Falling prevalence of beta-thalassaemia and eradication of malaria in the Maldives

Firdous, Naila; Gibbons, Stephen; Modell, Bernadette

doi:10.1007/s12687-011-0054-0

Cited by 15 publications

(8 citation statements)

References 30 publications

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“…Sri Lanka was declared malaria free in September 2016 but all of its South Asian neighbours except the Republic of Maldives[ 27 ] are endemic for malaria at present. The number of tourists visiting Sri Lanka has tripled during the period from year 2000 to 2013 from 400,000 per annum to 1,300,000 per annum[ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Response of imported malaria patients to antimalarial medicines in Sri Lanka following malaria elimination

et al. 2017

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After eliminating local malaria transmission and being certified as a malaria-free country, Sri Lanka is facing the challenge of imported malaria. At the same time, the country has the unique opportunity to be a case study for other countries in a similar situation by approaching this issue systematically, guided by evidence. This study demonstrates the importance of developing a mechanism to detect imported malaria and adopting an evidence-based approach to study the resistance of imported malaria to anti-malarial medicines. This is a prospective study of patients diagnosed with imported malaria in Sri Lanka and treated according to the national treatment guidelines, over 24 months (2015/2016). The clinical features, time to diagnosis, origin of the infection, infecting species, parasite density and the treatment given were recorded. All patients were followed up for 28 days, and in the case of Plasmodium vivax and P. ovale infections, the follow up period was extended to 12 months to establish treatment failures and relapses. Fifty nine uncomplicated and 15 severe imported malaria cases were reported in Sri Lanka during the study period. Most of these infections originated in either Sub-Saharan Africa or South and Southeast Asia. Having a P. vivax infection and low parasitic counts were significantly associated with relative diagnostic delay. One of the 14 uncomplicated P. falciparum patients and two of the 12 severe P. falciparum malaria patients who were followed up till day 28 had a late clinical failure. The others responded adequately to treatment both clinically and parasitologically. There was no treatment failure reported amongst any other species. This study, which is the first to assess the therapeutic response of imported malaria in Sri Lanka after elimination, demonstrates that the current antimalarial treatment policies and strategies in Sri Lanka have been effective against infections acquired overseas up until the end of year 2016.

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Section: Discussionmentioning

confidence: 99%

Response of imported malaria patients to antimalarial medicines in Sri Lanka following malaria elimination

et al. 2017

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“…The authors demonstrated that, although these mandatory programmes did not result in the reduction of at‐risk marriages, they were effective in reducing the prevalence of affected births in countries providing prenatal detection and therapeutic abortion (Saffi & Howard, ). With increased public awareness and acceptance, several countries with strong religious beliefs against termination of pregnancies, such as Iran (Firdous et al , ), Pakistan (Ahmed et al , ) and Cyprus (Angastiniotis & Hadjiminas, ), successfully negotiated with religious bodies to permit termination in early gestation in fetuses with severe β‐thalassaemia. Additionally, a study from Iran demonstrated that shared decision‐making counselling consultations resulted in a significant drop in decisional conflicts and decisional regrets in women who had undergone termination of pregnancy for β‐thalassaemia major three months after the procedure compared to those who did not (Moudi et al , ).…”

Section: Ethical Aspects Of Antenatal Haemoglobinopathy Screeningmentioning

confidence: 99%

Antenatal screening for haemoglobinopathies: current status, barriers and ethics

Chakravorty

Dick

2019

Br J Haematol

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Sickle cell disease (SCD) and thalassaemia are genetic disorders that are caused by errors in the genes for haemoglobin and are some of the most common significant genetic disorders in the world, resulting in significant morbidity and mortality. Great disparities exist in the outcome of these conditions between resource-rich and resource-poor nations. Antenatal screening for these disorders aims to provide couples with information about their reproductive risk and enable them to make informed reproductive choices; ultimately reducing the likelihood of children being born with these conditions. This review provides an overview of the current status of antenatal, pre-marital and population screening of SCD and thalassaemia in countries with both high-and low prevalence of these conditions, methods of screening in use, and discusses some of the pitfalls, ethical issues and controversies surrounding antenatal screening. It also discusses outcomes of some screening programmes and recognises the need for the establishment of antenatal screening in areas where their prevalence is highest; namely sub-Saharan Africa and India.

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“…Because of strict citizenship regulations, the Maldives is a 100% Sunni Islamic country, following the Shafi'i school of jurisprudence. A 1999 fatwa permitted PND and the medical termination of a pregnancy in cases of severe foetal abnormality, including being homozygous for thalassaemia (Firdous et al, : 175). Advanced invasive PND procedures (such as chorionic villus sampling or amniocentesis), however, are not locally available.…”

Section: Border‐crossing Preventionmentioning

confidence: 99%

Archipelagic genes: Medical travel as a creative response to limitations and remoteness in the Maldives

Knoll

2017

Asia Pacific Viewpoint

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Medical travel has become a self‐evident and intrinsic part of the medical landscape in the Republic of Maldives. This article raises the question of how exactly this has emerged as part of today's reality. The analysis describes the unfolding of a pronounced Maldivian medical travel culture by focusing on a particularly pressing health issue. The population of the Maldives has to face the world's highest prevalence of beta‐thalassaemia, a genetic disorder affecting the body's ability to create red blood cells. The country's 300:1 sea to land ratio, however, with its small population of 340 000 scattered over 200 islands is a challenging context for the curative and preventive measures in thalassaemia governance. The article follows the trail of thalassaemia‐related intra‐archipelagic and extra‐archipelagic medical travel of patients and clients requesting a blood transfusion, iron monitoring, bone marrow transplantation and prenatal diagnostic services. It discusses medical travel organised as a biosocial group activity, financed by insurance and religious bodies while interacting with the migration of health professionals.

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Falling prevalence of beta-thalassaemia and eradication of malaria in the Maldives

Cited by 15 publications

References 30 publications

Response of imported malaria patients to antimalarial medicines in Sri Lanka following malaria elimination

Response of imported malaria patients to antimalarial medicines in Sri Lanka following malaria elimination

Antenatal screening for haemoglobinopathies: current status, barriers and ethics

Archipelagic genes: Medical travel as a creative response to limitations and remoteness in the Maldives

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