1. This History Thread is about #malaria in Burma (Myanmar) and the way approaches to preventing, treating or controlling it have evolved. Malaria had long been the most deadly disease in Myanmar but cases and deaths have steeply declined in recent years. 
2. Malaria is a disease spread from human to human by mosquitos infected w. plasmodium parasites. Types endemic to Burma/Myanmar mainly P. falciparum (most fatalities) & P. vivax (relapses.) Affects liver, spleen, red blood cells; causes fever. Possible: anemia, cerebral malaria.
3. Fossil evidence preserved in Burmite (Burma Cretaceous amber) revealed a form of malaria parasite (P. burmacis) in midges 100 million+ yrs old. Modern malaria vectored by female anopheles mosquitos. 1st description: Chinese 2700 BC book Huangdi Neijing. today.oregonstate.edu/archives/2016/…
4. Anopheles mosquitos thrive in wet, tropical climates. Sino-Burmese War 1766-70, Qing dynasty’s northern Manchu bannermen invading Burma were decimated by malaria + dysentery, cholera. Burmese defenders had more immunity to malaria, which brought down invasion commander Fuheng.
5. British suffered malaria but conquered Burma. Missionaries noted variety of “malarious fevers.” Colonial irrigation for rice export appears to have increased malaria (mosquitos breed in stagnant water.) Quinine tablets & town hospitals rather than “rural sanitation” efforts.
6. WW2 in Burma malaria debilitated soldiers. Japanese scientist Omori Nanzaburo studied mosquitos there. US used mepacrine (Atabrine) & bed nets. British deployed East African troops thought to have immunity & used mepacrine + DDT spraying for advantage over Japanese in Arakan.
7. Independent Burma continued DDT spraying. Military dictatorship refused most outside aid incl USAID malaria eradication program. Regime had extremely low healthcare spending, poorly supported rural clinics. War zones, refugees, internal displacement increased malaria exposure.
8. When I crossed Thai/Burma border 1980s, malaria prophylaxis = chloroquine. But chloroquine resistant P. falciparum arose, also needed Fansidar (sulfadoxine-pyrimethamine) though Fansidar resistance there too. P. falciparum also developed resistance to mefloquine (didn’t take.)
9. 1991 Kachinland (Burma/China border) I used doxycycline for malaria prophylaxis. Kachin soldiers successfully treated malaria with Chinese plant-based medicine artemesia, first I heard of it. Artemisinin Combined Therapy (ACT) would become standard treatment for p. falciparum.
10. At Kachin Independence Army GHQ in 1991 I asked Kachin schoolchildren to make drawings on various topics to illustrate report in which I described malaria as “a standard rite of passage” among children “who become infected and fevered year after year.” projectmaje.org/pdf/j_rope.pdf
11. Myanmar early 21st C. malaria continued to be leading cause of illness & death, partic. children, esp. in regions disrupted by conflict & forced relocation. Thailand/Myanmar border Mae Tao Clinic researched malaria & sent backpack medics into war zone. thetyee.ca/Photo/2007/12/…
12. Global Fund to Fight AIDS, TB & Malaria (founded 2002) withdrew Myanmar funding 2005 due to regime’s restrictions. Gap filled by multi-donor Myanmar-specific 3 Diseases Fund (2006-2012.) Global Fund resumed Myanmar grants 2011. Global Fund 2014 video: theglobalfund.org/en/video/2016-…
13. With insecticide-treated bed nets & ACT #malaria illness & death in Myanmar declined drastically in 2010s. But Thai/Myanmar border region still hotspot of resistance to malaria drugs with ACT resistant P. falciparum appearing 2011. Clinics fought back. npr.org/sections/healt…
14. Awareness has grown of counterfeit malaria drugs in SE Asia incl Myanmar. Fake pills not only dangerous for consumers. If they have inadequate amounts of real malaria pharmaceuticals they can actually contribute to drug resistance of malaria parasites. npr.org/sections/healt…
15. Myanmar malaria cases down 85% 2012-19. Elimination goal partners incl foreign aid, NGOs, INGOs, Govt, Ethnic Armed Org.s, private sector. Medical workers’ community based approach w. testing, treatment & prevention (“forest-goer kits” nets, repellent) theguardian.com/global-develop…
16. Malaria hotspots persist in Myanmar, especially along Thailand border where drug resistance is a problem. Also remote areas like Naga region of Sagaing. Malaria threatens displaced people in ongoing war zone in northern Rakhine + southern Chin states. mmtimes.com/news/chin-refu…
17. Other mosquito vector diseases in Myanmar incl. Japanese encephalitis (JE), dengue hemorrhagic fever (DHF) & chikungunya. JE can kill as many as malaria in Myanmar. DHF virus deaths > malaria in Myanmar; as w. chikungunya virus, no specific treatment. frontiermyanmar.net/en/the-disease…
18. Sources incl. “The Fever” Sonia Shah 2010. Amber origins: Poinar 2016. Colonialism: Ritchell 2006, @rohandroy 2017. WW2: LL Williams 1940, M. Harrison 1996, Paltzer 2016. ACT: Smithuis et al 2006. Drug resistance: E. Yong 2014 & CDC '18. Community based: Tangseefa et al ’19.
19/19. Thanks to @himmoderator for reviewing this historical epidemiology thread! My previous History Threads & reports are at projectmaje.org. My recent @newmandala article on Burma/Myanmar epidemics & pandemics is at: newmandala.org/a-plague-of-ep…
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