RCAF in Africa; Fears of Drug Resistant Malaria

By Denise Hruby | March 1, 2014

The 74 Royal Cambodian Armed Forces (RCAF) soldiers who departed for a U.N. peacekeeping mission to Mali this week were only the latest batch of troops to bring their engineering and demining expertise to Africa.
Such skills, particularly demining abilities, are increasingly valued by the U.N. in post-conflict nations, particularly in Africa.

But, alongside their expertise, Cambodian troops also run the danger of bringing something unwanted to Africa: drug-resistant malaria.
“We assume that if a [soldier] is positive and goes to Africa and carries the Cambodian parasite…it’s a very big challenge,” Dr. Siv Sovannaroth, head of the National Malaria Center’s (CNM) technical office, said this week.
Resistance to artemisinin, the only drug used to treat malaria in Africa, was first found along the Cambodian-Thai border in 2008, and has since been reported in areas of Vietnam, Burma and Laos.
If drug resistance spreads to Africa, it could be a catastrophe, as 85 percent of all the world’s malaria cases occur in sub-Saharan Africa, according to the World Health Organization (WHO).
“If resistance were to spread to—or emerge in—India or sub-Saharan Africa, the public health consequences could be dire, as no alternative antimalarial medicine is available at present with the same level of efficacy and tolerability as ACTs” (artemisinin combination therapy), the WHO said.
In Mali alone, 2,171,739 cases of malaria were reported in 2012. The majority of those people survived after receiving ACTs.
In Cambodia, however, ACTs fail in about 30 percent of malaria cases in Pailin, Battambang, Pursat and Oddar Meanchey provinces, Dr. Sovannaroth said.
“We have switched to use Malarone in those provinces. But one dose of malarone costs $50, and ACTs cost only $1.50 per dose. Malaria also develops quick resistance to Malarone, and in Africa, there are so many cases, you can’t use it,” he said.
To prevent the possibility that a Cambodian soldier introduces artemisinin-resistant malaria to Africa, the Ministry of Defense and the CNM have discussed screening RCAF soldiers for malaria before deploying them on U.N. missions, Dr. Sovannaroth said.
Screening the soldiers, he said, would ensure that asymptomatic cases, which may or may not show artemisinin-resistance, are detected. According to the WHO, asymptomatic infections occur in malaria-endemic areas where persons can develop partial immunity due to the frequency of mosquito bites.
However, according to the Ministry of Defense, none of the total of 309 RCAF soldiers deployed to Mali between February and March have or will be screened for malaria parasites, said Dr. Ly Sokhey, a technical officer with the Ministry of Defense’s health department.
“Until now, we haven’t done this yet because we are still waiting for approval from the Minister [of Defense, General Tea Banh],” he said.
“We created the framework [for testing] a year ago…I don’t know why it hasn’t been approved yet,” Dr. Sokhey said.
Of the hundreds of peacekeepers Cambodia has sent to countries such as Chad, Sudan and Lebanon since participation in U.N. peacekeeping missions started in 2005, none has been screened for malaria, he added.
“We have sent military forces to Africa many times, but none of them were screened for diseases like malaria. We just screen them for hepatitis or TB,” Dr. Sokhey said.
More than 60 years ago, the malaria parasite developed a resistance against the drug called chloroquine, then used around the globe to treat malaria.
Then too, resistance to chloroquine was also found to have originated along the Cambodian-Thai border, from where it quickly spread across the world until the drug had to be deemed useless.
Sonny Krishnan, communications officer at the WHO’s regional office for emergency response to artemisinin resistance, said that so far, the government has not asked the WHO for help in screening soldiers for malaria.
The parasite, he said, uses both mosquitoes and humans as vectors, and could therefore easily cross long distances if carried by humans.
“The scenario is basically that somebody is asymptomatic, so doesn’t show clinical symptoms of malaria. That means they have the parasite in their blood, but very low loads, so you are basically a walking reservoir, and if you travel a long distance, you carry the parasite with you,” Mr. Krishnan said.
Although the WHO created a regional malaria hub in Phnom Penh last year to respond to artemisinin resistance and contain the spread within the region, a single traveler could quickly take a resistant strain across borders, Mr. Krishnan said.
“It is really important to properly screen people if they are traveling, because they could have low levels of the parasite,” Mr. Krishnan said.
The WHO said that it would assist RCAF with screenings if asked for help, but referred questions on health screenings for peacekeepers to the U.N.’s Department of Peacekeeping Operations in the U.S., which did not reply to a request for comment.
The U.N. has already been accused of bringing more than peacekeepers and assistance on its overseas missions.
In October, human rights lawyers in the U.S. filed a complaint against the U.N. for introducing cholera to Haiti, after peacekeepers from Nepal were deployed there to help in the aftermath of a devastating 2010 earthquake.
Of the more than 650,000 people who contracted the disease, 8,300 Haitians died.
The U.N. has claimed it has legal immunity from claims for compensation in Haiti.
(Additional reporting by Saing Soenthrith)

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