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Am. J. Trop. Med. Hyg., 79(5), 2008, pp. 662-669
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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Characterization of "Yaa Chud" Medicine on the Thailand–Myanmar Border: Selecting for Drug-resistant Malaria and Threatening Public Health

Paul N. Newton*, Christina Y. Hampton, Krystyn Alter-Hall, Thanongsak Teerwarakulpana, Sompol Prakongpan, Ronnatrai Ruangveerayuth, Nicholas J. White, Nicholas P. J. Day, Mabel B. Tudino, Natalia Mancuso, AND Facundo M. Fernández*
Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic; Faculty of Tropical Medicine, and Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia; Mae Sot Hospital, Mae Sot, Tak Province, Thailand; Departamento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

Multidrug-resistant Plasmodium falciparum malaria is a severe public health problem on the Thailand–Myanmar border. Many villagers buy packets of 4–5 mixed medicines ("yaa chud") from shops without medical assessment as their first-line malaria treatment. In 2000–2001 a local researcher purchased 50 yaa chud from 44 shops around Mae Sot, Thailand and Myawaddy, Myanmar (Burma), for his wife who was said to be pregnant with fever and drowsiness. The tablets/capsules were provisionally identified by appearance and active ingredients determined in a subset by using mass and atomic spectrometry. The most frequently detected active ingredients were acetaminophen (22%), chlorpheniramine (13.4%), chloroquine (12.6%), tetracycline/doxycycline (11.4%), and quinine (5.1%). Only seven bags contained potentially curative medicine for malaria. A total of 82% of the bags contained medicines contraindicated in pregnancy. Inappropriate, ineffective antimalarial drugs on the Thailand–Myanmar border are likely to increase malaria morbidity, mortality and health costs and engender the emergence and spread of antimalarial drug resistance.

Received April 29, 2008. Accepted for publication July 5, 2008.

Acknowledgments: We thank Yongyuth Losuppakarn (Mae Sot Hospital) and Kamolrat Silamut for assistance; the students of the Faculty of Pharmacy, Mahidol University (Bangkok) for help in provisionally identifying the yaa chud ingredients; Catherine Goodman, Elizabeth Ashley, Rose McGready, Shunmay Yeung, and Francois Nosten for helpful comments on the manuscript; and Amin Abdinasir, Karen Barnes, and Mayfong Mayxay for advice

Financial support: The collection of samples and part of the chemical analysis were supported by the Wellcome Trust of Great Britain as part of the Wellcome Trust–Mahidol University–Oxford Tropical Medicine Research Programme. Facundo M. Fernández was supported by a National Science Foundation CAREER grant for DART-MS analysis. Christina Y. Hampton was supported by a Molecular Biophysics Training Program from the Georgia Institute of Technology.

* Address correspondence to Paul N. Newton, Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic, E-mail: paul{at}tropmedres.ac or Facundo M. Fernández, School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA 30332, E-mail: facundo.fernandez{at}chemistry.gatech.edu

Note: Supplementary Figure 1 (Picture of yaa chud samples collected) and Supplementary Figure 2 (Poster of the Royal Government of Thailand warning of the dangers of yaa chud) appear online at www.ajtmh.org.

Authors’ addresses: Paul N. Newton, Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic, Tel/Fax: 856-21-242-168 and Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, United Kingdom, E-mail paul{at}tropmedres.ac. Christina Y. Hampton, Krystyn Alter-Hall, and Facundo M. Fernández, School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA 30332, Tel: 404-385-4432, Fax: 404-385-6447, E-mails: christina.hampton{at}gatech.edu and facundo.fernandez{at}chemistry.gatech.edu. Thanongsak Teerwarakulpana, Mae Sot, Tak Province, Thailand. Sompol Prakongpan, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand, E-mail: pyspk{at}mahidol.ac.th. Ronnatrai Ruangveerayuth, Mae Sot Hospital, Mae Sot, Tak Province, Thailand, E-mail ronnatrai{at}yahoo.com. Nicholas J. White and Nicholas P. J. Day, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand, Tel: 66-2-203-633, Fax: 66-2-203-6334 and Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, United Kingdom. Mabel B. Tudino and Natalia Mancuso, Departa-mento de Química Inorgánica, Analítica y Química Física/Instituto de Quimica de los Materiales, Medio Ambiente y Energia, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, 1428, Buenos Aires, Argentina, Tel: 54-11-4576-3360, Fax: 54-11-4576-3341, E-mail: tudino{at}q1.fcen.uba.ar.




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