1. Good Use of ACTs and Rapid Diagnostic Tests (RDTs) in Cambodia (GUARD)
2. Village Malaria Worker Access and Treatment study (VIMWAT)
3. Drug quality and antimalarial drug resistance - Tracking Resistance to Artemisinins Collaboration (TRAC)
What did we know before this research?
The border between Thailand and Cambodia is the world’s epicenter of cases of multi-drug resistant Plasmodium falciparum , the most dangerous malaria species. Recently, cases of resistance to artemisinin have been documented in the region and triggered efforst to contain further spread.
Private drug shops, pharmacies and clinics are important sources of treatment of fevers, including malaria. In fact, 70% to 80% of the time these are the first or only source of treatment. Historically there has been widespread availability of fake and sub-standard drugs, including artemisinin monotherapies , which are artemsinin derivatives on their own without an effective partner drug. The selling of ”cocktails” of drugs is also very popular.
Cambodia has implemented a number of innovative strategies, which include the social marketing of subsidised malaria rapid diagnostic tests (RDT) and artemisinin-based combination therapy (ACT)]. They have also set up a large network of community-based volunteers known as Village Malaria Workers (VMW) who provide free diagnosis and treatment with rapid diagnostic tests and ACT drugs.
What does this study add?
This set of studies in south-east Asia focuses on the access, use and quality of both rapid diagnostic tests and ACT drugs, with the aim to contribute to malaria control efforts globally.
The research provides an insight into what actually happens when patients with malaria symptoms seek care in the private sector. We have specifically explored what kind of treatment they are offered, and whether they are offered a blood test.
We have also investigated what drives patients to seek treatment from different providers, and whether this is influenced by their access to village malaria workers.
In addition, we have carried out an identification of what medicines are actually contained within the cocktail packages, and developed robust methodologies to collect drug samples in order to analyse their quality.
Finally, we are investigating the links between cases of sub-standard or counterfeit drugs and drug resistance to antimalarial treatments.
The research team
Dr Shunmay Yeung, London School of Hygiene & Tropical Medicine
Dr. Chea Nguon, National Malaria Control Programme, Cambodia
Dr. Poly Teng, National Malaria Control Programme, Cambodia
Clare Chandler, London School of Hygiene & Tropical Medicine
Patricia Tabernero, London School of Hygiene & Tropical Medicine/WWARN
Mikahel DeSouza, London School of Hygiene & Tropical Medicine/MSF
Ouk Rada, Cambodian National Malaria Control Programme
Mam Boravann, Cambodian National Malaria Control Programme
Edith Patouillard, London School of Hygiene & Tropical Medicine
Tom Drake, London School of Hygiene & Tropical Medicine
Nayantara Wijanandanda, London School of Hygiene & Tropical Medicine
3. Drug quality and drug resistance
Harparkash Kaur, London School of Hygiene & Tropical Medicine
Michael Green, Centers for Disease Control, Atlanta
Facundo Fernandez, Georgia Tech, Atlanta
Harriet Lawford, London School of Hygiene & Tropical Medicine
Liz Ashley, Mahidol Oxford Tropical Medicine Research Unit
Paul Newton, Mahosot Hospital/Lao Oxford Medical Research Unit
Mayfong Maxay, Mahosot Hospital/Lao Oxford Medical Research Unit
Khin Muang Lwin, Shokle Malaria Research Unit, Thailand
Sethavudh Kaewviset, Mahidol Universty, Thailand
Olubenga Mokuolo, University of Ilorin, Nigeria
Latest on this research
1. The GUARD study is now complete. The outlet survey and mystery client study included 217 private health providers. The research team held eight focus group discussions with 52 private health providers, and conducted a rapid diagnostic test user assessment of 68 health providers. We also tested the quality of rapid diagnostic tests from 12 drug shops and have completed the analysis of the quality of artemsinin containing drugs and content analayis of collected drug cocktails.
2. The data collection for the VIMWAT study is now complete, and analysis ongoing. We followed up 1147 households with and without access to Village Malaria Workers in 72 villages over a period of 6 months.
3. The medicines sample collection for the TRAC project has been completed in Cambodia, the Thai-Burma and Thai-Cambodia border, Attapeu in Lao and Ilorin in Nigeria. The laboratory analysis of the 291 Cambodian samples is complete. No counterfeits were identified.