Drug-Resistant Malaria

Mekong Regional Initiative

The ecology of malaria transmission and issues for control in Southeast Asia differ markedly from Africa. In Southeast Asia, particularly what is defined as the Greater Mekong sub region (Burma, Thailand, Laos, Cambodia, Vietnam, and Yunnan Province, China), the malaria mosquito vectors are largely confined to forested regions along the border areas. In addition to the indigenous communities living in these border areas, there is often a significant migrant population, both domestic (e.g., Cambodians moving to the western forests from the nonmalarious central part of the country) and international (e.g., Burmese workers moving from western Cambodia, to northeastern Burma, to southwest Thailand). To address this transborder regional problem, the USAID Regional Development Mission for Asia, based in Bangkok, Thailand, supports the regional Mekong Regional Initiative.

Components range from financial and technical support to coordination through the World Health Organization (WHO) Mekong Malaria Program, drug procurement resistance, and drug quality monitoring, diagnostics and laboratory quality improvement, monitoring and evaluation, community-based initiatives (particularly in Western Cambodia), and capacity building for a range of technical and management skills through the Asian Collaborative Training Network for Malaria.

Amazon Malaria Initiative

The 1990s witnessed a steady increase in malaria among the countries of the Amazon Basin region of South America, including the spread and intensification of resistance to the two antimalarial drugs used as first-line therapy for malaria (chloroquine and sulfadoxine-pyrimethamine) in most countries of the region. To address this issue, the USAID Latin America and Caribbean Bureau, Office of Regional Sustainable Development developed and launched the Amazon Malaria Initiative (AMI) in 2001. The AMI includes eight target countries: Bolivia, Brazil, Colombia, Ecuador, Venezuela, Guyana, Peru, and Suriname. By directing resources using a common conceptual framework to select and coordinate activities in priority countries, the Initiative intends to improve malaria control at the subregional level and contribute to decreased morbidity and mortality at the national level. This Initiative complements ongoing USAID Mission bilateral programs as well as efforts coordinated by the Pan American Health Organization (PAHO) to deal with the problem of antimalarial drug resistance in the region.

The AMI works through PHO to assist national malaria control programs in the region to strengthen their monitoring of antimalarial drug resistance, adopt new malaria treatment policies, and monitor implementation of those new policies. Other partners involved in the Initiative are the U.S. Centers for Disease Control and Prevention (CDC), the Strengthening Pharmaceutical Management project, and the U.S. Pharmacopeia Drug Quality and Information. As a result of the technical support provided through AMI between 2001 and 2005, South America became the first region in the world to adopt artemisinin-based combination therapies in all countries, as was recommended by the WHO. AMI has now expanded its activities to include monitoring insecticide resistance and strengthening vector control capabilities, improving the quality of malaria laboratory diagnosis, and strengthening malaria surveillance systems in the region.