Myanmar in the Time (and Space) of Malaria

For the first time, a team of researchers is exploring the impact and movement of malaria across Myanmar using satellite data and geospatial modeling. Ultimately, the data and models developed by Professor Tatiana Loboda and her team will help inform researchers, policymakers and public health workers in Myanmar and in the broader Southeast Asia Region about when malaria outbreaks are likely to happen, and which areas should be targeted to eliminate malaria.

This project, funded by the National Institutes of Health, requires Loboda to travel across various regions of Myanmar for 90 days a year for seven years.

“I feel like a yo-yo,” Loboda said, describing the challenges of focusing on this important work, while also serving as an Associate Chair and teaching in the Department of Geographical Sciences, working on other research projects, and connecting with her husband and her two children.

“When I spend three nights in the same hotel, that’s so exciting,” she said.

The hardship is worth it to Loboda, who finds the work both fascinating and intensely rewarding. She knows that she is helping to combat a disease that can be devastating.

Loboda is pictured, second from left, with colleagues and community partners in Myanmar.

An Adaptable Disease

Malaria is a mosquito-borne disease caused by a parasite; if untreated, symptoms such as fever, chills and flu-like illness can lead to serious complications and death. The Centers for Disease Control and Prevention estimated that about 219 million cases of malaria occurred worldwide in 2017, and 435,000 people died, mostly children in the African Region.

While clinical cases of malaria have declined globally in the past few years, and the malaria-caused death rate has dropped globally, malaria is still a serious health concern, especially in regions affected by poverty, lack of access to health care, and other concerns.

Because of its warm, humid climate, numerous bodies of water, and dense forests, Myanmar is “a mosquito paradise,” Loboda said.

Social, political and economic factors have also led the research team to focus on the emerging democracy that is Myanmar, even while the continent of Africa still suffers from the deepest impact of malaria illnesses and deaths worldwide.

Myanmar, Loboda explains, has been “scientifically cut off from the global community for decades” due to political unrest. It has only been since about 2009 that the nation has integrated back into the worldwide scientific community, Loboda said.

Now, Myanmar faces the highest burden of malaria in the region, not necessarily as an effect of economic instability, but from not having access to knowledge and resources that developed and were made available during that time of political upheaval.

While the overall impact of malaria in Myanmar is not as prevalent or as devastating as it is in Africa today, Southeast Asia faces a significant challenge of stealthily evolving malaria strains that are resistant to drugs.

“This is the third time that new strains of genetic mutations have occurred that make the drugs we have less effective,” Loboda said.

While the global community and entities including the World Health Organization have made enormous strides toward containing malaria, these types of resistant mutations in Myanmar and other countries of the Greater Mekong region could spread across the globe. Southeast Asia has been the historical gateway for the global dissemination of drug-resistant malaria. 

“When genetic resistance spreads, which can easily happen, we are likely to lose ground and see a massive resurgence of malaria everywhere,” Loboda said.

A Broader View

This project is a seven-year effort funded by the National Institutes of Health, which has identified the work as an International Center of Excellence in Malaria Research Project (ICEMR). The Principal Investigators are Drs. Christopher Plowe and Myaing Myaing Nyunt of the Duke Global Health Institute.

Loboda is working with a group of medical researchers to understand spatial patterns of malaria transmission in Myanmar. Professor Kathleen Stewart, a faculty member in the Department of Geographical Sciences and the director of UMD’s  Center for Geospatial Information Science, serves as the mapping core lead on this project.

Loboda and Stewart are specifically studying the environmental and human-mobility related drivers of malaria transmission, with a goal to develop models that can predict the likelihood of malaria outbreak in space and time. 

For this work, Loboda relies on characterizing environment using satellite observations and linking that to identifying conditions that can support robust mosquito populations.  She also assesses the potential for population exposure to malaria-carrying mosquitoes, through a combination of satellite monitoring of land use and socio-economic surveys.

The team is working to develop a better understanding of subclinical malaria cases and genetic mutations that lead to drug resistance. Data collected by Plowe and Nyunt for the ICMER projects inform Loboda and Stewart’s models about the distribution of the Plasmodium parasites—the cause of malaria—across Myanmar, which is not at all synonymous with mosquito distribution and cannot be observed remotely. 

“This is fascinating and truly exciting work with significant implications for global health outcomes,” Laboda said.

The researchers are working with a number of U.S. and International collaborators within Myanmar, as well as in Bangladesh and China. Loboda is teaching researchers and public health officials in Myanmar how to run and utilize geospatial applications in their work with the aim to build a cadre of geospatial experts who can continue the work even when Loboda herself is not on-site. 

Ultimately, that framework could be scaled up and applied to other countries.

Human Impact on Land Could Lead to Health Consequences for Humans

Initial findings suggest to Loboda that land use and human impact on the environment could be causing malaria outbreaks.

The team’s satellite views show that patches of forested land—roughly the size of farms—are being cleared out.

“We don’t know how these crews—and it must be crews, because individuals couldn’t clear areas of this size in such short time frames—are getting in and out. These are remote regions where there just aren’t road systems, but they’re getting crews in somehow,” Loboda said. “We don’t know who is doing this. We just know that these large patches of forest area are being cleared.”

As deforestation occurs, there seems to be related, predictable upticks in cases of malaria. While it is still too early to draw definitive conclusions, Loboda and her team are theorizing that the rate of land cover change might be a predictor of higher malaria occurrence.

While it might seem a natural conclusion that a reduction in trees and vegetation would lead to reduced mosquito habitat, and thus a thinner mosquito population, Loboda thinks that these work crews represent migrant workforce and might be bringing in malaria from other regions.

“When you take down a forest, you are bringing in people to do that work—people with parasites in their blood. People from other regions with different parasites in their blood than what might be typically found in the bodies of the people in the nearby villages,” Loboda said.

Loboda and her colleagues are also talking with the citizens of Myanmar to see what they think is bringing malaria to their towns and villages.

“Sometimes, we get good information. Sometimes, we get rural myths,” Loboda said. “But they are eager to talk with us. Malaria has had a big impact on their families, a big hit on their economic well-being and their quality of life.”

A Growing Portfolio of Malaria Research

In addition to this critical work, Loboda’s research portfolio also includes a project funded by NASA’s Land-Cover and Land-Use Change Program, which is helping researchers obtain the basic science and basic data they need to understand the prevalence and movement of malaria across the region.  Loboda also is working on a NASA Applications Project in Myanmar involving the Malaria Early Warning System (MEWS).

“We’re developing an early warning system for the country as a whole that can help predict outbreaks, both in space and in time,” Laboda said. “Our goal is to support malaria evaluation operations in Myanmar.”

Some of her other malaria projects are collaborations with the Bill and Melinda Gates Foundation related to testing the efficacy of malaria drug administration; she and Stewart are working on the spatial analysis and modeling elements of that project.  

The World Health Organization and the government of Myanmar believe it is possible to eliminate malaria by 2030; Loboda’s various projects may well be part of this transformative global health change.

“The impact of this research on human well-being is so obvious. I’m very excited about making a contribution,” Loboda said. “It is incredibly gratifying work.”

 

Published on Fri, Mar 1, 2019 - 2:00PM