Cambodia drug-resistant malaria stirs health fears

Pailin: In a dusty village near the Thai-Cambodia border, 24-year-old Oeur Samoeun sits on a dark green hammock recovering from a strain of malaria that has resisted the most powerful drugs available.

Ravaged by days of fever and chills, he is considered lucky: the parasite has left his body. But for many others, the potentially deadly disease never quite disappears.

His province of Pailin is the epicenter of strains of malaria that have baffled healthcare experts worldwide, raising fears a dangerous new form of malaria could already be spreading across the globe.

"The fear is what we`re observing right now could be the starting point for something worse regionally and globally," said Dr. Charles Delacollette, Mekong Malaria Program Coordinator at the World Health Organization.

A New England Journal of Medicine study last year showed that conventional malaria-fighting treatments derived from artemisinin took almost twice as long to clear the parasites that cause the disease in patients in Pailin and others in northwestern Thailand, suggesting the drugs were losing potency in the area.

That is echoed by US development agency USAID, which says artemisinin-based combination therapy is "now taking two to three times longer to kill malaria parasites along the Thai-Cambodian border than elsewhere." The agency has helped to monitor the situation in the area for years.

The disease transmitted via mosquito bites kills more than 1 million people worldwide each year and children account for about 90 percent of the deaths in the worst affected areas of sub-Saharan Africa and parts of Asia.

The studies shine a spotlight on the remote province of Pailin, a former stronghold of ultra-communist Khmer Rogue rebels and once renown for blood-red rubies and lush forests.

Multiplied and dispersed

Pailin is the origin of three drug-resistant malaria parasites over the past five decades. Thanks to prolonged civil conflict, dense jungles and movement of mass migrants in the gem mines in the 1980s and 90s, the strains multiplied and dispersed through Myanmar, India and two eventually reached Africa.

Few can say why it is a hotbed for drug-resistant malaria but experts point to a combination of sociological factors and a complicated history spanning the Khmer Rouge era when 1.7 million people, nearly a quarter of Cambodia`s population, perished from execution, overwork or torture during their 1975-79 rule.

Driven from the capital, the rebels waged an insurgency from western Cambodia with Pailin one of their last holdouts until their defeat in the late 1990s.

"During the Khmer Rouge era, people came here illegally and when they get malaria, they go to the market, buy pills and self-medicate," Sophal Uth, a Pailin-based field officer for non-profit Malaria Consortium said. "It was difficult for the government to control."

With weak public health infrastructure and rising malaria cases, Cambodia made malaria drugs available over the counter more than a decade ago. Most Cambodians don`t have access to public health services and rely on private medical centers.

The strategy carried risks. Easy access reduced the number of cases but also led to incorrect dosages and substandard or counterfeit medicine, which instead of killing the parasites only make them stronger.

For some like Oeur, a migrant worker who likely caught malaria on a logging trip or while sleeping in his rickety shed without a mosquito net, artemisinin-based medicine still works.

Artemisinin, derived from the sweet wormwood, or Artemisia annual plant, is the best drug available against malaria, especially when used in artemisinin combination therapy (ACT) medicines made by firms such as Swiss drugmaker Novartis AG and France`s Sanofi-Aventis.

Bureau Report

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