This Drug-Resistant Malaria Parasite is Spreading - Where is it Now?
A strain of drug-resistant malaria that was discovered last summer along the Thailand-Cambodia border has been spreading throughout Southeast Asia, to Laos, Vietnam, Cambodia and Myanmar.
A spread into India “would pose a serious threat to the global control and eradication of malaria,” said a statement that accompanied a study published in The Lancet Infectious Diseases.
“If drug resistance spreads from Asia to the African sub-continent, or emerges in Africa independently as we've seen several times before, millions of lives will be at risk.”
The senior author of the study, Charles Woodrow of the Mahidol-Oxford Tropical Medicine Research Unit in Bangkok, said researchers had confirmed the presence of resistant parasites at Homalin, Sagaing Region, just 25 kilometers from India.
“To see the levels of resistant parasites that we do extending that far sort of north [in Myanmar] and close to the border was, to some degree, a surprise,” Woodrow said.
“We don't know exactly how fast things are moving," he added. "Our study is a snapshot, really, as to the current situation. It's reasonable to say that, yes, we should be worried about movement of people and parasites over relatively short distances and that being a process which would lead for this process to spread further.”
Researchers fear the parasites will follow the trajectory of previous drug-resistant strains that eventually migrated all the way to Africa, ruining the current opportunity to eradicate malaria.
Since the Plasmodium parasite developed resistance to other drug types, artemisinin is the best and safest medicine to treat the estimated 198 million malaria infections that occurred worldwide in 2013.
There were about 584,000 deaths, according to the UN's World Health Organization (WHO) – 90 percent of them in Africa.
Artemisinin resistance has not yet been detected in Africa, but is a growing problem in southeast Asian nations like Cambodia, Thailand and Vietnam, and is suspected, though not proven, to have taken hold in South America.
Myanmar, which carries the region's highest malaria burden, is considered the parasite's main route from southeast Asia to India and beyond.
For the study, researchers collected samples from patients at 55 treatment centers across Myanmar and border regions of Thailand and Bangladesh in 2013 and 2014, and examined them for telltale mutations in the K13 or "kelch" gene.
Thirty-nine percent of 940 malaria samples carried a mutation, they found.
"This study highlights that the pace at which artemisinin resistance is spreading or emerging is alarming," said study co-author Philippe Guerin, director of the Worldwide Antimalarial Resistance Network.
"We need a more vigorous international effort to address this issue in border regions."
The malaria parasite is transmitted via the bites of infected mosquitoes.
It multiplies in the human liver and infects red blood cells, and can be deadly if untreated.
"The new research shows that history is repeating itself with parasites resistant to artemisinin drugs, the mainstay of modern malaria treatment, now widespread in Myanmar," said Mike Turner of the Wellcome Trust which co-funded the study.
"We are facing the imminent threat of resistance spreading into India, with thousands of lives at risk."
The team stressed there was no evidence that artemisinin resistance has indeed reached India, "however, few data are available".
The WHO has recommended artemisinin-only treatments be withdrawn from the market in favor of combination therapies to protect against the spread of resistance, but they remain available in many countries.
COVID-19 "causing mass trauma among world’s nurses"
Healthcare providers are facing ongoing nursing shortages, and hospitals are reporting high rates of staff turnover and burnout as a result of the COVID-19 pandemic. In June a report found that levels of burnout among staff in England had reached "emergency" levels.
Registered nurses Molly Rindt and Erika Haywood are nurse mentors on US recruitment platform Incredible Health. In this joint Q&A they tell Healthcare Global about their own experiences of burnout and what can be done to tackle it.
What does it mean to be suffering from burnout?
Some of the most common reasons for nurse burnout include long work hours, sleep deprivation, a high-stress work environment, lack of support, and emotional strain from patient care.
While every profession has its stressors, the nursing industry has some of the highest burnout rates. The massive influence on patients’ lives, the long hours, and many other factors put nurses at risk of severe burnout. And with the rise of COVID-19, many healthcare professionals feel the strain more than ever.
Burnout in nurses affects everyone — individual nurses suffer, patients are impacted, and employers struggle with enormous turnover. This is why it’s crucial for healthcare systems and management to watch for signs of nurse burnout and take steps to provide a healthier workplace. Employers should be careful to watch for burnout symptoms in their healthcare staff — and not ignore them.
Symptoms include constant tiredness, constant anxiety related to work, emotional detachment and unexplained sickness.
How widespread is this problem?
Unfortunately, burnout affects approximately 38% of nurses per year and even the WHO recently labelled burnout as an official medical diagnosis. To put this statistic into perspective, nearly 4 out of 10 nurses will drive to work dreading their shift. Burnout is a reason nurses leave their positions.
Other top reasons for leaving included a stressful work environment, lack of good management or leadership, inadequate staffing, and finding better pay or benefits elsewhere.
Even before the pandemic, demanding workloads and aspects of the work environment such as poor staffing ratios, lack of communication between physicians and nurses, and lack of organisational leadership were known to be associated with burnout in nurses.
Have either of you experienced burnout?
Rindt: I have experienced burnout as an RN. I was constantly fatigued, never felt like I was off work, and would frequently dream I was still at work taking care of patients. In my particular situation, I needed to take a step back and restructure my work schedule to allow for more time off. After doing this, I was able to reduce burnout by deciding to work two shifts back-to-back and then have 2-3 days off.
Haywood: I definitely experienced constant anxiety related to work - so much so it would impact the days I wasn’t at work. At one point, I was even on medication to help combat the anxiety and stress I was facing on the job.
I had heart palpitations, chest pain, and wouldn’t be able to sleep before working the next day, which slowly started to impact other aspects of my life. I knew I couldn’t continue to live this way, it wasn’t sustainable. Because of this, I began to focus on my needs and prioritising self-care, especially during the beginning of the pandemic. Putting my needs first and not feeling guilty were necessary for me to overcome burnout.
What impact is COVID-19 having on nurses' wellbeing?
Some nurses have suffered devastating health consequences. Many nurses have dealt with excessive on-the-job stress, fears of becoming infected, and grief over seeing patients succumb to COVID-19 while isolated from their families.
New evidence gathered by the International Council of Nurses (ICN) suggests COVID-19 is causing mass trauma among the world’s nurses. The number of confirmed nurse deaths now exceeds 2,200, and with high levels of infections in the nursing workforce continuing, overstretched staff are experiencing increasing psychological distress in the face of ever-increasing workloads, continued abuse and protests by anti-vaccinators.
However, other small silver linings that came from the pandemic include increased professional autonomy, leadership opportunities and career growth potential.
How much of the cause of burnout is due to the hospitals or healthcare providers, and what can they do to address it?
Nurse fatigue poses serious problems for healthcare organisations, and a recent survey from Kronos found 63% of nurses say their job has caused burnout. The survey also found that more than 4 out of 5 nurses think hospitals today are losing good staff because other employers offer a better work/life balance.
Nurse burnout not only contributes to staff turnover, but it can impact the facility’s quality of care, patient satisfaction, and even medical outcomes.
Strategies to address burnout include training improving nurse-to-patient ratios, include nurses in policy discussions, and prioritise fostering a healthy work culture in hospitals.
What does your role mentoring nurses on the Incredible Health platform involve?
Rindt: My role can vary based on the needs of the nurses. The nurses love knowing they have someone in their corner who can give interview preparation advice or provide suggestions on how to improve their resume. Knowing that there is someone who is well-versed in the job process and can help set expectations on what to anticipate, really helps to remove a layer of uncertainty.
Haywood: When screening nurses, it is customised to what their individual RN or nurse practitioner needs, and at a time that is most convenient for them. Nurses are busy and often aren’t thought of first. Being able to provide support from the very beginning of their career advancement journey helps tremendously. We also provide resources such as resume templates and tips that can help nurses be successful and feel supported.