Wanted: Permanent cure for drug-resistant malaria

Drug-resistant malaria has become a global issue, resulting in elimination efforts and collaboration among several actors, including the national programmes, donors, researchers and critically, public health providers. Early detection, strong surveillance and patient follow-up are crucial in fighting the spread of the drug-resistant Malaria.

CHIOMA UMEHA (HEALTH EDITOR) who was among   the eight journalists who recently participated in “Covering the Fight to Eradicate Malaria: A Fellowship for U.S. and International Centre for Journalists (ICFJ)” in Thailand and Cambodia under the sponsorship of the International Center for Journalists and Malaria No More programme  writes her experience on efforts in tackling drug-resistant malaria in these countries.

Inside a clinic at Steung Market, Tbong Khmom province, Ponhea Krek District, Cambodia, Cheng Koy, pricks Sourn Morm’s finger and squeezes out five drops of blood.

He checks his temperature and asks about his symptoms. Then he gets out a file and enters Morm’s answers.

“I am very worried about malaria,” said Koy. “If patients with malaria cases report late and we cannot treat them, they will die. Many years ago we used to see that.”

Koy runs his own dispensary and clinic when he’s not running the local health center. Koy’s favourite uncle, a farmer, encouraged him to take up medicine during the 1980s, when if you didn’t have a vocation, you’d be arrested and forced into the Khmer Rouge’s army.

Mr. Cheng Koy with some International Centre for Journalists (ICFJ) Fellows 2015 (Chioma Umeha - third extreme right) during an interview session recently, at his clinic at Tbong Khmom province, Ponhea Krek District, Cambodia.
It is interesting to know that Koy was trained by PSKhmer (PSK) under the Public Provider Mix (PPM) Network Programme which is funded by The Global Fund-trainings, supplies, commodities, medical detailing (suppoartive supervision).

Some select journalists who recently visited Thailand and Cambodia to study on-going malaria research and development, drug resistance, and innovation had an encounter with Koy.

Aged 50, Koy, a Secondary Nurse conducts Rapid Diagnostic Tests (RDT) for community members of Tbong Khmom province to check if they are infected with Plasmodium Vivax (PV) or Plasmodium Falciprum(PF).

The PPM worker who has been into community health work for over a decade however said: “After conducting RDT for patients I administer Artemisinin-based combination therapy (ACT) to treat them, if they test positive of malaria, I also set up IV for administration of injection when necessary.”

According to him, the diagnostic kits are very easy to use, just as he added that it does not require much training to use it.

Koy is just one out of nearly 400 health providers enrolled in the Public Provider Mix (PPM) Network Programme of PSK. The PPM Network Programme health providers guarantee quality control for diagnosing and treating malaria in Cambodia.

Collaborating, the Programme Manager for Technology Integration, PSK, Graham T. Smith, said that PSK has nearly 400 health providers in its PPM Network involved in quality control assurance in malaria diagnosis and treatment in the Asian country.

After their training, PPM workers receive quality-assured anti-malarials which usually increases their business reputation, the Programme Manager said, adding that their data and the data they collected play a large role in decision making.

According to him, PSI and PSK partners easily track malaria cases, identify outbreaks and re-direct resources to where they are most needed through the data collected by PPM health workers.

Population Services International (PSI) is a global network of 65 nationally rooted health organizations dedicated to improving the health of people in the developing world. PSKhmer (PSK) is PSI’s independent, local network member in Cambodia.

Describing malaria transmission in Cambodia, malaria Technical Advisor for PSI Cambodia, Abigail Pratt, said that the disease is a big issue in Cambodia.

Her words: “With over 50,000 cases reported in 2014, malaria remains a concern in Cambodia, both in terms of public health and economic burden. 21 of 25 provinces are considered endemic, putting nearly eight million people at risk of the disease.

According to her, nearly 63 per cent of confirmed cases are Plasmodium falciparum (Pf) and 37 per cent Plasmodium vivax (Pv) malaria.

The World Health Organization (WHO) recommends using malaria rapid diagnostic tests (RDTs) and prescribing anti-malarials only to patients who have a positive test result.

The T3: Test. Treat. Track initiative of the WHO Global Malaria Programme sets targets of universal access to diagnostic testing in the public and private health care sectors as well as at the community level.

 In Nigeria, Malaria is still a major cause of morbidity and mortality among Nigerians. Prompt and accurate diagnosis of malaria is necessary in controlling this high burden and preventing unnecessary use of anti-malarial drugs, according to experts.

Malaria rapid diagnostic test (MRDT) offers the hope of achieving this goal. However, investigations by Newswatch Times show that the performance of these kits among the most vulnerable age group to malaria is inadequate.

Also, findings by Newswatch Times confirmed that majority of suspected malaria episodes are initially treated by private health workers or community health workers who, in most areas, don’t have access to microscopy or RDTs to carry out malaria testing.

Probably the biggest challenge in scaling up and monitoring good quality in RDT programmes will be to provide adequate supplies of rapid diagnostic tests and appropriate training to all health workers in endemic areas, according to one Nkemakolam Okenwa, a dealer on medicals. “Most areas often report stock-outs, therefore it is critical to sustain supply to ensure that tests are used persistently,” Okenwa suggested.

Global strategies to control and eliminate malaria depend on sustained access to Artemisinin-based combination therapy (ACT) – the WHO recommended first line treatment for P. falciparum malaria – in public and private health facilities.

But, the common experience in Nigeria is that health workers frequently do not prescribe treatment according to the result even when tests are available which lead to wastage of expensive ACTs and RDTs, he added.

Obviously, access to quality artemisinin-based combination therapy (ACT) to treat malaria is increasing around the world, but its misuse, together with the use of cheaper, ineffective drugs can lead to dangerous drug resistance. Spread of resistance could jeopardize the efficacy of ACT, the best treatment currently available. This is food for thought.

This story was published in Newswatch Times on December 5, 2015.


  1. Drug resistant malaria is big global issue calling for attention!


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