Malaria Elimination in the Greater Mekong Subregion: Challenges and Prospects

Malaria is a significant public health problem and impediment to socioeconomic development in countries of the Greater Mekong Subregion (GMS), which comprises Cambodia, China’s Yunnan Province, Lao People’s Democratic Republic, Myanmar, Thailand, and Vietnam. Over the past decade, intensified malaria control has greatly reduced the regional malaria burden. Driven by increasing political commitment, motivated by recent achievements in malaria control, and urged by the imminent threat of emerging artemisinin resistance, the GMS countries have endorsed a regional malaria elimination plan with a goal of eliminating malaria by 2030. However, this ambitious, but laudable, goal faces a daunting array of challenges and requires integrated strategies tailored to the region, which should be based on a mechanistic understanding of the human, parasite, and vector factors sustaining continued malaria transmission along international borders. Malaria epidemiology in the GMS is complex and rapidly evolving. Spatial heterogeneity requires targeted use of the limited resources. Border malaria accounts for continued malaria transmission and represents sources of parasite introduction through porous borders by highly mobile human populations. Asymptomatic infections constitute huge parasite reservoir requiring interventions in time and place to pave the way for malaria elimination. Of the two most predominant malaria parasites, Plasmodium falciparum and P. vivax, the prevalence of the latter is increasing in most member GMS countries. This parasite requires the use of 8-aminoquinoline drugs to prevent relapses from liver hypnozoites, but high prevalence of glucose-6-phosphate dehydrogenase deficiency in the endemic human populations makes it difficult to adopt this treatment regimen. The recent emergence of resistance to artemisinins and partner drugs in P. falciparum has raised both regional and global concerns, and elimination efforts are invariably prioritized against this parasite to avert spread. Moreover, the effectiveness of the two core vector control interventions—insecticide-treated nets and indoor residual spraying—has been declining due to insecticide resistance and increased outdoor biting activity of mosquito vectors. These technical challenges, though varying from country to country, require integrated approaches and better understanding of the malaria epidemiology enabling targeted control of the parasites and vectors. Understanding the mechanism and distribution of drug-resistant parasites will allow effective drug treatment and prevent, or slow down, the spread of drug resistance. Coordination among the GMS countries is essential to prevent parasite reintroduction across the international borders to achieve regional malaria elimination

A study on health-related quality of life and comorbidity among elderly population in rural Sabah, Malaysia

Ageing is a global phenomenon. In Malaysia, a projected model estimated that the number of elderly would be 3.4 million in 2020 which is more than 10% of the population. A cross-sectional study targeted the elderly population of three villages in rural Sabah, Malaysia aimed to investigate the health-related quality of life, comorbidity, and the socio-demographic profile amongst the elderly in the community. Participants (60 years and above) were selected for face-to-face interviews using health-related quality of life questionnaires (SF-36). SPSS 21 was used for statistical analyses. Results showed that mean (sd) of age; 67.71 (6.95) years. Five common co-morbidities were hypertension (67%), bone and joint pain (63%), gastric pain (67%), poor vision (58%), and hearing problems (33%). The highest HRQoL score was social functioning (67.96) whereas the lowest HRQoL score is role limitation due to emotional problems (30.54). There is a significant relationship between HRQoL domains and socio-demographic factors (gender, marital status, membership in association), and health condition (co-morbidities and access to healthcare, bone and joint pain or arthritis and treatment, hearing impairment and treatment) which indicated need for health and social support like participating in association and access to health care for rural elderly in future programme. We recommend a further study to compare elderly HRQoL in rural, urban and institutional settings for future health-care planning

Effect of seminal plasma removal, washing solutions, and centrifugation regimes on boer goat semen cryopreservation

Three experiments were carried out to improve semen quality during cryopreservation process. Total motility, forward motility, acrosome integrity, live spermatozoa, and normal spermatozoa were measured as semen quality. In Experiment 1, the effects of seminal plasma removal were analyzed by using two different extenders (GE and FE). The removal of seminal plasma gave higher and significant (P<0.05) effect in the total motility, forward motility, and live spermatozoa after cryopreservation. For two different extenders, however, the differences were not observed on the semen quality. In Experiment 2, three different washing solutions (namely, phosphate buffered saline, normal saline and Tris-based extender) were tested to evaluate the effects of semen quality after cryopreservation. Tris-based extender (TCG) conferred the highest (P<.05) sperm quality values in the total motility, forward motility, and live spermatozoa after cryopreservation. In Experiment 3, the effects of different centrifugation regimes (3000 × g for 3 min, 1600 × g for 10 min, 800 × g for 15 min) were evaluated on Boer semen quality. Semen quality parameters (namely, total motility, forward motility, acrosome integrity, and live spermatozoa) were significantly (P<.05) higher for cryopreserved spermatozoa centrifuged with 3000 × g for 3 min than the others. In conclusion, the removal of seminal plasma, washing solution TCG, and the use short-term centrifugation with a relative high g-force could contribute to the increased Boer semen quality after cryopreservation

ミャンマー連邦シャン州北部およびカチン州における稲遺伝資源の探索収集

Myanmar is a country having a large genetic diversity of crop genetic resources. But through the introduction of improved varieties, local varieties so called landraces are now on the verge of extinction. It is a critical stage to explore, collect and conserve domestic plant genetic resources in the country for future utilization. Thus a joint rice exploration program of MAFF Genebank project and Myanmar Seed Bank was carried out in the Northern Shan State and Kachin State of Myanmar from November 16 to December 15,2000. Of the lowland rice varieties collected, 80 percent were improved varieties introduced from foreign countries in the past 3～5 years. However some landraces suitable for the eating habitat of local people or local agro-ecological conditions such as alkali soil are still remained. On the other hand, most of the upland rice varieties were landraces although improved varieties have been gradually introduced. A total of 104 varieties including landraces, improved varieties and wild rices were collected. In the landraces, a big variation was observed on grain shape, grain color, plant type, tolerance to cool weather and resistance to pests and diseases

Effect of sugars on characteristics of Boer goat semen after cryopreservation

In order to improve Boer goat semen quality during cryopreservation process, the influence of sugar supplementation on semen characteristics of sperm were investigated. Three experiments were carried out to investigate the effect of (a) addition of two monosaccharides (fructose and glucose) and two disaccharides sugars (trehalose and sucrose) (b) sugar combination (fructose and trehalose, sucrose and trehalose, glucose and trehalose), and control (glucose without trehalose) (c) different concentrations of trehalose on cryopreservation using Tris based extender. The total motility, forward motility, viability, normal spermatozoa, acrosome integrity and membrane integrity were assessed subjectively. Differences were not detected among monosaccharides, but glucose increased (P 0.05) among disaccharide sugar supplementation. Combination of glucose and trehalose significantly improved the characteristics of Boer spermatozoa after cryopreservation (P < 0.05). Supplementation of trehalose (198.24 mM) into the glucose extender significantly increased total motility, forward motility, live spermatozoa, acrosome integrity and membrane integrity following cryopreservation (P < 0.05). In conclusion, glucose had the better ability to support Boer sperm motility and movement patterns. Combination of monosaccharide (glucose) and disaccharide (trehalose) improved semen quality following cryopreservation. Trehalose supplementation at the concentration of 198.24 mM to the glucose extender conferred the greater improvement of semen quality for Boer semen cryopreservation

Estimation on local transmission of malaria by serological approach under low transmission setting in Myanmar

Background: As the prevalence of the malaria has been decreasing in many endemic countries including Myanmar, malaria elimination in Greater Mekong Region was targeted not later than 2030. The relevance of molecular and serological tools to identify residual transmission remains to be established in this setting. Methods: One-year cohort study was conducted and sera samples were collected in every 3 months with active and passive case detection for clinical malaria episodes by RDT, microscopy and molecular method. The sera were used to detect the malaria antibody against PfMSP1-19, PvAMA1, PvDBPII and PvMSP1-19 by protein microarray. Results: Among the recruited 1182 participants, there was no RDT positive case for malaria infection although two vivax infections were detected by microscopy in initial collection. Molecular methods detected the asymptomatic cases of 28/1182 (2.37%) in first, 5/894 (0.42%) in second, 12/944 (1.02%) in third, 6/889 (0.51%) in fourth collection, respectively. Seropositivity rates against the PfMSP1-19, PvMSP1-19, PvAMA1 and PvDBPII were 73/270 (27.0%), 85/270 (31.5%), 65/270 (24.1%) and 160/270 (59.3%), respectively. PfMSP1-19 and PvMSP1-19 showed high and stable antigenicity in acute and subacute samples but declining in 1-year history samples. No cross reactivity of PfMSP1-19 and PvMSP1-19 between the two species and higher seropositivity among the asymptomatic carriers were observed. Mapping data indicated serological surveillance can detect the geographical pattern of malaria infection under low transmission setting. Conclusions: These findings support that PfMSP1-19 and PvMSP1-19 are suggested for serosurveillance of the malaria especially in low transmission setting for further necessary actions have to be carried out to eliminate the malaria.Publisher PDFPeer reviewe

Political transition and emergent forest-conservation issues in Myanmar.

Political and economic transitions have had substantial impacts on forest conservation. Where transitions are underway or anticipated, historical precedent and methods for systematically assessing future trends should be used to anticipate likely threats to forest conservation and design appropriate and prescient policy measures to counteract them. Myanmar is transitioning from an authoritarian, centralized state with a highly regulated economy to a more decentralized and economically liberal democracy and is working to end a long-running civil war. With these transitions in mind, we used a horizon-scanning approach to assess the 40 emerging issues most affecting Myanmar's forests, including internal conflict, land-tenure insecurity, large-scale agricultural development, demise of state timber enterprises, shortfalls in government revenue and capacity, and opening of new deforestation frontiers with new roads, mines, and hydroelectric dams. Averting these threats will require, for example, overhauling governance models, building capacity, improving infrastructure- and energy-project planning, and reforming land-tenure and environmental-protection laws. Although challenges to conservation in Myanmar are daunting, the political transition offers an opportunity for conservationists and researchers to help shape a future that enhances Myanmar's social, economic, and environmental potential while learning and applying lessons from other countries. Our approach and results are relevant to other countries undergoing similar transitions

Political transition and emergent forest-conservation issues in Myanmar.

Political and economic transitions have had substantial impacts on forest conservation. Where transitions are underway or anticipated, historical precedent and methods for systematically assessing future trends should be used to anticipate likely threats to forest conservation and design appropriate and prescient policy measures to counteract them. Myanmar is transitioning from an authoritarian, centralized state with a highly regulated economy to a more decentralized and economically liberal democracy and is working to end a long-running civil war. With these transitions in mind, we used a horizon-scanning approach to assess the 40 emerging issues most affecting Myanmar's forests, including internal conflict, land-tenure insecurity, large-scale agricultural development, demise of state timber enterprises, shortfalls in government revenue and capacity, and opening of new deforestation frontiers with new roads, mines, and hydroelectric dams. Averting these threats will require, for example, overhauling governance models, building capacity, improving infrastructure- and energy-project planning, and reforming land-tenure and environmental-protection laws. Although challenges to conservation in Myanmar are daunting, the political transition offers an opportunity for conservationists and researchers to help shape a future that enhances Myanmar's social, economic, and environmental potential while learning and applying lessons from other countries. Our approach and results are relevant to other countries undergoing similar transitions

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security