PAVE PNG: partnership for vivax elimination

Hello, my name is Dr Moses Laman. I am the deputy director of the Papua New Guinea Institute of Medical Research. I have close to 20 years of experience in malaria research and within Papua New Guinea, vivax malaria is a big problem. The parasites hide in the liver and it is not easy to treat. Because of this, we are working on a treatment, that will effectively treat and cure vivax malaria. And we are working in partnership with the National Department of Health, Provincial Health Authorities, Burnet Institute and 4 clinics within Papua New Guinea, to find a better way to treat and cure vivax malaria. In this video, you will learn some things about vivax malaria and the treatment for it. 

What is vivax malaria? Sik vivax malaria em wanem?

Plasmodium vivax is a type of malaria that is common in Papua New Guinea. Similar to other kinds of malaria, the parasite that causes vivax malaria is transmitted by female anopheles mosquitoes. 

After the mosquito injects the malaria parasites into the bloodstream, the parasites multiply in the blood and cause illness.

Mala-1 is the medicine that treats the malaria parasites that are in the blood. However vivax malaria has a stage that can hide or sleep in the liver, called hypnozoites, for weeks, months and even years. This hidden liver stage of vivax malaria can come out into the blood every now and then, causing repeated infection and illness. When picked up by a mosquito, it passes onto another person causing them infection and illness. 

These repeated episodes of infection and illness can cause both acute and chronic health problems.

Primaquine is the medicine that removes the hidden malaria parasites from the liver. 

Primaquine / Primakwin

Primaquine is an anti-malarial medicine that is approved by the PNG government to treat and remove the hidden liver stage parasites of vivax malaria in Papua New Guinea. Mala-1 treats the blood stage of the parasite but not the liver stage. Meaning even though you complete Mala-1 and feel better, only the blood stage of the parasite has been cleared, the liver stage will remain for months and then emerge into the bloodstream and reinfect you. 

This is why it’s important to complete primaquine antimalarial treatment to successfully clear all the parasites in the liver.

Primaquine can cause severe side effects in some people. So the dose of primaquine needs to be determined by a test that the health worker will do. As a result, Papua New Guinea Institute of Medical Research is conducting a study to introduce this new test to determine the optimal dose of primaquine to clear all the stages of vivax malaria. 

Possible side effects of primaquine to be aware of / Makmak we i ken kamap taim sik manmeri i kisim primakwin

These are the signs/symptoms to be aware of when taking primaquine because they require immediate clinical care.

Displa em ol mak we sikman o wasman blong sikman i mas lukuluk long em. Taim displa ol mak i stat long kamap long dikman, em mas toksave kwik taim long ol wokman blong haus sik. 
- Dark urine - red or the colour of Coca Cola / Kala belong pisps i senis em l ken Luk orem red o kala blong koko kola 
- Nausea and/or vomiting / pill trait bel tanim
- Yellow of the skin or the whites of the eyes / kala blong skin I Luk yelo/waitpla pat blong ai em go yelo
- Breathlessness or shortness of breath / Hat long pulim win/Sotwin
– Dizziness / Ai raun 
– Rapid heart rate / Hatbit blong sikman i  hariap hariap tumas
– Fever / Skin hot 
– Pale skin or unhealthy appearance / kala blong skin blong sikman i kamap lait liklik o em i luk sik
– Fatigue / Filim silip planti

If you have these signs/symptoms you should seek care from your nearest clinic or hospital. 

Sapos sikman i gat displa ol makmak, em mas go lukim ol wokman long haus sik we stap klostu long em.

Primaquien can also cause gastrointestinal upset, especially if you do not take it with food.

Primakwin i ken kamapim bel pen na bel tanim anim. Displa em bai kamap sapos yu no kaikai gut pastaim long yu kisim marasin. 

Taking primaquine as directed by your health worker / Kisim primakwin osem hau ol wokman bilong haus sik i tokim yu

For primaquine, it is the total dose that you take that determines whether all the parasites in the liver are cleared and the treatment is effective. This totla dose needs to be split over multiple days in order for the treatment to be safe. It is extremely important that the total amount of primaquine presscribed to you is taken according to the health workers instructions. It is important to not give your primaquine tablets to other members of thecommunity as it will impact its effetiveness on curing your vivax malaria infection and it will not be good for the person who receives the primaquine. To minimise the risk of gastrointestinal side effects when taking primaquine, take your medication with food. 

I hope you have learned something from this video and remember, if you are sick, you must get treatment from the nearest clinic or hospital. Always remember to sleep under a mosquito net, and lastly, I thank you for watching. I thank all the communities that are supporting us to do research to help eliminate malaria in Papua New Guinea. Thank you.

P. vivax malaria poses a persistent challenge to our shared malaria elimination goals. Unless fully treated, the parasite can hide in a person's liver, causing recurring illness, which can lead to severe anemia and even death. 
Children are 4 times as likely as adults to be infected. 

The Partnership for Vivax Elimination (PAVE) seeks to support countries in accelerating elimination of P. vivax malaria. PAVE coordinates with malaria programs to develop tailored approaches to support the introduction and optimal use of effective diagnostics and treatments. This will lead to more people being fully treated. 
Tackling P. vivax is key to eliminating malaria. Together, we can beat it.