Guyana’s proactive response to malaria drug resistance

Mar 15, 2015 News

(From the desk of the Vector Control Director, Dr Reyaud Rahman)

In 2013 the Vector Control Services/ Ministry of Health in collaboration with the World Health Organization

Dr Reyaud Raham

and the Pan American Health Organization conducted a study to determine if persons in Guyana had any resistance to the first line malaria drugs used to treat Plasmodium falciparum malaria.
This particular study is done every two to three years in Guyana to ensure that the medication is working well and the malaria parasites are being destroyed when used.
When Guyana reported its findings from previous studies it was recommended by the World Health Organization and the Pan American Health Organization to do another study to determine if we in fact had Artemisinin resistance. This was some cause for concern, as Artemisinin resistance was only recorded in South East Asia.It was noted that some patients in Guyana appeared to take longer to clear parasites than others in comparison to what had previously been reported years before.
It was necessary at this point to conduct a study to determine if there was Artemisinin resistance in Guyana or resistance to the first line drug that treats Plasmodium falciparum malaria, which is the most dangerous type of malaria to contract. If an individual contracts P. falciparum malaria and does not drink any medication, 90 per cent of such persons will die.
This alarmed us, as history reminds us of what transpired 50 years ago when resistance to the drug Chloroquine emerged in Asia, then spread from Myanmar (in South East Asia) and then to India and the rest of the world, killing millions of people. If we carefully look at history, it appears like history is repeating itself in terms of how the resistance is spreading. In 2015 the World Health Organization was able to confirm that five countries – Cambodia, the Lao People’s Democratic Republic, Myanmar, Thailand and Vietnam – have confirmed Artemisinin resistance.
People develop resistance to drugs because of several factors such as poor adherence to the drugs prescribed. Patients sometimes only drink a few tablets, and when they feel better they stop using the tablets altogether, poor quality medication (counterfeit medication), and widespread availability to poor quality single drugs. This is a problem because malaria should be treated with combination drug therapies and no single or monotherapy regime.
There are, however, some main reasons why resistant parasites develop. In 2013 researchers identified a particular molecular marker which was associated with the delayed parasite clearance, it was known as the K13. This K13 assists as a means to map and monitor the resistance pattern.
Guyana, like Suriname, completed the therapeutic efficacy study in 2014, and it must be highlighted that these were the only two countries in South America to have completed this study to rule out Artemisinin resistance.
Guyana had also recruited many more patients, and had almost zero patients who did not follow up, but had submitted samples to check for K13 mutations and gotten back the results from those samples. We were able to find no K13 mutations, which meant that we do not have Artemisinin resistance at this moment. However, what we were able to find is that parasites were taking longer to die than normal.
In 2012 the World Health Organization released a Global Plan for Artemisinin resistance containment calling on all stakeholders to ensure that there is a beneficial change to the use of the malaria medication and the reduction and elimination of Plasmodium falciparum malaria. Since 2012 we have taken a stern approach towards scaling up our activities.
We have recognized the very important fact that the only way to protect the people of this country is to ensure that we minimize the number of people who contract malaria or become infected with malaria. It was therefore necessary to increase/step up activities to manage and control malaria in Guyana.
We started by increasing the work that we were doing in endemic regions such as increasing our distribution of Long Lasting Insecticidal Nets (LLIN’S); sensitizing the public to vector-borne diseases, especially malaria; ensuring that medication is always available at health care facilities and no stock out of medication occurs; following-up on patients to ensure medication adherence was being observed and doing active case detection work by going to camps, villages and places where malaria was being transmitted to take off blood smears, find a diagnosis or type of malaria and treat the cases in the field.
This has proven very successful as we have recorded a significantly low number of malaria cases as we have cut malaria by more than 50 per cent in 2014 in comparison to our 2013 figures.
In order to scale up prevention and control interventions, it is necessary for increased funding in malaria, a long term political commitment, and the cooperation of the public/at-risk population to adhere to medication and prevention methods. Without this commitment and discipline from individuals, we will not be able to sustain gains or make any significant impact to this huge public health problem.