SMRU annual report
Progress Report for the fiscal year 2006-2007

Prof. F. Nosten
Shoklo Malaria Research Unit
Faculty of Tropical Medicine, Mahidol University

 

Downloads :

Summary report document
SMRU maela annual report
SMRU migrants annual report

SMRU migrant non malaria report

        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

  1. Treatment of malaria: During this fiscal year we have continued to conduct studies on the treatment of malaria. A phase III clinical trial sponsored by MMV on DHA-piperaquine was completed and is now being analyzed. A new trial, also sponsored by MMV has started using a new ACT: artesunate+pyronaridine. These 2 GCP trials have been carried out in collaboration with Mae Sot and Mae Ramat Hospitals. We completed the trial sponsored by the WHO on the treatment of malaria in pregnancy with artemether-lumefantrine and this is now being submitted for publication. It showed that this ACT was not fully effective in pregnancy and this is most likely due to altered kinetics of lumefantrine in pregnancy. In the meantime we have continued to provide treatment services in Maela camps and in our clinics for migrants. In our clinics in Maela camp the Chemotherapy department has seen 16,471 patients of which 3,103 were malaria cases for a population of 45,000. This represent a 40% drop when compared to the previous year. The majority of the cases (82%) were in patients who had left the camp area in the previous 2 months and most likely acquired their infection while working in Myanmar or in the surrounding areas. 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 33,732 non-malaria patients (almost double from the previous year) and the main identifiable causes of illness in this group were respiratory infections and diarrhea.  For malaria, we confirmed 12,488 cases of P.falciparum, 8,333 cases of P.vivax and 128 cases of either P.ovale or P.malariae. In total in these migrant workers clinics we have treated this year 29,086 cases of malaria for a population estimated between 30,000 and 50,000. By comparison the total number of malaria cases treated in the camps for displaced people in Thailand (circa 150,000) was just over 19,000 during the same period.

 

  1. 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 2083 new pregnant women in antenatal consultations. This represents almost 90% of all pregnant women in the camp. In 36,532 consultations we detected only 43 cases of falciparum (compared to 127 the previous year), 182 cases of vivax. This illustrates the very low transmission rate within the camp perimeter. 90% of the pregnant women were fully immunized against tetanus. Less than 5% 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 1753 women. In Pho Phra and Mae Ramat districts we followed 1581 new pregnant women in 19,096 antenatal consultations. We diagnosed 283 cases of P.falciparum, 732 cases of P.vivax and 2 cases of P. ovale. The study on the efficacy of artemether lumefantrine in uncomplicated malaria was completed and there are 30 infants that remain to be followed up till they reach 12 months.
  2. 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. 
  3. 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. We performed 252 female sterilizations in Maela camp.
  4. Malaria Control Programme: collaboration with NGOs: SMRU assists the medical NGOs working in camps for displaced people, with their malaria programmes trhough the Malaria Task Force (MTF). SMRU continues to provide a quality control service for the laboratories of the NGOs. Guidelines, manuals and other materials are produced and distributed and annual meetings organized.
  5. In Mae Sot the new laboratory routinely monitors the in vitro sensitivity of P.falciparum and P.vivax andcarries out the parasite genotyping in the context of the drug trials.
  6. SMRU has received support from the US. CDC to conduct work on respiratory infections in the camps for displaced people and in the migrant population. This is aimed at documenting the main pathogens causing respiratory infections and characterizing their susceptibility to antibiotics. The work so far has concentrated on establishing the laboratory in Mae Sot and to put in place a surveillance system in collaboration with A.M.I. The number of ARI is now reported in a standard way and included in the attached annexes.
  7. The study of the impact of DDT and micro-nutrient deficiencies in pregnant women and their infants has continued during this year and the results should be available in Q4 of 2008. This work is supported by the UBS Foundation.

 

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 camps population is concerned, the malaria situation is still under control. 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 in the migrant workers.