This article is part of a series on Health care in Burma, edited by Dr. Chris Beyrer.

Research

Prevalence of plasmodium falciparum in active conflict areas of eastern Burma: a summary of cross-sectional data

Adam K Richards^1,2 , Linda Smith^2,3 , Luke C Mullany^4,2 , Catherine I Lee^2,3 , Emily Whichard^2,3 , Kristin Banek^5,6,2 , Mahn Mahn⁷ , Eh Kalu Shwe Oo⁸ and Thomas J Lee^9,2

¹Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 305 East 161^st Street, Bronx, USA 10451

²Global Health Access Program, Mae Sot, Thailand

³Planet Care/Global Health Access Program, 801 Cedar Street Suite 200, Berkeley, CA, USA 94710

⁴Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, USA 21205

⁵The MENTOR Initiative-Liberia, Monrovia, Liberia

⁶15806 East Saratoga Place Aurora, CO 80015 USA

⁷Backpack Health Worker Team, 659, Moo 1 – Thasailuad, Mae Sot, Tak, Thailand, 63110

⁸Karen Department of Health and Welfare, No. 663 Moo 1 – Thasailuad, Asia High Way, Mae Sot, Tak, Thailand 63110

⁹Department of Medicine, University of California at Los Angeles, 924 Westwood Blvd. Suite 300, Los Angeles, CA, USA 90024

author email corresponding author email

Conflict and Health 2007, 1:9doi:10.1186/1752-1505-1-9

Published:	5 September 2007

Abstract

Background

Burma records the highest number of malaria deaths in southeast Asia and may represent a reservoir of infection for its neighbors, but the burden of disease and magnitude of transmission among border populations of Burma remains unknown.

Methods

Plasmodium falciparum (Pf) parasitemia was detected using a HRP-II antigen based rapid test (Paracheck-Pf^®). Pf prevalence was estimated from screenings conducted in 49 villages participating in a malaria control program, and four retrospective mortality cluster surveys encompassing a sampling frame of more than 220,000. Crude odds ratios were calculated to evaluate Pf prevalence by age, sex, and dry vs. rainy season.

Results

9,796 rapid tests were performed among 28,410 villagers in malaria program areas through four years (2003: 8.4%, 95% CI: 8.3 – 8.6; 2004: 7.1%, 95% CI: 6.9 – 7.3; 2005:10.5%, 95% CI: 9.3 – 11.8 and 2006: 9.3%, 95% CI: 8.2 – 10.6). Children under 5 (OR = 1.99; 95% CI: 1.93 – 2.06) and those 5 to 14 years (OR = 2.24, 95% CI: 2.18 – 2.29) were more likely to be positive than adults. Prevalence was slightly higher among females (OR = 1.04, 95% CI: 1.02 – 1.06) and in the rainy season (OR = 1.48, 95% CI: 1.16 – 1.88). Among 5,538 rapid tests conducted in four cluster surveys, 10.2% were positive (range 6.3%, 95% CI: 3.9 – 8.8; to 12.4%, 95% CI: 9.4 – 15.4).

Conclusion

Prevalence of plasmodium falciparum in conflict areas of eastern Burma is higher than rates reported among populations in neighboring Thailand, particularly among children. This population serves as a large reservoir of infection that contributes to a high disease burden within Burma and likely constitutes a source of infection for neighboring regions.