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Insights into the availability and distribution of oral artemisinin monotherapy in Myanmar: evidence from a nationally representative outlet survey.
Malar J. 2017 04 25; 16(1):170.MJ

Abstract

BACKGROUND

The 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.

METHODS

A 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.

RESULTS

A 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.

CONCLUSIONS

Given 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.

Authors+Show Affiliations

No affiliation info availablePopulation Services International Myanmar, No. 16, West Shwe Gone Dine 4th Street, Yangon, Myanmar. stthein@psimyanmar.org.Population Services International Myanmar, No. 16, West Shwe Gone Dine 4th Street, Yangon, Myanmar.National Malaria Control Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28438145

Citation

ACTwatch Group, et al. "Insights Into the Availability and Distribution of Oral Artemisinin Monotherapy in Myanmar: Evidence From a Nationally Representative Outlet Survey." Malaria Journal, vol. 16, no. 1, 2017, p. 170.
ACTwatch Group, Thein ST, Khin HSS, et al. Insights into the availability and distribution of oral artemisinin monotherapy in Myanmar: evidence from a nationally representative outlet survey. Malar J. 2017;16(1):170.
Thein, S. T., Khin, H. S. S., & Thi, A. (2017). Insights into the availability and distribution of oral artemisinin monotherapy in Myanmar: evidence from a nationally representative outlet survey. Malaria Journal, 16(1), 170. https://doi.org/10.1186/s12936-017-1793-0
ACTwatch Group, et al. Insights Into the Availability and Distribution of Oral Artemisinin Monotherapy in Myanmar: Evidence From a Nationally Representative Outlet Survey. Malar J. 2017 04 25;16(1):170. PubMed PMID: 28438145.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insights into the availability and distribution of oral artemisinin monotherapy in Myanmar: evidence from a nationally representative outlet survey. AU - ,, AU - Thein,Si Thu, AU - Khin,Hnin Su Su, AU - Thi,Aung, Y1 - 2017/04/25/ PY - 2016/12/19/received PY - 2017/03/31/accepted PY - 2017/4/26/entrez PY - 2017/4/26/pubmed PY - 2018/1/20/medline SP - 170 EP - 170 JF - Malaria journal JO - Malar J VL - 16 IS - 1 N2 - BACKGROUND: The 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. METHODS: A 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. RESULTS: A 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. CONCLUSIONS: Given 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. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/28438145/Insights_into_the_availability_and_distribution_of_oral_artemisinin_monotherapy_in_Myanmar:_evidence_from_a_nationally_representative_outlet_survey_ L2 - https://malariajournal.biomedcentral.com/articles/10.1186/s12936-017-1793-0 DB - PRIME DP - Unbound Medicine ER -