Tropical climates and seasonal rains make much of the Asia-Near East (ANE) region ideal breeding grounds for mosquitoes carrying Plasmodium—the bloodborne parasite that causes malaria. South-East Asia alone accounts for 30 percent of the global morbidity due to malaria. In addition, the lack of access to and irrational use of medicines and counterfeit and substandard medicines contribute to emergence of antimicrobial resistance (AMR)—a growing concern to international health management partners as drug-resistant strains of the disease spread.

Improving access to and rational use of quality antimalarial medicines is essential for regional malaria and AMR control efforts. The United States Pharmacopeia Drug Quality and Information program (USP/DQI), in cooperation with the U. S. Agency for International Development (USAID), World Health Organization (WHO), and other regional and local authorities, began monitoring the quality of antimalarials in Cambodia, Laos, Thailand, Vietnam, and China’s Yunnan Province. The monitoring effort in Cambodia, for example, revealed that a significant proportion of medicines contained sub-optimal amounts of active ingredient. These results became the basis for RPM Plus work in the region with multidrug-resistant (MDR) malaria and collaborative efforts with international partners to raise awareness about medicine use issues and to assist countries in taking action.

Since 2001, RPM Plus has joined with Mekong regional country partners in an expanded approach to understanding the factors that contribute to MDR malaria, including medicine use and quality. As part of the effort to better recognize household and provider behaviors, RPM Plus provided technical assistance in designing and carrying out medicine use surveys in Cambodia (2002), Thailand (2004), and Laos (2004), which revealed an unregulated private pharmaceutical sector, inappropriate prescribing and dispensing practices, lack of biological diagnosis for malaria, and poor or non-existent provider training.

To address these findings, RPM Plus introduced pharmaceutical management of antimalarials through the Asian Collaborative Training Network for Malaria (ACTMalaria)—a regional consortium of 11 countries dedicated to addressing malaria control. RPM Plus also makes available other primary resources in pharmaceutical management, such as the Artemesinin-based Combination Therapy (ACT) Implementation Guide, to assist countries in implementing drug policy changes.

Through continued collaboration and expansion of its partners’ network, RPM Plus continues to effectively manage antimalarials and contribute to the control of malaria and AMR.

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