Background to the Research Programme

The malaria research programme of the SMRU started in 1986. The research unit is a field station of the Faculty of Tropical Medicine, Mahidol University, Bangkok. It is part of the Oxford Mahidol University Tropical Medicine Research Programme funded by the Wellcome Trust of Great Britain. The main objectives are to establish the appropriate strategy for treatment and prevention of malaria in the communities living along the Thai-Myanmar border.(http://www.shoklo-unit.com/)

Main research Areas

Treatment of malaria: During this fiscal year we have reported the results of the study of the efficacy and tolerability of the fixed combination of mefloquine and artesunate under the auspices of The Drugs for Neglected Diseases (DNDi) and WHO/TDR, for the treatment of uncomplicated P.falciparum malaria. The trial included 500 patients and the results indicate that the fixed combination is as effective as the loose one and well tolerated. In our clinics in Maela camp the Chemotherapy department has seen 23,223 patients of which 5,322 were malaria cases for a population of 45,000. For more details on the activities in Maela camp please see the attached report in Annex 1. In Mawker Tai, Munruchai and Mae Kong Ken (Pho Pra district) and Wang Pha (Mae Ramat District) we continued our consultations. Here we treated 17,177 non-patients and the main identifiable causes of illness in this group were respiratory infections and diarrhea. In Mawker Tai there were 4,320 blood test positive cases of malaria of which 2,728 were P.falciparum, and 3,674 patients received chloroquine, included 1,746 confirmed cases of P.vivax. In Munruchai we treated 1,896 test positive cases including 1330 cases of falciparum, while 1,678 treatments with chloroquine were given to 644 confirmed cases of non-falciparum infections and 1,034 presumptive treatments. The corresponding figures for Mae Kon Ken (opened in May 2005) were 2,918 malaria positive tests (2059 falciparum) and 2,456 CQ treatments (986 positives and 1,470 presumptive). In Wang Pha the largest number of laboratory confirmed malaria cases was seen: 9,859 including 7,573 falciparum, while 6,697 treatments with chloroquine were prescribed to 2,757 confirmed cases of non-falciparum and 3,940 were presumptive. In total in these migrant workers clinics we have treated this year 28,328 cases of malaria for a population estimated between 25,000 and 40,000.

Malaria in pregnancy: in the antenatal clinics of SMRU, the majority of pregnant women from Maela camp continued to be seen on a weekly basis. Those who have travelled outside the camp in the previous 2 months get tested for malaria. All cases of malaria (falciparum or vivax) were treated according to SMRU protocol. Our ANC department in Maela has seen over 11,000 women in antenatal consultation. This represents almost 90% of all pregnant women in the camp. In 39,031 consultations we detected 127 cases of falciparum, 201 cases of vivax. 92% of the pregnant women were fully immunized against tetanus. 3.8 % of the women tested had a Middle Arm Circumference (MUAC) under 21 cm (the cut-off of entering the supplementary ration program). Our delivery room has been fully functional and the midwives delivered 1,374 women. In Pho Phra and Mae Ramat district we followed 7,383 pregnant women in 15,710 antenatal consultations. The study on the efficacy of artemether lumefantrine in uncomplicated malaria was completed and 253 women have been recruited.

Collaboration with the Ministry of Health: The work has continued under the collaboration with the Tak Public Health Office. The consultations in Pho Pra and Mae Ramat district have continued uninterrupted (see Annex 2). These include consultations for pregnant women (see above). These ANC are conducted to facilitate the access to malaria diagnosis and treatment to pregnant women in the remote areas of the province. In July-August we faced a malaria epidemic opposite Wang Pha village and with the help of the Vector Disease Control Departement and a grant from the Dutch Embassy in Bangkok, we offered mosquito nets and intra domiciliary insecticide spaying to the affected villages.

Campaign against HIV: in Maela camp, the education and information campaign on the prevention of HIV has continued and several workshops and other activities were organized to explained pregnant women about the mother to child HIV transmission prevention. The topics on HIV, Drug, Reproductive Health and Sex education are also discussed during the training for adolescents in the camp. We also take responsibility for the program of prevention of the materno-fetal transmission of HIV.
Malaria Control Programme: collaboration with NGOs: SMRU assists the medical NGOs working in camps for displaced people, with their malaria programmes. SMRU continues to provide a quality control service for the laboratories of the NGOs.
In Mae Sot the new laboratory routinely monitors the in vitro sensitivity of P.falciparum and carries out the parasite genotyping in the context of the drug trials.

Conclusion: This progress report and the attached data, indicate that SMRU has carried out the planned activities, without encountering any significant difficulty. As far as the camp population is concerned, the malaria situation is still under control but we recorded an increase in the total number of malaria cases. Close monitoring of the drug resistance of P. falciparum is essential as it is the highest in the world. More work is needed to allow access to malaria diagnosis and treatment to vulnerable groups such as children and pregnant women, especially amongst the migrant worker population. In this population, this year was marked by a sharp increase in malaria cases.

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