Anti-malarial landscape in Myanmar: Results from a nationally representative survey among community health workers and the private sector outlets in 2015/2016

Louis Akulayi, Angela Alum, Andrew Andrada, Julie Archer, Ekundayo D. Arogundade, Erick Auko, Abdul R. Badru, Katie Bates, Paul Bouanchaud, Meghan Bruce, Peter Buyungo, Angela Camilleri, Emily D Carter, Steven Chapman, Nikki Charman, Desmond Chavasse, Robyn Cyr, Kevin Duff, Gylsain Guedegbe, Keith EschIllah Evance, Anna Fulton, Hellen Gataaka, Tarryn Haslam, Emily Harris, Christine Hong, Catharine Hurley, Whitney Isenhower, Enid Kaabunga, Baraka D. Kaaya, Esther Kabui, Beth Kangwana, Lason Kapata, Henry Kaula, Gloria Kigo, Irene Kyomuhangi, Aliza Lailari, Sandra Lefevre, Megan Littrell, Greta Martin, Daniel Michael, Erik Monroe, Godefroid Mpanya, Felton Mpasela, Felix Mulama, Anne Musuva, Julius Ngigi, Edward Ngoma, Marjorie Norman, Bernard Nyauchi, Kathryn A. O'Connell, Carolyne Ochieng, Edna Ogada, Linda Ongwenyi, Ricki Orford, Saysana Phanalasy, Stephen Poyer, Justin Rahariniaina, Jacky Raharinjatovo, Lanto Razafindralambo, Solofo Razakamiadana, Christina Riley, John Rodgers, Andria Rusk, Tanya Sensalire, Simon Rusk, Julianna Smith, Phok Sochea, Tsione Solomon, Raymond Sudoi, Martine Esther Tassiba, Katherine Thanel, Rachel Thompson, Mitsuru Toda, Chinazo Toda, Cynthia Ujuju, Marie Alix Valensi, Vamsi Vasireddy, Cynthia Whitman, Cyprien Zinsou, Si Thu Thein, Hnin Su Su Khin, Aung Thi

Research output: Contribution to journalArticle

Abstract

Background: In 2015/2016, an ACTwatch outlet survey was implemented to assess the anti-malarial and malaria testing landscape in Myanmar across four domains (Eastern, Central, Coastal, Western regions). Indicators provide an important benchmark to guide Myanmar's new National Strategic Plan to eliminate malaria by 2030. Methods: This was a cross-sectional survey, which employed stratified cluster-random sampling across four regions in Myanmar. A census of community health workers (CHWs) and private outlets with potential to distribute malaria testing and/or treatment was conducted. An audit was completed for all anti-malarials, malaria rapid diagnostic tests. Results: A total of 28,664 outlets were approached and 4416 met the screening criteria. The anti-malarial market composition comprised CHWs (41.5%), general retailers (27.9%), itinerant drug vendors (11.8%), pharmacies (10.9%), and private for-profit facilities (7.9%). Availability of different anti-malarials and diagnostic testing among anti-malarial-stocking CHWs was as follows: artemisinin-based combination therapy (ACT) (81.3%), chloroquine (67.0%), confirmatory malaria test (77.7%). Less than half of the anti-malarial-stocking private sector had first-line treatment in stock: ACT (41.7%) chloroquine (41.8%), and malaria diagnostic testing was rare (15.4%). Oral artemisinin monotherapy (AMT) was available in 27.7% of private sector outlets (Western, 54.1%; Central, 31.4%; Eastern; 25.0%, Coastal; 15.4%). The private-sector anti-malarial market share comprised ACT (44.0%), chloroquine (26.6%), and oral AMT (19.6%). Among CHW the market share was ACT (71.6%), chloroquine (22.3%); oral AMT (3.8%). More than half of CHWs could correctly state the national first-line treatment for uncomplicated falciparum and vivax malaria (59.2 and 56.9%, respectively) compared to the private sector (15.8 and 13.2%, respectively). Indicators on support and engagement were as follows for CHWs: reportedly received training on malaria diagnosis (60.7%) or national malaria treatment guidelines (59.6%), received a supervisory or regulatory visit within 12 months (39.1%), kept records on number of patients tested or treated for malaria (77.3%). These indicators were less than 20% across the private sector. Conclusion: CHWs have a strong foundation for achieving malaria goals and their scale-up is merited, however gaps in malaria commodities and supplies must be addressed. Intensified private sector strategies are urgently needed and must be scaled up to improve access and coverage of first-line treatments and malaria diagnosis, and remove oral AMT from the market place. Future policies and interventions on malaria control and elimination in Myanmar should take these findings into consideration across all phases of implementation.

Original languageEnglish (US)
Article number129
JournalMalaria Journal
Volume16
Issue number1
DOIs
StatePublished - Apr 25 2017
Externally publishedYes

Fingerprint

Myanmar
Private Sector
Antimalarials
Malaria
Chloroquine
Therapeutics
Surveys and Questionnaires
Vivax Malaria
Benchmarking
Oral Diagnosis
artemisinine
Falciparum Malaria
Pharmacies
Censuses
Routine Diagnostic Tests

Keywords

  • Anti-malarial
  • Artemisinin combination therapy
  • Chloroquine
  • Malaria testing
  • Oral artemisinin monotherapy

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases

Cite this

Anti-malarial landscape in Myanmar : Results from a nationally representative survey among community health workers and the private sector outlets in 2015/2016. / Akulayi, Louis; Alum, Angela; Andrada, Andrew; Archer, Julie; Arogundade, Ekundayo D.; Auko, Erick; Badru, Abdul R.; Bates, Katie; Bouanchaud, Paul; Bruce, Meghan; Buyungo, Peter; Camilleri, Angela; Carter, Emily D; Chapman, Steven; Charman, Nikki; Chavasse, Desmond; Cyr, Robyn; Duff, Kevin; Guedegbe, Gylsain; Esch, Keith; Evance, Illah; Fulton, Anna; Gataaka, Hellen; Haslam, Tarryn; Harris, Emily; Hong, Christine; Hurley, Catharine; Isenhower, Whitney; Kaabunga, Enid; Kaaya, Baraka D.; Kabui, Esther; Kangwana, Beth; Kapata, Lason; Kaula, Henry; Kigo, Gloria; Kyomuhangi, Irene; Lailari, Aliza; Lefevre, Sandra; Littrell, Megan; Martin, Greta; Michael, Daniel; Monroe, Erik; Mpanya, Godefroid; Mpasela, Felton; Mulama, Felix; Musuva, Anne; Ngigi, Julius; Ngoma, Edward; Norman, Marjorie; Nyauchi, Bernard; O'Connell, Kathryn A.; Ochieng, Carolyne; Ogada, Edna; Ongwenyi, Linda; Orford, Ricki; Phanalasy, Saysana; Poyer, Stephen; Rahariniaina, Justin; Raharinjatovo, Jacky; Razafindralambo, Lanto; Razakamiadana, Solofo; Riley, Christina; Rodgers, John; Rusk, Andria; Sensalire, Tanya; Rusk, Simon; Smith, Julianna; Sochea, Phok; Solomon, Tsione; Sudoi, Raymond; Tassiba, Martine Esther; Thanel, Katherine; Thompson, Rachel; Toda, Mitsuru; Toda, Chinazo; Ujuju, Cynthia; Valensi, Marie Alix; Vasireddy, Vamsi; Whitman, Cynthia; Zinsou, Cyprien; Thein, Si Thu; Khin, Hnin Su Su; Thi, Aung.

In: Malaria Journal, Vol. 16, No. 1, 129, 25.04.2017.

Research output: Contribution to journalArticle

Akulayi, L, Alum, A, Andrada, A, Archer, J, Arogundade, ED, Auko, E, Badru, AR, Bates, K, Bouanchaud, P, Bruce, M, Buyungo, P, Camilleri, A, Carter, ED, Chapman, S, Charman, N, Chavasse, D, Cyr, R, Duff, K, Guedegbe, G, Esch, K, Evance, I, Fulton, A, Gataaka, H, Haslam, T, Harris, E, Hong, C, Hurley, C, Isenhower, W, Kaabunga, E, Kaaya, BD, Kabui, E, Kangwana, B, Kapata, L, Kaula, H, Kigo, G, Kyomuhangi, I, Lailari, A, Lefevre, S, Littrell, M, Martin, G, Michael, D, Monroe, E, Mpanya, G, Mpasela, F, Mulama, F, Musuva, A, Ngigi, J, Ngoma, E, Norman, M, Nyauchi, B, O'Connell, KA, Ochieng, C, Ogada, E, Ongwenyi, L, Orford, R, Phanalasy, S, Poyer, S, Rahariniaina, J, Raharinjatovo, J, Razafindralambo, L, Razakamiadana, S, Riley, C, Rodgers, J, Rusk, A, Sensalire, T, Rusk, S, Smith, J, Sochea, P, Solomon, T, Sudoi, R, Tassiba, ME, Thanel, K, Thompson, R, Toda, M, Toda, C, Ujuju, C, Valensi, MA, Vasireddy, V, Whitman, C, Zinsou, C, Thein, ST, Khin, HSS & Thi, A 2017, 'Anti-malarial landscape in Myanmar: Results from a nationally representative survey among community health workers and the private sector outlets in 2015/2016', Malaria Journal, vol. 16, no. 1, 129. https://doi.org/10.1186/s12936-017-1761-8
Akulayi, Louis ; Alum, Angela ; Andrada, Andrew ; Archer, Julie ; Arogundade, Ekundayo D. ; Auko, Erick ; Badru, Abdul R. ; Bates, Katie ; Bouanchaud, Paul ; Bruce, Meghan ; Buyungo, Peter ; Camilleri, Angela ; Carter, Emily D ; Chapman, Steven ; Charman, Nikki ; Chavasse, Desmond ; Cyr, Robyn ; Duff, Kevin ; Guedegbe, Gylsain ; Esch, Keith ; Evance, Illah ; Fulton, Anna ; Gataaka, Hellen ; Haslam, Tarryn ; Harris, Emily ; Hong, Christine ; Hurley, Catharine ; Isenhower, Whitney ; Kaabunga, Enid ; Kaaya, Baraka D. ; Kabui, Esther ; Kangwana, Beth ; Kapata, Lason ; Kaula, Henry ; Kigo, Gloria ; Kyomuhangi, Irene ; Lailari, Aliza ; Lefevre, Sandra ; Littrell, Megan ; Martin, Greta ; Michael, Daniel ; Monroe, Erik ; Mpanya, Godefroid ; Mpasela, Felton ; Mulama, Felix ; Musuva, Anne ; Ngigi, Julius ; Ngoma, Edward ; Norman, Marjorie ; Nyauchi, Bernard ; O'Connell, Kathryn A. ; Ochieng, Carolyne ; Ogada, Edna ; Ongwenyi, Linda ; Orford, Ricki ; Phanalasy, Saysana ; Poyer, Stephen ; Rahariniaina, Justin ; Raharinjatovo, Jacky ; Razafindralambo, Lanto ; Razakamiadana, Solofo ; Riley, Christina ; Rodgers, John ; Rusk, Andria ; Sensalire, Tanya ; Rusk, Simon ; Smith, Julianna ; Sochea, Phok ; Solomon, Tsione ; Sudoi, Raymond ; Tassiba, Martine Esther ; Thanel, Katherine ; Thompson, Rachel ; Toda, Mitsuru ; Toda, Chinazo ; Ujuju, Cynthia ; Valensi, Marie Alix ; Vasireddy, Vamsi ; Whitman, Cynthia ; Zinsou, Cyprien ; Thein, Si Thu ; Khin, Hnin Su Su ; Thi, Aung. / Anti-malarial landscape in Myanmar : Results from a nationally representative survey among community health workers and the private sector outlets in 2015/2016. In: Malaria Journal. 2017 ; Vol. 16, No. 1.
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abstract = "Background: In 2015/2016, an ACTwatch outlet survey was implemented to assess the anti-malarial and malaria testing landscape in Myanmar across four domains (Eastern, Central, Coastal, Western regions). Indicators provide an important benchmark to guide Myanmar's new National Strategic Plan to eliminate malaria by 2030. Methods: This was a cross-sectional survey, which employed stratified cluster-random sampling across four regions in Myanmar. A census of community health workers (CHWs) and private outlets with potential to distribute malaria testing and/or treatment was conducted. An audit was completed for all anti-malarials, malaria rapid diagnostic tests. Results: A total of 28,664 outlets were approached and 4416 met the screening criteria. The anti-malarial market composition comprised CHWs (41.5{\%}), general retailers (27.9{\%}), itinerant drug vendors (11.8{\%}), pharmacies (10.9{\%}), and private for-profit facilities (7.9{\%}). Availability of different anti-malarials and diagnostic testing among anti-malarial-stocking CHWs was as follows: artemisinin-based combination therapy (ACT) (81.3{\%}), chloroquine (67.0{\%}), confirmatory malaria test (77.7{\%}). Less than half of the anti-malarial-stocking private sector had first-line treatment in stock: ACT (41.7{\%}) chloroquine (41.8{\%}), and malaria diagnostic testing was rare (15.4{\%}). Oral artemisinin monotherapy (AMT) was available in 27.7{\%} of private sector outlets (Western, 54.1{\%}; Central, 31.4{\%}; Eastern; 25.0{\%}, Coastal; 15.4{\%}). The private-sector anti-malarial market share comprised ACT (44.0{\%}), chloroquine (26.6{\%}), and oral AMT (19.6{\%}). Among CHW the market share was ACT (71.6{\%}), chloroquine (22.3{\%}); oral AMT (3.8{\%}). More than half of CHWs could correctly state the national first-line treatment for uncomplicated falciparum and vivax malaria (59.2 and 56.9{\%}, respectively) compared to the private sector (15.8 and 13.2{\%}, respectively). Indicators on support and engagement were as follows for CHWs: reportedly received training on malaria diagnosis (60.7{\%}) or national malaria treatment guidelines (59.6{\%}), received a supervisory or regulatory visit within 12 months (39.1{\%}), kept records on number of patients tested or treated for malaria (77.3{\%}). These indicators were less than 20{\%} across the private sector. Conclusion: CHWs have a strong foundation for achieving malaria goals and their scale-up is merited, however gaps in malaria commodities and supplies must be addressed. Intensified private sector strategies are urgently needed and must be scaled up to improve access and coverage of first-line treatments and malaria diagnosis, and remove oral AMT from the market place. Future policies and interventions on malaria control and elimination in Myanmar should take these findings into consideration across all phases of implementation.",
keywords = "Anti-malarial, Artemisinin combination therapy, Chloroquine, Malaria testing, Oral artemisinin monotherapy",
author = "Louis Akulayi and Angela Alum and Andrew Andrada and Julie Archer and Arogundade, {Ekundayo D.} and Erick Auko and Badru, {Abdul R.} and Katie Bates and Paul Bouanchaud and Meghan Bruce and Peter Buyungo and Angela Camilleri and Carter, {Emily D} and Steven Chapman and Nikki Charman and Desmond Chavasse and Robyn Cyr and Kevin Duff and Gylsain Guedegbe and Keith Esch and Illah Evance and Anna Fulton and Hellen Gataaka and Tarryn Haslam and Emily Harris and Christine Hong and Catharine Hurley and Whitney Isenhower and Enid Kaabunga and Kaaya, {Baraka D.} and Esther Kabui and Beth Kangwana and Lason Kapata and Henry Kaula and Gloria Kigo and Irene Kyomuhangi and Aliza Lailari and Sandra Lefevre and Megan Littrell and Greta Martin and Daniel Michael and Erik Monroe and Godefroid Mpanya and Felton Mpasela and Felix Mulama and Anne Musuva and Julius Ngigi and Edward Ngoma and Marjorie Norman and Bernard Nyauchi and O'Connell, {Kathryn A.} and Carolyne Ochieng and Edna Ogada and Linda Ongwenyi and Ricki Orford and Saysana Phanalasy and Stephen Poyer and Justin Rahariniaina and Jacky Raharinjatovo and Lanto Razafindralambo and Solofo Razakamiadana and Christina Riley and John Rodgers and Andria Rusk and Tanya Sensalire and Simon Rusk and Julianna Smith and Phok Sochea and Tsione Solomon and Raymond Sudoi and Tassiba, {Martine Esther} and Katherine Thanel and Rachel Thompson and Mitsuru Toda and Chinazo Toda and Cynthia Ujuju and Valensi, {Marie Alix} and Vamsi Vasireddy and Cynthia Whitman and Cyprien Zinsou and Thein, {Si Thu} and Khin, {Hnin Su Su} and Aung Thi",
year = "2017",
month = "4",
day = "25",
doi = "10.1186/s12936-017-1761-8",
language = "English (US)",
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issn = "1475-2875",
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TY - JOUR

T1 - Anti-malarial landscape in Myanmar

T2 - Results from a nationally representative survey among community health workers and the private sector outlets in 2015/2016

AU - Akulayi, Louis

AU - Alum, Angela

AU - Andrada, Andrew

AU - Archer, Julie

AU - Arogundade, Ekundayo D.

AU - Auko, Erick

AU - Badru, Abdul R.

AU - Bates, Katie

AU - Bouanchaud, Paul

AU - Bruce, Meghan

AU - Buyungo, Peter

AU - Camilleri, Angela

AU - Carter, Emily D

AU - Chapman, Steven

AU - Charman, Nikki

AU - Chavasse, Desmond

AU - Cyr, Robyn

AU - Duff, Kevin

AU - Guedegbe, Gylsain

AU - Esch, Keith

AU - Evance, Illah

AU - Fulton, Anna

AU - Gataaka, Hellen

AU - Haslam, Tarryn

AU - Harris, Emily

AU - Hong, Christine

AU - Hurley, Catharine

AU - Isenhower, Whitney

AU - Kaabunga, Enid

AU - Kaaya, Baraka D.

AU - Kabui, Esther

AU - Kangwana, Beth

AU - Kapata, Lason

AU - Kaula, Henry

AU - Kigo, Gloria

AU - Kyomuhangi, Irene

AU - Lailari, Aliza

AU - Lefevre, Sandra

AU - Littrell, Megan

AU - Martin, Greta

AU - Michael, Daniel

AU - Monroe, Erik

AU - Mpanya, Godefroid

AU - Mpasela, Felton

AU - Mulama, Felix

AU - Musuva, Anne

AU - Ngigi, Julius

AU - Ngoma, Edward

AU - Norman, Marjorie

AU - Nyauchi, Bernard

AU - O'Connell, Kathryn A.

AU - Ochieng, Carolyne

AU - Ogada, Edna

AU - Ongwenyi, Linda

AU - Orford, Ricki

AU - Phanalasy, Saysana

AU - Poyer, Stephen

AU - Rahariniaina, Justin

AU - Raharinjatovo, Jacky

AU - Razafindralambo, Lanto

AU - Razakamiadana, Solofo

AU - Riley, Christina

AU - Rodgers, John

AU - Rusk, Andria

AU - Sensalire, Tanya

AU - Rusk, Simon

AU - Smith, Julianna

AU - Sochea, Phok

AU - Solomon, Tsione

AU - Sudoi, Raymond

AU - Tassiba, Martine Esther

AU - Thanel, Katherine

AU - Thompson, Rachel

AU - Toda, Mitsuru

AU - Toda, Chinazo

AU - Ujuju, Cynthia

AU - Valensi, Marie Alix

AU - Vasireddy, Vamsi

AU - Whitman, Cynthia

AU - Zinsou, Cyprien

AU - Thein, Si Thu

AU - Khin, Hnin Su Su

AU - Thi, Aung

PY - 2017/4/25

Y1 - 2017/4/25

N2 - Background: In 2015/2016, an ACTwatch outlet survey was implemented to assess the anti-malarial and malaria testing landscape in Myanmar across four domains (Eastern, Central, Coastal, Western regions). Indicators provide an important benchmark to guide Myanmar's new National Strategic Plan to eliminate malaria by 2030. Methods: This was a cross-sectional survey, which employed stratified cluster-random sampling across four regions in Myanmar. A census of community health workers (CHWs) and private outlets with potential to distribute malaria testing and/or treatment was conducted. An audit was completed for all anti-malarials, malaria rapid diagnostic tests. Results: A total of 28,664 outlets were approached and 4416 met the screening criteria. The anti-malarial market composition comprised CHWs (41.5%), general retailers (27.9%), itinerant drug vendors (11.8%), pharmacies (10.9%), and private for-profit facilities (7.9%). Availability of different anti-malarials and diagnostic testing among anti-malarial-stocking CHWs was as follows: artemisinin-based combination therapy (ACT) (81.3%), chloroquine (67.0%), confirmatory malaria test (77.7%). Less than half of the anti-malarial-stocking private sector had first-line treatment in stock: ACT (41.7%) chloroquine (41.8%), and malaria diagnostic testing was rare (15.4%). Oral artemisinin monotherapy (AMT) was available in 27.7% of private sector outlets (Western, 54.1%; Central, 31.4%; Eastern; 25.0%, Coastal; 15.4%). The private-sector anti-malarial market share comprised ACT (44.0%), chloroquine (26.6%), and oral AMT (19.6%). Among CHW the market share was ACT (71.6%), chloroquine (22.3%); oral AMT (3.8%). More than half of CHWs could correctly state the national first-line treatment for uncomplicated falciparum and vivax malaria (59.2 and 56.9%, respectively) compared to the private sector (15.8 and 13.2%, respectively). Indicators on support and engagement were as follows for CHWs: reportedly received training on malaria diagnosis (60.7%) or national malaria treatment guidelines (59.6%), received a supervisory or regulatory visit within 12 months (39.1%), kept records on number of patients tested or treated for malaria (77.3%). These indicators were less than 20% across the private sector. Conclusion: CHWs have a strong foundation for achieving malaria goals and their scale-up is merited, however gaps in malaria commodities and supplies must be addressed. Intensified private sector strategies are urgently needed and must be scaled up to improve access and coverage of first-line treatments and malaria diagnosis, and remove oral AMT from the market place. Future policies and interventions on malaria control and elimination in Myanmar should take these findings into consideration across all phases of implementation.

AB - Background: In 2015/2016, an ACTwatch outlet survey was implemented to assess the anti-malarial and malaria testing landscape in Myanmar across four domains (Eastern, Central, Coastal, Western regions). Indicators provide an important benchmark to guide Myanmar's new National Strategic Plan to eliminate malaria by 2030. Methods: This was a cross-sectional survey, which employed stratified cluster-random sampling across four regions in Myanmar. A census of community health workers (CHWs) and private outlets with potential to distribute malaria testing and/or treatment was conducted. An audit was completed for all anti-malarials, malaria rapid diagnostic tests. Results: A total of 28,664 outlets were approached and 4416 met the screening criteria. The anti-malarial market composition comprised CHWs (41.5%), general retailers (27.9%), itinerant drug vendors (11.8%), pharmacies (10.9%), and private for-profit facilities (7.9%). Availability of different anti-malarials and diagnostic testing among anti-malarial-stocking CHWs was as follows: artemisinin-based combination therapy (ACT) (81.3%), chloroquine (67.0%), confirmatory malaria test (77.7%). Less than half of the anti-malarial-stocking private sector had first-line treatment in stock: ACT (41.7%) chloroquine (41.8%), and malaria diagnostic testing was rare (15.4%). Oral artemisinin monotherapy (AMT) was available in 27.7% of private sector outlets (Western, 54.1%; Central, 31.4%; Eastern; 25.0%, Coastal; 15.4%). The private-sector anti-malarial market share comprised ACT (44.0%), chloroquine (26.6%), and oral AMT (19.6%). Among CHW the market share was ACT (71.6%), chloroquine (22.3%); oral AMT (3.8%). More than half of CHWs could correctly state the national first-line treatment for uncomplicated falciparum and vivax malaria (59.2 and 56.9%, respectively) compared to the private sector (15.8 and 13.2%, respectively). Indicators on support and engagement were as follows for CHWs: reportedly received training on malaria diagnosis (60.7%) or national malaria treatment guidelines (59.6%), received a supervisory or regulatory visit within 12 months (39.1%), kept records on number of patients tested or treated for malaria (77.3%). These indicators were less than 20% across the private sector. Conclusion: CHWs have a strong foundation for achieving malaria goals and their scale-up is merited, however gaps in malaria commodities and supplies must be addressed. Intensified private sector strategies are urgently needed and must be scaled up to improve access and coverage of first-line treatments and malaria diagnosis, and remove oral AMT from the market place. Future policies and interventions on malaria control and elimination in Myanmar should take these findings into consideration across all phases of implementation.

KW - Anti-malarial

KW - Artemisinin combination therapy

KW - Chloroquine

KW - Malaria testing

KW - Oral artemisinin monotherapy

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