Drug-Resistant Malaria - libdoc.who.int - World Health Organization

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6 / OPENING ADDRESS It is a fact, however, that malaria was a major health obstacle to the physical and economic development of this country especially in the earlier years. As we opened up our forests for rubber estates and tin mines, so did we expose the population to the malaria disease-carrying mosquito. Our workers were defenceless against it and deaths from malaria were consistently high. We had no preventive measures and very few curative ones. Our major port is Port Keland - it was then know as Port Swettenham. Its early development was nearly abandoned because of malaria. The first permanent antimalarial measures were started in Kelang in 1901. The port at Ke1ang flourishes today and is no longer menaced by malaria, neither are the majority of our rubber estates and tin mines. Malaysia is still learning how to cope with this disease out of its own past experience in preventive and curative medicine backed up by continuing research in our Institute for Medical Research. We have paid for this hard experience in terms of human wastage to this disease. We must continue to be vigilant against it although as the incidence of this disease decreases, there is danger of complacency creeping in where our attitude is concerned. Health workers and the population must be continually reminded that the danger still exists although it is controlled. The very effectiveness of the present programmes here in reducing the incidence of malaria from more than 300,000 cases a year to 9,110 reported cases in 1980, can lead to the erroneous conclusion amongst planners that we can now devote our resources to other health activities. Statistics alone do not hide the fact that malaria still exists here and in the region. It can flare up again as it has flared up elsewhere. We share the experience of other countries in that particular problems over eradication and control measures still remain. We now face a new anxiety that you have all gathered here to tackle in greater depth - the emergence of the drug-resistant malaria parasite. We have identified this resistant strain in various parts of our country since its first detection in the State of Per1is in Northern Malaysia in 1967. Unless we can effectively counter it, the growing emergence of this strain will pose serious curative problems for us, part icularly in Sabah where there is a tradit ion of migrant labour moving in and out. This is why we have always stressed the vital importance of bilateral health programmes between us and our immediate neighbours of Indonesia, Thailand and Singapore. We have established so-called "border health committees" with all these friendly neighbours to further develop preventive measures for the control of tropical communicable diseases. We cannot remain isolated or secure in the knowledge that our own preventive measures are effective. We must also be reasonably certain that we are not transmitting this disease to others, just as much as we would expect others to be reasonably careful that they are not transmitting the disease to us. The malaria parasite does not recognize political or geogra-
OPENING ADDRESS / 7 phical boundaries. With the rapid region, and the increasing mobility have to widen our horizons as well. development of our total of this whole populat ion, we The World Health Organization and the Ministry of Health are now conducting a joint study on this particular problem of drugresistant malaria in Malaysia. We shall be happy to share our knowledge with others as I am certain that you would wish to share yours with us. We have a common enemy in our midst. It is in this context that I am paticularly happy that the World Health Organization has proposed the establishment of a network of National Malaria Training Centres in Asia, which will receive training and research support from a Permanent Secretariat which will also give assistance on request to any of the countries concerned. We are particularly glad to accept its further proposal that such a Permanent Secretariat should be established in Kuala Lumpur. I have already obtained the endorsement of the Malaysian Government to this proposal, together with the formal agreement to establish such a Permanent Secretariat at the Institute for Medical Research. Arrangements are being made for this agreement to be signed shortly. When this Permanent Secretariat is established here, with the benefit of both local and foreign expertise, I hope for the further strengthening of the health links that already exist in this Region. Some of the delegates here may belong to different Regions in the World Health Organization purely because of administrative divisions. This does not necessarily mean, however, that we cannot or should not have bilateral arrangements or other health groupings that can serve our common interests. We already have such a health grouping in the Association of South East Asian Countries. The establishment of this Permanent Secretriat for Malaria for the whole of Asia gives us yet another dimension to work in. As the Minister of Health, I have readily recommended the acceptance of these proposals to our Government as I believe that they will be of immense benefit to Asia. We regard this as also being a singular honour to Malaysia in recognition of our own efforts to control this disease, if not to eradicate it altogether. We look forward to the early establishment of this Permanent Secretariat accordingly just as we look forward to continued cooperation amongst us all to fight the mosquito and the malaria parasite. We cannot afford the wastage of human energy to this debilitating disease, especially when it affects our rural people whose social and economic betterment is of priority concern to us all. I wish this meeting every success accordingly.
Page 1: Drug-Resistant Malaria The Report o
Page 5: Foreword A meeting on drug-resistan
Page 8 and 9: CONTENTS Page Drug Pressure and Res
Page 10 and 11: 2 / INTRODUCTION Differences in dru
Page 13: II. Opening Address and Messages Ol
Page 17 and 18: OPENING ADDRESS / 9 to preserve for
Page 19 and 20: OPENING ADDRESS / 11 is also here a
Page 21 and 22: Ill. Review of Drug Resistance in P
Page 23 and 24: REVIEW I 15 Table 1. Sensitivity Te
Page 25 and 26: REVIEW / 17 Other Studies Validatio
Page 27 and 28: Distribution of Chloroquine-Resista
Page 29 and 30: REVIEW I 21 are signs to suggest th
Page 31 and 32: REVIEW / 23 (h) specialized investi
Page 33 and 34: REVIEW / 25 TABLE 3~ Comparison of
Page 35 and 36: REVIEW / 27 Of 22 mefloquine in vit
Page 37 and 38: REVIEW / 29 operational conditions
Page 39 and 40: REVIEW / 31 the possible influence
Page 41 and 42: IV. Monitoring of Drug Response of
Page 43 and 44: MONITORING / 35 during recent years
Page 45 and 46: MONITORING / 37 India, Sri Lanka an
Page 47 and 48: Table 4. Results of Micro In Vitro
Page 49 and 50: MONITORING / 41 The superiority of
Page 51 and 52: MONITORING / 43 input of the result
Page 53 and 54: MONITORING / 45 table time 1ag and
Page 55 and 56: Table 6. Probability of Detecting t
Page 57 and 58: MONITORING / 49 prevalence = 10% an
Page 59: MONITORING / 51 TDR. At the end of
Page 62 and 63: 54 / RESEARCH RESULTS characteristi
Page 64 and 65:
56 / RESEARCH RESULTS EXO-ERYTHROCY
Page 67 and 68:
VI. Control of Drug-Resistant P. fa
Page 69 and 70:
CONTROL / 61 DRUG USE AIMING AT PRE
Page 71 and 72:
Table 7. Specific Actions for the C
Page 73 and 74:
CONTROL / 65 Table 8. Drugs or Comb
Page 75 and 76:
Table 9. Suggested Use of Antimalar
Page 77 and 78:
Table 9. Suggested Use of Antimalar
Page 79 and 80:
CONTROL / 71 Radical therapy of mic
Page 81 and 82:
CONTROL / 73 Tanzania several years
Page 83 and 84:
VII. Field and Laboratory Research
Page 85 and 86:
RESEARCH FOR CONTROL / 77 In vivo a
Page 87 and 88:
RESEARCH FOR CONTROL / 79 migrants
Page 89 and 90:
RESEARCH FOR CONTROL / 81 and Phase
Page 91:
RESEARCH FOR CONTROL / 83 (b) Metho
Page 94 and 95:
86 / RECOMMENDATIONS and sulfonamid
Page 96 and 97:
88 / RECOMMENDATIONS (xiii) Simple
Page 99 and 100:
IX. Summary The Meeting on Drug-Res
Page 101 and 102:
APPENDIX 1 List of Participants, Ob
Page 103 and 104:
APPENDICES / 95 Sri Lanka Dr M.K. B
Page 105 and 106:
APPENDICES / 97 Papua New Guinea Dr
Page 107 and 108:
APPENDICES / 99 TEMPORARY ADVISERS
Page 109 and 110:
APPENDICES / 101 Dr L.E. Molineaux
Page 111 and 112:
APPENDIX 2 List of Documents A. WOR
Page 113 and 114:
APPENDICES / 105 Comparative study
Page 115 and 116:
APPENDIX 3.1 I 107 RESPONSE OF Plas
Page 117:
APPENDIX 3.2 / 109 RESPONSE OF P. F
Page 120 and 121:
112 / APPENDICES 0.25 0.50 0.75 1.0
Page 122 and 123:
114 / APPENDICES Chloroquine is eff
Page 124 and 125:
116 / APPENDICES 1.4 Sulfonamide pl
Page 126 and 127:
118 / Various tetracycline analogs
Page 128 and 129:
120 / APPENDICES A loading dose on
Page 130 and 131:
122 / APPENDICES The drug should be
Page 132 and 133:
124 / APPEND ICE S 2. INDICATIONS f
Page 134 and 135:
126 / APPENDICES they are already r
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128 / APPENDICES 5.2 In suppressive
Page 138 and 139:
130 / APPENDICES Outline research p
Page 140 and 141:
132 / APPENDICES Long-term To preve
Page 143 and 144:
APPENDIX 8 Considerations Related t
Page 145 and 146:
APPENDICES / 137 4. Screening point
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