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Stopping the risks of malaria drug resistance
Antimalarial drug resistance is becoming a major threat to many countries, including Viet Nam. Although there have been no recorded cases in Binh Dinh province, it is a great opportunity for the province to receive and deploy the Artemisinin Resistance Containment Project. Antimalarial drug resistance has been defined as "the ability of a parasite to survive and/or multiply despite the administration and absorption of a drug given in doses equal to or higher than those usually recommended but within tolerance of the subject" (WHO, 2001). This means that the therapeutic efficacy of the using drugs is gone, or at least reduced, and the parasites are not affected by the drugs or any other internal causes. Widespread Risks Dr.Huynh Hong Quang, Vice-Director of the IMPE-QN, told the Thailand-Cambodia border area was the first place to report artemisinin resistance of malaria parasites in 2009. After that, the antimalarial drug resistance spread to Myanmar, Viet Nam and then "was threatening" the African continent and other countries, especially India and Bangladesh. So far in Vietnam, several cases of Artemisinin reduced sensitivity and resistance have been detected in four sentinel sites of Binh Phuoc, Dak Nong, Gia Lai and Quang Nam provinces, which were confirmed and verified by the Global Malaria Program-World Health Organization (WHO). In 2011, Viet Nam planned to prevent Artemisinin resistance in these provinces, especially Binh Phuoc and Dak Nong. The main activities included: implementing impregnated bed-net provision, vector control, detection, treatment and elimination of malaria; conducting health education; supplying stand-by treatment, supervising and preventing any acts of sale, circulation and use of oral artemisinin-based monotherapies in order to remove it from the market; and at the same time, promoting health care facilities to apply artemisinin-based combination therapies (ACTs) for the malaria cases caused by the Plasmodium falciparum to prevent the potential for development of the antimalarial drug resistance. Meanwhile, Dr. Hoang Xuan Thuan-Director of the Binh Dinh Center for the Prevention of Malaria and Endocrinology - assured that Binh Dinh province has not recorded any drug resistant cases but the potential risk of spreading resistance should be taken into consideration. In the first nine months of 2013, there were 303 malaria cases, decreased by 9.82% in comparison with the same period last year; however the imported malaria cases still accounted a major proportion. (above 60% of the total cases). He added: "At present, there hasn't any report of free-market sale and uses of oral artemisinin-based monotherapy and its derivatives in Binh Dinh province. The anti-malarial drugs are administered free-of-charge to people at the local health stations."  | Medical staff from the Binh Dinh Center for the Prevention of Malaria and Endocrinology is conducting diagnosis
for the people in the malaria hot-spot of Gia Van hamlet, My Hoa commune, Phu My district. |
As explained by Dr. Quang: "Binh Dinh is an adjacent province to Gia Lai, with a great number of laborers move to work in the farms, coffee plantations of the highland province. This creates the favorable conditions for the drug resistant parasites to widespread in the community."
Efforts of prevention In order to contain the drug resistance of malaria parasites, the Drug Administration of Viet Nam (Ministry of Health) has announced the halt of drug use nationwide and withdrew the registration numbers of all artemisinin-based oral monotherapy and its derivatives from the registered drug list. Dr.Quang said that it could be a disaster if the artemisinin resistance occurs on a large scale because the other antimalarials drugs are still under the study. Thus, this is an important decision to prevent the spread of anti-malarial drug resistance. The Artemisinin Resistance Containment Project (ARCP), which is funded by the Global Fund, will be implemented in Viet Nam from January 2014 to December 2016 with a total budget of USD 13.5 million. The overall goal of the project is to prevent or at minimum significantly delay the spread of artemisinin resistant parasites in some localities. The project will be deployed in 14 provinces, including 4 provinces in region 1 (with proven evidences of early or late treatment failures, including: Binh Phuoc, Dak Nong, Gia Lai, Quang Nam) and 10 provinces in region 2 (adjacent to the provinces of region 1 such as Thua Thien Hue, Quang Ngai, Binh Dinh, Phu Yen, Kon Tum, Dak Lak, Lam Dong, Dong Nai, Binh Duong, Tay Ninh) Dr. Quang said: "The intervention activities from this project will reduce the risks of spreading drug resistance; help us to effectively manage and treat the malaria patients, who are the mobile population going into the drug resistance areas." Within the framework of the project, various activities will be deployed, such as purchase and supply of long-lasting insecticide treated bed-net (LLINs) and hammocks for forest goers and field hut sleepers, supports for the village health staff to propagandize malaria control and early case detection; implementation of epidemical supervisions, blood examinations to detect malaria cases in the areas suspected of transmission. At the same time, field-based studies will be deployed to ensure the effects of the ARCP plan such as those on behaviors of the mobile population, on novel treatment regimes which suit with the current circumstance of drug resistance in malaria. Dr. Hoang Xuan Thuan said: "The reception of this project is a favorable condition for our province to "consolidate" and improve the quality of malaria control activities in the community. This is seriously making sense in the context of anti-malarial drug resistance reaching at the high risk of spreading in Viet Nam and all over the world."
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