CONTAINMENT

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AFRIMS Mobile Units Help Detect Malaria

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CONTAINMENT’s Nat Sumon accompanied an Armed Forces Medical Research Institute for Medical Science (AFRIMS) mobile unit to a remote location on the Thailand side of the border to screen soldiers for malaria.

Thai soldiers line up for blood samples to be taken from them by the AFRIMS mobile unit. Pix by WHO/ Nat Sumon

Over the course of history, in times of war, more soldiers have died from malaria than in direct combat. During the Vietnam War (1962–1975), malaria felled more combatants during the war than bullets. The disease reduced the combat strength of some units by half.

Over 40,000 cases of malaria were reported in U.S. Army troops alone between 1965 and 1970 with 78 deaths. The U.S. Army established a malaria drug research program when U.S. troops first encountered drug resistant malaria during the war. In 1967, Chinese scientists set up Project 523 – a secret military project – to help the Vietnamese military defeat malaria by developing artemisinin based anti malarial formulations.

For the Thai army, malaria still remains a threat despite the drastic fall in cases of falciparum malaria – the most fatal form of the mosquito-borne disease. According to 2010 Royal Thai Army statistics, 572 soldiers contracted malaria along the Thai-Cambodian border and constituted one-fourth of overall malaria patients seeking treatment in the area.

Many Thai soldiers used to harsh tropical jungle conditions are well aware of protective measures. If they fall sick, they are instructed to go either to local malaria clinics or local hospitals to have their blood tested on a weekly basis.

Malaria education should be made compulsory. And while the subject may not be exciting to the new recruits, they will come to realize the importance of being armed with malaria knowledge once they start their field trainings.

But due to current military sensitivities in certain areas of the Thai-Cambodian border, mobile malaria clinics and malaria post workers have no access to high-security areas. And soldiers sick with malaria are often unable to leave their posts to seek treatment in the neighboring health facilities in a timely manner as well.

Indeed there is a gap between the early diagnosis and treatment of Thai soldiers posted along the Thailand – Cambodian border. Fortunately, the Armed Forces Research Institute for Medical Science (AFRIMS) addresses this serious problem by sending out mobile units to carry out active malaria case detections among army and border police personnel stationed in areas where civilian public health workers have no access.

AFRIMS was set up as collaboration between the Thai and U.S. governments to combat a widespread cholera outbreak in Bangkok during the late 1950s. Recognizing the importance of this cooperative effort, the two governments agreed to continue joint medical research efforts, which led to the establishment of the SEATO Cholera Research Laboratory. After a series of transformations, the research institute was renamed AFRIMS in 1977. Over the last 50 years AFRIMS has been a benchmark of success in tropical infectious disease research.

Today, AFRIMS has programs in enteric diseases, malaria vaccine and drug research and viral diseases including dengue fever, hepatitis and HIV.

Microscopists in the AFRIMS mobile unit analyzing blood slides to detect positive malaria cases. Pix by WHO/ Nat Sumon

Recently, CONTAINMENT accompanied an AFRIMS’ malaria mobile unit to Srisaket along the Thai-Cambodian border to test and treat Thai soldiers stationed there. The mobile unit collects blood samples, from the soldiers, for blood slides and also records the history of movements of the individual soldier, like which border checkpoints he had been stationed in previous months. If any soldier’s temperature is more than 37.5°C, the mobile unit would carry out a rapid diagnostic test and collect blood samples from the patient. If the RDT is positive for any plasmodium species, malaria treatment commences immediately.

After having collected blood samples from the soldiers, for the day, the AFRIMS mobile team makes their way back to their hotel rooms and to start working on Giemsa-staining the blood slides for viewing under their microscopes. Later that night, they discover a positive case of falciparum malaria and immediately the next morning make their way back to the platoon to seek the patient and start his malaria treatment. More blood is also taken from the patient for the AFRIMS database in research on gametocytogenesis in Plasmodium falciparum  and P. vivax  and the production of different stages of human and animal malaria parasites in order to support drug and vaccine development and transmission blocking strategies.

While the AFRIMS mobile epidemiology unit analyzes the blood slides using microscopy, Colonel Dr. Jariyanart Gaywee, the head of AFRIMS epidemiology division, ensures that army units in remote locations are equipped with anti malarials and RDTs.

Because of limited manpower and resources, the AFRIMS malaria mobile units cannot be in the field along the Thai – Cambodian border as often as they wish in order to help their fellow soldiers. But Col. Dr. Gaywee has found a way forward.

“AFRIMS is piloting a project with the help of the local commanders to train soldiers to carry out early diagnosis and treatment using RDTs for units stationed in extremely remote areas along the Thai-Cambodian border,” she told CONTAINMENT.

AFRIMS is also in charge of educating newly recruited soldiers on the importance of vector control and protecting themselves from malaria. The officer in charge of this task is Colonel Pradith Kaewsatien.

“Malaria education should be made compulsory. And while the subject may not be exciting to the new recruits, they will come to realize the importance of being armed with malaria knowledge once they start their field trainings. Malaria prevention knowledge is essential for jungle survival training for a soldier,” he added.

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Written by malariacontainment

July 21, 2011 at 3:44 pm

One Response

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  1. This is such an interesting blog. While our efforts are not the same as the military’s, I work with a company, Good Days from Chronic Disease Fund, and it is our mission to help chronic disease patients get the medical care they need, at an affordable price. Visit our website to learn how to support our cause http://www.gooddaysfromcdf.org/

    Good Days from CDF

    July 29, 2011 at 8:16 am


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