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Malaria Situation & Drug Policy Malaysia. Infectious Disease Consultant/Physician MOH Malaysia. Malaria incidence 1961-2004. Incidence and Incidence Rate Malaria in Malaysia 1995-2004. 6154. MALARIA CASES AND INCIDENCE RATE BY GEOGRAPHICAL AREA (STATE) 2004.

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malaria situation drug policy malaysia

Malaria Situation & Drug PolicyMalaysia

Infectious Disease Consultant/Physician

MOH Malaysia

slide4

MALARIA CASES AND INCIDENCE RATE

BY GEOGRAPHICAL AREA (STATE) 2004

slide8

Malaria cases among Malaysian and foreign citizens 2000-2004

4145

2070

16.3%

3232

25.3%

3468

31.5%

2009

32.6%

1627

25.7%

malaria deaths contributed by malaysians and foreign citizens in 2004
Malaria Deaths contributed by Malaysians and foreign citizensin 2004

Mortality Rate:

Malaysian: 18/4145 (0.43%)

Foreigners: 17/2008 (0.84%)

slide11

MANAGEMENT:

DRUG THERAPY:

PROPHYLAXIS: 1. FANSIDAR & CHLOROQUINE

2. PROGUANIL & CHLOROQUINE

3. DOXYCYLINE

RISK GROUP:

1. VISITORS TO HIGH RISK AREA IN SABAH,SARAWAK

& PAHANG

2. ARMY : WORKING OR FIELD TRAINING IN

HIGH RISK AREA

3. LOCAL PEOPLE WHO WORK OR ENTER HIGH RISK

AREA-surveyors,loggers or jungle related occ.

slide12

MANAGEMENT

DRUG TREATMENT:

-TO ALL CONFIRMED CASES

-ALL CASES WILL BE HOSPITALISED EXCEPT THOSE FROM REMOTE

AREA

NON COMPLICATED

slide13

COMPLICATED CASES

1.RESISTANT MALARIA

(i) QUININE & DOXYCLINE- physician approval

(ii) MEFLOQUINE – requires Health State Director Approval

2. SEVERE MALARIA

(i) QUININE at 10mg/kg with 5% Dextrose over 4 hours then 8hourly

AND DOXYCYLINE

(ICU or HDW Management)

slide14

Status of P. falciparum resistance to antimalarial drugs

West Malaysia.

28.5% CQ resistance (1963 by Montgomery & Eyles)

> 60% by the mid-90's (Hakim et al, 1996) in Peninsular Malaysia.

47.4% SP resistance for the first time in Malaysia.

2000-2001, two 28-day in vivo studies on the CQ+SP combination reported

51.4% (19/37) resistance in Kemaman, Terengganu state,

62.5% (15/24) in Air Bah, Perak state.

Sentinel surveillance was started early 2003 in 10 sites

looking at treatment response (unpublished Report, 2003. VBDC, MoH)

slide17

East Malaysia.

  • There are no studies documented on chloroquine resistance from 1990.
  • In 1996, the VBDC, MoH reported 29.4% SP treatment failures
  • ( 28-day in vivo study done in Tawau, Sabah, East Malaysia).
  • -100% sensitivity to Mefloquine and Quinine,
  • 16.6% (2/12) failures to Artesunate 20 mg/kg x 6 days
  • (Unpublished report, 2003).
  • 1999-2000 in Sarawak - 43% failures to the CQ+SP combination
  • (Cox-Singh et al, 2003).
  • There are 8 surveillance sites in Sarawak and Sabah (4 each)
  • as part of the MoH/IMR National Surveillance Program that
  • started early this year.
slide19

CHALLENGES

1.CROSS BORDER MIGRATION

- Sarawak & Indonesia

- Northern part of Pen Malaysia & Thailand

2.Foreign workers from endemic areas- urban malaria outbreaks

& emergence of resistance

3.Geographical inaccessibility : Remote settlement/interior area-

4.As the number of malaria cases comes down

- delay in diagnosis/ management

5. Inadequate drug efficacy monitoring & resistance surveillance

6. Lack in number of experienced personnel in malaria management

7. Unavailability of anti-malaria drug policy

act issue
ACT issue
  • ACT will be a definite treatment alternative for Malaysia because of its benefits
  • Formulation of anti malaria drug policy

.