Multidisciplinary Investigations of Sustained Malaria Transmission in the Greater Mekong Subregion

Sattabongkot, Jetsumon; Aung, Pyae Linn; Brashear, Awtum; Cao, Yaming; Kaewkungwal, Jaranit; Khamsiriwatchara, Amnat; Kyaw, Myat Phone; Lawpoolsri, Saranath; Menezes, Lynette; Miao, Jun; Nguitragool, Wang; Parker, Daniel M.; Phuanukoonnon, Suparat; Roobsoong, Wanlapa; Siddiqui, Faiza Amber; Soe, Myat Thu; Sriwichai, Patchara; Yang, Zhaoqing; Zhao, Yan; Zhong, Daibin

doi:10.4269/ajtmh.21-1267

Cited by 7 publications

(4 citation statements)

References 186 publications

(297 reference statements)

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“…Lastly, the coup in 2021 and COVID-19 pandemic (beginning in 2020) have disrupted many malaria control and elimination efforts. From passive case surveillance in Laiza town in Kachin State along the China-Myanmar border, malaria cases declined from 2016 to 2019 but increased rapidly beginning in 2020 [ 58 ]. This suggests that local governments or organizations should resume malaria surveillance and implementation of interventions as soon as possible.…”

Section: Discussionmentioning

confidence: 99%

Spatio-temporal trends of malaria incidence from 2011 to 2017 and environmental predictors of malaria transmission in Myanmar

et al. 2023

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Background Myanmar bears the heaviest malaria burden in the Greater Mekong Subregion (GMS). This study assessed the spatio-temporal dynamics and environmental predictors of Plasmodium falciparum and Plasmodium vivax malaria in Myanmar. Methods Monthly reports of malaria cases at primary health centers during 2011–2017 were analyzed to describe malaria distribution across Myanmar at the township and state/region levels by spatial autocorrelation (Moran index) and spatio-temporal clustering. Negative binomial generalized additive models identified environmental predictors for falciparum and vivax malaria, respectively. Results From 2011 to 2017, there was an apparent reduction in malaria incidence in Myanmar. Malaria incidence peaked in June each year. There were significant spatial autocorrelation and clustering with extreme spatial heterogeneity in malaria cases and test positivity across the nation (P < 0.05). Areas with higher malaria incidence were concentrated along international borders. Primary clusters of P. falciparum persisted in western townships, while clusters of P. vivax shifted geographically over the study period. The primary cluster was detected from January 2011 to December 2013 and covered two states (Sagaing and Kachin). Annual malaria incidence was highest in townships with a mean elevation of 500‒600 m and a high variance in elevation (states with both high and low elevation). There was an apparent linear relationship between the mean normalized difference vegetative index and annual P. falciparum incidence (P < 0.05). Conclusion The decreasing trends reflect the significant achievement of malaria control efforts in Myanmar. Prioritizing the allocation of resources to high-risk areas identified in this study can achieve effective disease control. Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

Spatio-temporal trends of malaria incidence from 2011 to 2017 and environmental predictors of malaria transmission in Myanmar

et al. 2023

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“…Malaria eradication remains a public health goal, so a better understanding of malaria transmission dynamics and population genetics is essential. Laiza and Myitsone are hot spots of P. vivax transmission along the China–Myanmar border [ 16 ]. Despite their proximity, we lack knowledge about the impact of control measures on parasite populations from these two areas.…”

Section: Discussionmentioning

confidence: 99%

“…In Laiza, however, compared to the 2006-2008 parasite population, which showed that the Type A allele was most frequent, followed by Type B [14], this study identified a more evenly distributed Pvmsp-3α types, with Type C being the most abundant (37%). This difference may reflect recent parasite population expansion events revealed by whole-genome sequencing analysis [27], since the Laiza parasite population has experienced several outbreak events [16]. Multiple infections of genetically distinct clones of the same Plasmodium species are common in many places where malaria is endemic [29].…”

Section: Discussionmentioning

confidence: 99%

Genetic diversity of Plasmodium vivax populations from the China–Myanmar border identified by genotyping merozoite surface protein markers

et al. 2023

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Background Parasite diversity and population structure influence malaria control measures. Malaria transmission at international borders affects indigenous residents and migrants, defying management efforts and resulting in malaria re-introduction. Here we aimed to determine the extent and distribution of genetic variations in Plasmodium vivax populations and the complexity of infections along the China–Myanmar border. Methods We collected clinical P. vivax samples from local and migrant malaria patients from Laiza and Myitsone, Kachin State, Myanmar, respectively. We characterized the polymorphisms in two P. vivax merozoite surface protein markers, Pvmsp-3α and Pvmsp-3β, by PCR-restriction fragment length polymorphism (PCR–RFLP) analysis. We sought to determine whether these genetic markers could differentiate these two neighboring parasite populations. Results PCR revealed three major size variants for Pvmsp-3α and four for Pvmsp-3β among the 370 and 378 samples, respectively. PCR–RFLP resolved 26 fragment-size alleles by digesting Pvmsp-3α with Alu I and Hha I and 28 alleles by digesting Pvmsp-3β with Pst I. PCR–RFLP analysis of Pvmsp-3α found that infections in migrant laborers from Myitsone bore more alleles than did infections in residents of Laiza, while such difference was not evident from genotyping Pvmsp-3β. Infections originating from these two places contained distinct but overlapping subpopulations of P. vivax. Infections from Myitsone had a higher multiplicity of infection as judged by the size of the Pvmsp-3α amplicons and alleles after Alu I/Hha I digestion. Conclusions Migrant laborers from Myitsone and indigenous residents from Laiza harbored overlapping but genetically distinct P. vivax parasite populations. The results suggested a more diverse P. vivax population in Myitsone than in the border town of Laiza. PCR–RFLP of Pvmsp-3α offers a convenient method to determine the complexity of P. vivax infections and differentiate parasite populations.

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“…The countries of the Greater Mekong Subregion have set the ambitious target of eliminating malaria in their territories by 2030 [ 1 ]. However, malaria continues to pose a significant public health threat in certain nations and Myanmar in particular [ 2 , 3 ]. According to the latest World Malaria Report of the World Health Organization (WHO) [ 1 ], Myanmar had 157,533 cases of malaria in 2022, reflecting a near doubling from the cases reported in 2021.…”

Section: Introductionmentioning

confidence: 99%

Ownership and use of insecticide-treated nets in Myanmar: insights from a nationally representative demographic and health survey

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Sattabongkot

et al. 2024

Malar J

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Background Malaria poses a substantial public health threat in Myanmar, indicating the need for rigorous efforts to achieve elimination of the disease nationwide by 2030. The use of insecticide-treated nets (ITNs) forms part of a pivotal strategy for preventing transmission. This study explored the ownership and use of ITNs in Myanmar and identified factors associated with non-use of ITNs. Methods Household datasets from the 2015–2016 Myanmar Demographic and Health Survey were utilised, which encompassed all household members except children under the age of five. Descriptive statistics and inferential tests, including simple and multiple logistics regression models and Pearson correlations, were employed for analysis. All analyses, taking the two-stage stratified cluster sampling design into account, used weighting factors and the “svyset” command in STATA. The ownership and use of bed nets were also visualised in QGIS maps. Results Among the 46,507 participants, 22.3% (95% CI 20.0%, 24.5%) had access to ITNs, with only 15.3% (95% CI 13.7, 17.1%) sleeping under an ITN the night before the survey. Factors associated with the non-use of ITNs included age category (15–34 years—aOR: 1.17, 95% CI 1.01, 1.30; 50+ years—aOR: 1.19, 95% CI 1.06, 1.33), location (delta or lowland—aOR: 5.39, 95% CI 3.94, 7.38; hills—aOR: 1.80, 95% CI 1.20, 2.71; plains—aOR: 3.89, 95% CI 2.51, 6.03), urban residency (aOR: 1.63, 95% CI 1.22, 2.17), and wealth quintile (third—aOR: 1.38, 95% CI 1.08, 1.75; fourth—aOR: 1.65, 95% CI 1.23, 2.23; fifth—aOR: 1.47, 95% CI 1.02, 2.13). A coherent distribution of the ownership and use of ITNs was seen across all states/regions, and a strong correlation existed between the ownership and use of ITNs (r: 0.9795, 95% CI 0.9377, 0.9933, alpha < 0.001). Conclusions This study identified relatively low percentages of ITN ownership and use, indicating the need to increase the distribution of ITNs to achieve the target of at least one ITN per every two people. Strengthening the use of ITNs requires targeted health promotion interventions, especially among relatively affluent individuals residing in delta or lowland areas, hills, and plains.

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Multidisciplinary Investigations of Sustained Malaria Transmission in the Greater Mekong Subregion

Cited by 7 publications

References 186 publications

Spatio-temporal trends of malaria incidence from 2011 to 2017 and environmental predictors of malaria transmission in Myanmar

Spatio-temporal trends of malaria incidence from 2011 to 2017 and environmental predictors of malaria transmission in Myanmar

Genetic diversity of Plasmodium vivax populations from the China–Myanmar border identified by genotyping merozoite surface protein markers

Ownership and use of insecticide-treated nets in Myanmar: insights from a nationally representative demographic and health survey

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