Measuring drug resistant Malaria in Myanmar

This provided UCL infectious disease epidemiologists with an opportunity to undertake an international research project on malaria drug resistance in Myanmar.

An important area for such research is mapping malaria parasites resistant to the main antimalarial drug (artemisinin), which have recently emerged in Southeast Asia and spread to Myanmar.

A UCL-led international team undertook the first major malaria prevalence study in central Myanmar for many years, supported by grants from UCL's Grand Challenge of Global Health and the Chadwick Trust. UCL researchers, in collaboration with the University of Medicine 2 in Yangon, Myanmar, went from house-to-house in rural areas during the monsoon season in 2013.

Nearly 2,000 people took part, giving blood spot samples and answering questionnaires about malaria risk factors. The blood spots were tested at the London School of Hygiene and Tropical Medicine (LSHTM) for evidence of malaria infection, and - in particular - artemisinin-resistant parasites.

The results, published this year in the Malaria Journal, were striking. Although most people had no evidence of malaria exposure, working-age men were at substantially increased risk. The most common form of malaria was falciparum malaria, which is also the most dangerous. Importantly, most of those infected showed no symptoms, and more than a quarter had a genetic mutation capable of causing artemisinin resistance - the first time these mutations have been found in this area.

The World Health Organization aims to eliminate malaria in Southeast Asia and control the spread of artemisinin-resistance. Our data demonstrated the importance of targeting working age-men, who often work in forested areas at dawn and dusk, for malaria control interventions - even those who show no signs of infection.

UCL's Grand Challenges funded a workshop in Yangon in December 2016 bringing together key stakeholders in malaria control in Myanmar to discuss the findings.

Many avenues for future research were identified - including a research focus on asymptomatic carriers of drug-resistant malaria. As Myanmar continues to open up, UCL will continue to lead research that directly impacts on policy to improve the health of vulnerable communities.

UCL research team

• Dr Nigel Field (Principal Investigator), UCL Infection and Population Health
• Dr Isaac Ghinai (co-applicant and lead author), UCL Infection and Population Health
• Dr Teddy Hla (co-applicant), UCL Institute for Global Health
• Prof Therese Hesketh (co-applicant), UCL Institute for Global Health
• Dr Hein Myat Thu Htet (collaborator), UCL Infection and Population Health (honorary)

Collaborators from other universities

• London School of Hygiene and Tropical Medicine (LSHTM): Dr Jackie Cook, Prof Chris Drakeley, Tom Hall, Prof David L. Heymann, Dr Inke Lubis, Dr Colin Sutherland
• University of Medicine 2, Yangon, Myanmar: Dr Mya Mya Lwin, Prof Tint Swe Latt
• Others: Dr Rosanna Ghinai, Dr Ye Naung