The Jakarta Post, 17 Desember 2010
There is the potential for malaria epidemics to break out in the country due to the disease’s increasing resistance to the one effective drug in circulation, scientists warn.Din Syafruddin of Eijkman Institute for Molecular Biology, said Tuesday that malaria’s resistance to drugs was an inevitable result of the improper use of anti-malarial medicines.“We have misused anti-malarial medicines, resulting in a growing anti-malarial drug resistance,” he told The Jakarta Post at a three-day symposium titled “Human Genetics and Infection: Towards Better Management of Disease”, which concluded Wednesday.The symposium was held by Eijkman Institute and the NITD-Eijkman Institute-Hasanuddin University Clinical Research Initiative.He said many people took anti-malarial medicines even though they had not been properly diagnosed with the disease.
“This has caused malarial parasites to become resistant,” he said, adding that such drugs should never be prescribed to anyone who was not confirmed to have the disease.Malaria is a blood disease that is transmitted by the Anopheles mosquito. “Even if they show malarial clinical symptoms such as high fever, we cannot assume that they have malaria,” Din said.The World Health Organization reported that there were 250 million cases of malaria annually, resulting in 880,000 deaths.More than 75 percent of malarial cases occurred in children under five years old.
Research shows that malaria is one of the most dangerous infectious diseases in the world.Stephen Rogerson of the University of Melbourne, Australia, said pregnant women were highly susceptible to malaria.He said pregnant women who contracted malaria would increase the risk of the baby being under-weight. “These newly born babies usually weigh less than 2,500 grams [or about five pounds] only,” he said.Malaria during pregnancy causes 100,000 infant deaths per year, he added.
“If we understand how malaria causes under-weight babies, perhaps we can develop a better preventive strategy,” he said. In Indonesia, about 30 million people contract malaria per year, resulting in 12,000 deaths.“It’s far bigger than all existing infectious diseases. So, malaria is still a big problem in Indonesia,” said Din, adding that most malaria cases in Indonesia occurred in the eastern part of the country.He said a vaccine would be the best prevention against malaria, but no vaccine exists.
“Up until now, we depend on anti-malarial drugs,” he said.Artemisinin, first introduced by the WHO in 2000, is the only effective malarial drug in the world.Din said Artemisinin, which derived from a Chinese traditional medicine called qing hao su, and its derivatives, was the fastest acting of all current anti-malarial drugs.Indonesia has used artemisinin-based anti-malarial drugs since 2004.Artemisinin kills parasites when they are in the blood stream.Consuming artemisinin for three days should kill all parasites in blood stream.
Quinine tablets, common in the past, are now ineffective, he said.“[Quinine] is a kind of chloroquine medicine. Malarial parasites are resistant to chloroquine. So, consuming a resistant drug is not useful at all,” Din said.However, quinine tablets are still prescribed to pregnant women in the first few months of pregnancy, because it is safer than artemisinin.The use of artemisinin alone to cure malaria may have fostered the parasite’s resistance to it, Din said. “About a year ago, a Thai newspaper wrote that artemisinin drug resistance had been found on the border areas of Myanmar and Cambodia, but artemisinin is the only effective anti-malarial drug in the world.”
Since the Cambodia case was revealed, WHO has warned that all malarial endemic areas including Indonesia should be more careful in using the drug due to the increasing number of signs that malarial parasites are becoming more resistant to it.Emiliana Tjitra of National Institute of Health Research and Development said a therapy that combined artemisinin with other drugs, called artemisinin combination therapy, would be more effective to cure malaria than using artemisinin only. “A combined therapy that includes artemisinin will also slower resistance to anti-malarial drugs, because we are using two kinds of medicine,” she told the Post. (ebf)