Insights into the availability and distribution of oral artemisinin monotherapy in Myanmar: evidence from a nationally representative outlet surveyReport as inadecuate




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Malaria Journal

, 16:170

First Online: 25 April 2017Received: 19 December 2016Accepted: 31 March 2017DOI: 10.1186-s12936-017-1793-0

Cite this article as: ACTwatch Group, Thein, S.T., Khin, H.S.S. et al. Malar J 2017 16: 170. doi:10.1186-s12936-017-1793-0

Abstract

BackgroundThe containment of artemisinin resistance in Myanmar, historically an important probable origin and route of anti-malarial resistance to the India sub-continent and beyond, is crucial to global malaria control and elimination. This paper describes what is currently known about the sale and distribution of oral artemisinin monotherapy AMT across Myanmar, where this medicine is commonly found.

MethodsA nationally representative 2015 outlet survey was conducted in the private sector, and among community health workers across four geographical domains. A national sample of outlets was screened for availability of malaria testing and treatment, and an audit was completed for all anti-malarials.

ResultsA total of 3859 outlets across Myanmar had an anti-malarial in stock on the day of survey. Of the 3859 anti-malarial stocking outlets, 988 outlets stocked oral AMT. Availability of oral AMT was highest among outlets in the Western border 36.8% versus other domains Eastern, 15.0%; Central, 19.3% Coastal, 10.7%. Over 90% of the oral AMT service delivery points were private sector outlets: general retailers 49.4%, pharmacies 23.5%, and itinerant drug vendors 14.2%. Eleven unique oral AMT products were audited. The most common product audited was Artesunate, manufactured by Mediplantex in Vietnam, which accounted for 79.9% of the oral AMT market share. Other oral AMT products were manufactured in China and in Myanmar. Over 60% of oral AMT products had a shelf life at purchase of greater than 2 years and only 14.7% were expired. The median number of oral AMT tablets typically dispensed to treat malaria was two tablets, approximately one tenth of a full adult course. The median price of a 50 mg tablet was $0.16.

ConclusionsGiven the high availability and distribution of oral AMT, it is possible that Myanmar has become the last remaining viable market for any oral AMT in the region for manufacturers. National and international organizations need to act quickly and effectively to stop the production and distribution to both improve malaria control within Myanmar and reduce risk of artemisinin resistance spreading to India and Africa.

AbbreviationsAETDadult equivalent treatment dose

AMTartemisinin monotherapy

ACTartemisinin-based combination therapy

AMTRartemisinin monotherapy replacement

BCCbehaviour change communication

FDAMyanmar Food and Drug Administration

GMSGreater Mekong Sub-region

MoHMinistry of Health

PPSprobability proportional to population size

RDTRapid diagnostic test

WHOWorld Health Organization

Electronic supplementary materialThe online version of this article doi:10.1186-s12936-017-1793-0 contains supplementary material, which is available to authorized users.





Author: ACTwatch Group - Si Thu Thein - Hnin Su Su Khin - Aung Thi

Source: https://link.springer.com/



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