most important annual events.

Although the Cambodian capital Phnom Penh is usually viewed as the focal point of the celebrations, people staying in Siem Reap hotels will also enjoy an authentic festival experience.

This year, the three days of the new year will take place on April 14th, 15th and 16th.

Each day has a special title and features particular events in accordance with tradition.

The first day of the new year is called Maha Songkran and includes people lighting candles and making offerings to the Buddha by bowing, kneeling and prostrating themselves three times before his image.

On the second day - Wanabat - people offer charity to the poor and homeless, as well as attending a dedication ceremony to their ancestors.

The third day is known as Tngay Leang Saka and sees people bathing statues of the Buddha with perfumed water.

People who decide to visit Phnom Penh during the new year celebrations can expect to enjoy free concerts around the Wat Phnom area at night.

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