Vol.33
No.04
DECEMBER 2005

ISSN 1348-8945

Vol.33 No.04 DECEMBERISSN 1348-8945

2005

Tropical Medicine and Health

Tropical Medicine
and Health【CONTENTS】
Original articles
Prescription patterns of antimalarial drugs among medical practitioners in
Osogbo metropolis. South-west Nigeria.
Ogungbamigbe TO, Ogunro PS, Elemile PO, Egbewale BE, Olowu OA and Abiodun OO

201

Discovery of two more new species of Simulium (Montisimulium) (Diptera: Simuliidae)
in Doi Inthanon National Park, Chiang Mai, Thailand
Takaoka H and Choochote W

209

Information of the first master course for Tropical Medicine in Japan
Inauguration of the Master Course in Tropical Medicine at Nagasaki University:a milestone in tropical medical education in Japan.
Osamu Nakagomi, MD, PhD and Hiroshi Nakaoka, MBChB, MTropMed (Liverpool)

Vol.33 No.04 DECEMBER 2005

Tropical Medicine
and Health217

JAPANESE SOCIETY OF TROPICAL MEDICINEJAPANESE SOCIETY OF
TROPICAL MEDICINE

Trop.Med.Health日本熱帯医学会表紙!−" ＣＭＹＫ 芦塚 中村 中村

背は２mm
（決）

Vol.33
No.04
DECEMBER 2005

ISSN 1348-8945

Vol.33 No.04 DECEMBERISSN 1348-8945

2005

Tropical Medicine and Health

Tropical Medicine
and Health【CONTENTS】
Original articles
Prescription patterns of antimalarial drugs among medical practitioners in
Osogbo metropolis. South-west Nigeria.
Ogungbamigbe TO, Ogunro PS, Elemile PO, Egbewale BE, Olowu OA and Abiodun OO

201

Discovery of two more new species of Simulium (Montisimulium) (Diptera: Simuliidae)
in Doi Inthanon National Park, Chiang Mai, Thailand
Takaoka H and Choochote W

209

Information of the first master course for Tropical Medicine in Japan
Inauguration of the Master Course in Tropical Medicine at Nagasaki University:a milestone in tropical medical education in Japan.
Osamu Nakagomi, MD, PhD and Hiroshi Nakaoka, MBChB, MTropMed (Liverpool)

Vol.33 No.04 DECEMBER 2005

Tropical Medicine
and Health217

JAPANESE SOCIETY OF TROPICAL MEDICINEJAPANESE SOCIETY OF
TROPICAL MEDICINE

Trop.Med.Health日本熱帯医学会表紙!−" ＣＭＹＫ 芦塚 中村 中村

背は２mm
（決）

Tropical Medicine and Health Vol. 33 No. 4, 2005, pp. 201-208
Copyright! 2005 by The Japanese Society of Tropical Medicine

２０
１

PRESCRIPTION PATTERNS OF ANTIMALARIAL DRUGS AMONG
MEDICAL PRACTITIONERS IN OSOGBO METROPOLIS.
SOUTH -WEST NIGERIA.
OGUNGBAMIGBE TO１，５, OGUNRO PS２, ELEMILE PO３, EGBEWALE BE４,
OLOWU OA４ and ABIODUN OO１Accepted 6, October, 2005

Abstract.
Objective: In view of the increased prevalence of chloroquine resistance and the recent WHO malaria drug policy
recommendation to use a combination of therapies especially artemisinin-based combination therapies (ACTs) in
Africa, we tried to assess the prescription pattern and level of knowledge in the use of antimalarial drugs including
ACTs among medical practitioners in Osogbo metropolis, southwest Nigeria, an endemic area of Plasmodium falciparum infection.
Method: Questionnaires were sent to every medical practitioner working in all the health facilities in the metropolis, namely, a teaching hospital, general hospital, mission hospital, comprehensive health centre and 20 privately
owned health facilities. Of the total of 100 questionnaires sent out, 96 were completed and returned while the remaining 4 were not returned. The questionnaires were self-administered.
Result: Sixty-seven percent of the respondents work in the teaching hospital, while the remaining 33% either workin the general hospital or in private medical practice. 82.4% prescribed chloroquine despite the widespread resistance, indicating that this remains the most prescribed antimalarial drug. 45.7% apply the dosage regimen correctly (χ２ P<0.005); 66.7% prefer the use of chloroquine injection; 85.6% give chlorpheniramine with chloroquine
because of pruritus; 14.4% give it because of its synergistic and reversal mechanism. Other commonly prescribeddrugs include sulphadoxine-pyrimethamine (71.1%), halofantrine (53.6%), amodiaquine and quinine (51.1%), mefloquine (20.6%), artemisinin or ACTs (18.6%) and co-trimoxazole (17.5%). Of these, the dosage regimen was applied correctly for: sulphadoxine-pyrimethamine (30.9%), halofantrine (12.8%), amodiaquine (3.2%), cotrimoxazole (2.1%), ACTs, quinine and artemisinin monotherapy (1.1%). About 40% of practitioners prefer theuse of combination therapy in the future.
Conclusion: There is an obvious paucity of knowledge on the prescription of antimalarial drugs. The proportionof practitioners anticipating the use of combination therapy in the future indicates that with continued medical education the use of combination therapies especially ACTs will be accepted easily.
Key words: Antimalarial drugs, Prescription pattern, Medical practitioners, Osogbo.

INTRODUCTION
Malaria is the second leading health problem in SubSaharan Africa. It accounts for more than one million

deaths every year in the region, with about 5% of children
under 5 years dying from malaria related illnesses. [1]Therefore, early diagnosis as well as prompt, accurate andeffective treatment are principal technical components of1). Department of Pharmacology & Therapeutics, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo.
2). Department of Chemical Pathology, College of Health Sciences, Ladoke Akintola University of Technology Osogbo.
3). Department of Paediatrics, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo.
4). Department of Community medicine, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo.
5). Malaria Research Clinic & Laboratory, College of Health Sciences, Ladoke Akintola University of Technology, Teaching Hospital, Osogbo.
Corresponding author:
Dr. T.O. Ogungbamigbe
MALARIA RESEARCH CLINIC & LABORATORY,
Department of Pharmacology & Therapeutics,
College of Health Sciences,
Ladoke Akintola University of Technology, Osogbo, Nigeria
E-mail:- bisiogun1562@yahoo.com.
Mobile phone: - 08035012702

２０２

the global strategy to control this endemic disease. [2]The rational use of an effective antimalarial drug will
not only reduce the risk of severe disease and death but also
shorten the duration of the illness, increase man-hour effectiveness help to slow down the development of parasite resistance to antimalarial drugs. It will also prevent misdiagnosis of resistance to antimalarial drugs and over-diagnosisof typhoid infection.
The emergence of and rapid spread of Plasmodium falciparum resistance to the first-line antimalarial drug chloroquine in Sub-Saharan Africa has led to the production ofseveral other antimalarial drugs for both monotherapy andcombination therapy. Although slightly more expensive,these are available but are not often considered for use incases of failure to chloroquine, the first-line antimalarial
drug in Nigeria. As a response to increasing levels of antimalarial resistance, however, WHO recommends that all
countries experiencing resistance to conventional monotherapies such as chloroquine, amodiaquine, and sulphadoxine/pyrimethamine should use combination therapies, preferably those containing artemisinin derivatives (ACTs) for
falciparum malaria. This has led to increased enthusiasm
and pressure on African governments by WHO to movequickly in adopting the use of ACTs in malaria control programs on the continent. [3]Gradually, several countries are adopting the use of
ACTs as first-line malaria chemotherapeutic agents. South
Africa adopted artesunate/lumefantrine combination for
KwaZulu Natal and Zanzibar adopted artesunate/amodiaquine. [4] Recently in Nigeria, the pressure to change
antimalarial drug policy to ACTs is also on the increase.
The low level of education and utilization of thesevarious alternatives prompted our determination to embark
on this study to:
1. Assess the level of knowledge of medical practitioners
on malarial infection and the available chemotherapeutic approaches.
2. Assess the level of knowledge about dosage regimens
and the commonly prescribed antimalarial drugs.
3. Assess the acceptability of combination therapies as a
new strategy in combating the development of resistance in Plasmodium falciparum.
The objective therefore is to plan an appropriate intervention approach in terms of continuous medical education
on new malaria management strategies, especially in areasof high resource constraints such as Sub-Saharan Africa,
where the lack of resources has contributed to the continued
use of drugs whose effectiveness has been compromised bydrug resistance. [5]MATERIALS AND METHODS
After an ethical approval from a joint university/teaching hospital ethic review committee the study was commenced using semi-structured self-administered questionnaires to interview a total of one hundred medical practitioners working in health facilities situated within Osogbo metropolis between June and August 2004. These health facilities are a teaching hospital, general hospital, mission
hospital, comprehensive health centre and 20 private medical practices. The correctness of prescription was assessedusing the WHO dosage regimen found in the report on an
informal consultation on the use of antimalarial drugs (1317 November 2000) as a reference for correct dosage regimen prescription.

STATISTICAL ANALYSISThe statistical package used for data entry and analysis
was SPSS version 7.5. Significance was determined using
chi-square test for data above five and Fisher’s Exact Testfor data below five at P<0.05.

RESULTSOut of 100 questionnaires, 96 were completed and returned while 4 were not returned. The status of the respondents showed that 71 (74%) have basic qualification and areworking as residents or general medical practitioners inhealth institutions, while 25 (26%) have postgraduate fellowship in different specialties in addition to their basic
qualification.
The symptoms seen by the respondents include: fever(93%), vomiting and headache (92%), body pains (86%),
rigours and chills (85%), abdominal pains (28%), diarrhoea(27%), stuffy or running nose (13%), pruritus (13%), andcough (9%).
Twenty-five (26.0%) always request an investigation
before writing a prescription, 45 (46.9%) prescribe drugs
without an investigation, while 26 (27.1%) only investigate
after a failed initial prescription. (P<0.05).
Eighty-two (85%) prescribed chloroquine as a firstline antimalarial drug, despite the widespread resistance.
Of the 45 (46.9%) who prescribed it correctly, 40 (89%) areresidents or general medical practitioners while 5 (11%)
have postgraduate fellowship. (P<0.001). Of the 51(53.1%) who prescribed the drug incorrectly, 31 (61%) areresidents or general medical practitioners while 20 (39%)
had postgraduate fellowship (P<0.002). Table II
Sixty-four (66.7%) give chloroquine by as injection,
while 32 (33.3%) prefer oral tablets. The frequency of２０３

Table I: The antimalarial drugs available in the region and the proportion of respondents that prescribe each of these drugs.

% of prescribers.

CQ
82(85.4%)

S-P
68(70.1%)

HF
52(53.6%)

QN
49(51.1%)

AQ
49(51.1%)

ASU
36(37.1%)

MXP
27(28.8%)

FMF
19(20.6%)

CTM
17(18.6%)

CXZ
16(17.5%)

MQ
14(15.5%)

CQ=chloroquine: S-P=sulphadoxine-pyrimethamine: HF=halofantrine: QN=quinine: AQ=amodiaquine: ASU=artesunate: MXP=sulphamethoxazolepyrimethamine: FMF=sulphadoxine-pyrimethamine/mefloquine: CTM=artemether/lumefantrine: CXZ=co-trimoxazole: MQ=mefloquine.

chloroquine injection varies: daily for 3 days (15.6%), 8
hourly for 24 hours (10.4%), 6 hourly for 48 hours (6.3%),
12 hourly for 60 hours (6.2%), 6 hourly for 36 hours (4.2%)
and 8 hourly for 60 hours (2.1%).
Eighty-three (85.4%) routinely prescribe antihistamines along with chloroquine to prevent pruritus associatedwith chloroquine therapy, while 13 (14.6%) do not give antihistamines because of the reversal of chloroquine resistance in Plasmodium falciparum parasite.
Sixty-eight(71.1%)
prescribedsulphadoxinepyrimethamine as a second-line antimalarial drug. Of the
30 (31.3%) who prescribed correctly, 23 (76.6%) are residents or general medical practitioners and 7 (23.4%) havepostgraduate fellowship. Of the 66 (69.7%) who prescribedincorrectly, 48 (72.7%) are residents or general medical
practitioners and 18 (27.3%) have postgraduate fellowship.
Of the 52 (53.6%) prescribed halofantrine, 13 (13.5%)
prescribed correctly, 10 (76.9%) are residents or general
medical practitioners, while 3 (23.1%) have postgraduate
fellowship. Of the 83 (86.5%) who prescribed incorrectly,
61 (73.5%) are residents or general medical practitioners
while 22 (26.5%) have postgraduate fellowship
Forty-nine (51.1%) prescribed amodiaquine and quinine. Three (3.1%) prescribed correctly for amodiaquine, 2
being residents or general medical practitioner and 1 having
postgraduate fellowship. Of the 93 (96.9%) prescribed incorrectly, 69 (74.2%) are residents or general medical practitioners, and 24 (25.8%) had postgraduate fellowship.
Other prescriptions are: artesunate 36 (37.1%),
sulphamethoxazole-pyrimethamine27(28.8%),

sulphadoxine-pyrimethamine/mefloquine 19 (20.6%) artemether/lumefantrine (ACTs) 17 (18.6%), co-trimoxazole 16(17.2%) and mefloquine 14 (15.5%). The proportion ofcorrect prescription is: sulphadoxine-pyrimethamine/mefloquine (3.1%), co-trimoxazole (2%), artemisinin (1%), artemether/lumefantrine (1%), and mefloquine (0%). Table II
Forty-nine (51%) readily give antibiotics after a failed
first prescription, namely, amoxicillin (29%), cotrimoxazole (10%), ciprofloxacin (8%), chloramphenicol(5%), erythromycin (8%), tetracycline (5.2%), and benzylpenicillin (4%).
Antimalarial drugs prescribed after chloroquine failures are: sulphadoxine-pyrimethamine/mefloquine (62.1%),
co-trimoxazole (55.5%), artemether/lumefantrine (27.3%),
artesunate (24.0%), quinine (20.0%), halofantrine (12.5%),
amodiaquine (11.3%) and sulphadoxine-pyrimethamine(10.3%).
Thirty-three (34.9%) give combination therapy, while
63 (65.1%) do not. The following combinations are preferred: amodiaquine/sulphadoxine-pyrimethamine (14.4%),
chloroquine/sulphadoxine-pyrimethamine (11.4%), quinine/sulphadoxine-pyrimethamine ( 7.3% ) , chloroquine / cotrimoxazole(4.1%) ,mefloquine / sulphadoxinepyrimethamine (2.1%), and mefloquine/artesunate (1%).
Forty (41.7%) advised on the use of combination therapy in the future, while 36 (37.5%) advised against it, with20 (21.8%) not responding. The main reason cited for theuse of combination therapy was for treatment of chloroquine resistant strains of Plasmodium falciparum.

Table II: The proportion of respondents with correct prescription pattern of all the antimalarial drugs available for common use in
Osogbo metropolis, Southwest, Nigeria using WHO dosage regimen of November 2000 as reference.
CQ
5M.B., B.S. Degree + postgraduate
N=25(20.0%)

S-P
7(28.0%)

HF
3(12.0%)

QN
1(4.0%)

AQ
1(4.0%)

ASU
0

MXP
0

FMF
0

CTM
0

CXZ
0

MQ
0

M.B., B.S. Degree only.
N=71

40(56.3%)

23(32.4%)

10(14.1%)

02(2.8%)

1(1.4%)

9(12.7%)

3(4.2%)

1(1.4%)

2(2.8%)

0

Total no of respondents.
N=96
P-ValueChi-square- Value
Df
Fisher’s Exact test

45
(46.9%)<0.001
9.804
1
0.002

30
(31.3%)
>0.05
0.166
1
0.444

13
(13.5%)
>0.05
0.069
1
0.547

1
(1.0%)
>0.05
0.451
1
0.691

3
(3.1%)
>0.05
0.850
1
0.600

1
(1.0%)
>0.05
0.356
1
0.740

9
(9.4%)
>0.05
3.497
1
0.126

3
(3.1%)
>0.05
1.090
1
0.400

1
(1.0%)
>0.05
0.356
1
0.740

2
(2.8%)
>0.05
0.719
1
0.524

0

CQ=chloroquine: S-P=sulphadoxine-pyrimethamine: HF=halofantrine: QN=quinine: AQ=amodiaquine: ASU=artesunate: MXP=sulphamethoxazolepyrimethamine: FMF=sulphadoxine-pyrimethamine/mefloquine: CTM=artemether/lumefantrine: CXZ=co-trimoxazole: MQ=mefloquine.

２
０
４

DISCUSSION AND CONCLUSION
The use of questionnaires to determine the prescription
patterns and level of knowledge among medical practitioners in Osogbo metropolis provides the opportunity to critically appraise factors directly or remotely connected withthe development of resistance to chemotherapeutic agents in
Plasmodium falciparum.
Less than fifty percent had sufficient knowledge of thedosage regimen of common antimalarial drugs ― chloroquine and sulphadoxine-pyrimethamine. Among these, theresidents and general medical practitioners showed betterprescribing practices than those with postgraduate fellowship. Malaria is an endemic disease; therefore every medical practitioner regardless of area of specialty should be
able to correctly prescribe commonly used antimalarial
drugs. This finding was inconsistent with from the findingsof A.Djimde where all the sanctioned providers prescribedcorrect dosage regimens for the recommended drugs, i.e.
chloroquine and sulphadoxine-pyrimethamine, according to
the National Malaria Control Program and World HealthOrganisation. [6]The majority of respondents in our survey do not makeuse of the laboratory in malaria diagnosis. This often led to
misdiagnosis of falciparum infection or over diagnosis of
typhoid infection. The habit of requesting laboratory investigation to confirm falciparum infection after an initial
failed prescription often contributed to resistance development because of exposure of the Plasmodium parasite to
drug pressure. The failure to request laboratory investigation often led to misdiagnosis because the majority of cases
are usually viral or bacteria upper respiratory tract infections. (Ogungbamigbe TO, Ojuroungbe O. unpublisheddata)
The use of chloroquine injection to treat cases of acutefalciparum infection is still on the increase despite a serious
campaign against it, as shown by the fact that more than
two-thirds of the respondents readily prescribe chloroquine
by intramuscular injection. The erratic pharmacokinetic
profile of chloroquine resulting from this frequent administration at sub-therapeutic dosages has increased the level ofresistance. [7]Most of the respondents give chlorpheniramine, an H1receptor antagonist for the prevention of pruritus, in patientswith or without history of allergy to the drug. The regularuse of this drug has helped inadvertently to promote to asignificant degree the susceptibility of Plasmodium falciparum to chloroquine because of its advantage in causing a reversal of resistance to chloroquine. [8, 9] (Ogungbamigbe et
al in the press).
There is a general lack of adequate knowledge as tothe dosage regimen of the other antimalarial drugs, and thishas affected the percentage of prescribers of these drugs, especially the newly introduced ACTs. Less than a quarter ofpractitioners prefer to use two different antimalarial drugs
as combinations, with amodiaquine / sulphadoxinepyrimethamine ranking highest. Others are: combination ofchloroquine, or quinine, or mefloquine with sulphadoxinepyrimethamine, and mefloquine / artesunate.
These combinations underscore the fact that the basic
principle of combination therapy is not well understood,
since the majority favour combinations of drugs to which
resistance has already developed and those to which resistance is reportedly on the increase. [10]It is worthy of note, however, that a fairly large number expressed the intention to use combination therapy inthe future. This clearly shows that with continued medical
education and training it will be possible to improve theprescription pattern, especially with regard to the use of
ACTs and other antimalarials in our health institutions.
In conclusion, we observed a general paucity ofknowledge about the dosages of various antimalarial drugs,
especially chloroquine, as recommended by the National
Malaria Control Program and World Health Organization.
This may have contributed to the recent increase in chloroquine resistant Plasmodium falciparum infection in the region.

REFERENCES
１．WHO Bulletin 2000. Quarterly bulletin of world healthorganization Lagos, Nigeria. Vol. 15 No 2 June 2000.
２．A global strategy for malaria control, Geneva. World
Health Organization: Geneva 1993.
３．The use of antimalarial drugs: Reports of a WHO informal
consultation. 13-17 November 2000, Geneva.
４．Antimalarial drug combination therapy: WHO (2001b) Report of a WHO Technical consultation. 4-5 April 2001, Geneva. WHO/CDS/RBM/2001. 35.
５．Baker L, Barnes K 2001 ― New antimalarial treatment for
KwaZulu Natal. South Africa Medical Journal . 91: 358359.
６．Abdoulaye Djimde, Christopher V Power, Samba Diop,
Alassane Dicko, Thomas E. Wellems and Ogobara
Doumbo. ―The use of antimalarial drugs in Mali: Policy
versus Reality. The American Society of Tropical Medicine
andHygiene. 1998: 376-379.
７．Walker O, Dawodu AH, Salako LA, Alvan G, and Johnson
AOK. ― Single dose disposition of chloroquine in kwashiorkor and normal children ― Evidence for decreased absorption in kwashiorkor. British Journal of Clinical Pharmacology. (1987), 23: 467-472.
８．Sowunmi A, Oduola AMJ, Ogundahunsi AOT, Falade CO,
Gbotoso GO, & Salako LA. (1997a). Enhanced efficacy of２０５chloroquine-chlorpheniramine combination in acute uncomplicated falciparum malaria in children. Transactionsof the Royal Society of Tropical Medicine and Hygiene. 91,
63-67.
９．Omitowoju, GO Ogundahunsi OAT, Milhous WK, Greene
L, Sowunmi A, Schuster BG & Oduola AMJ. (1992).
Chlorpheniramine: a resistance-reversing agent with potential clinical application. American Journal of Tropical
Medicine and Hygiene, 47, 175 (abstract).
１
０．WHO 2000: Geneva (WHO Technical Report Series
No. 895) ― The use of essential drugs, Geneva.

ACKNOWLEDGEMENTS
We would like to thank the staff of the Malaria Research Clinic and Laboratory, Ladoke Akintola University
Teaching Hospital and the Secretary to the Department ofPharmacology and Therapeutics, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo
for the data entry.

２０６

A SURVEY OF PRESCRIPTION PATTERN OF ANTI-MALARIAL DRUGS AMONG
MEDICAL PRACTITIONERS IN OSOGBO, SOUTHWEST NIGERIA.
QUESTIONNAIRES.
IDNUM…………………………
1. Location i.e Town ………………………………………………………………………………………………………
2. Area of Practice ― Private Medical Practice1
Teaching Hospital2
General Hospital
3
Comprehensive Health Centre.
4
Others specify ……………………………………………………………………………
3. Qualifications ……………………………………………………………………………………………………………
4. Area of Specialty ― General
1
Surgery
2
Internal Medicine
3
Other Specialties Specify
4
5. Symptoms of Malaria that are commonly presented in your practice include ―(a) Headache
1(b) Fever2(c) Chills and rigors
3(d) Abdominal pains or cramps
4(e) General body pains
5(f) Stuffy / running nose
6(g) Cough7(h) Pruritus
8(i) Vomiting
9(j) Diarrhea
10
6. What are the common drugs that you will readily prescribe for the treatment of malaria in order of preference using
figures 1, 2, 3, ……… e.t.c?
(a) Chloroquine ……………………………………………………………………………………………1(b) Amodiaquine (Camoquin) ……………………………………………………………………………2(c) Halofantrine (Halfan) …………………………………………………………………………………3(d) Pyrimethamine/ sulphadoxine (Fansidar) ……………………………………………………………4(e) Pyrimethamine/ sulphamethoxazole (Malozone) ……………………………………………………5(f) Artesunate ……………………………………………………………………………………………6(g) Quinine ………………………………………………………………………………………………7(h) Trimethoprim/ sulphadoxine (Septrin) ………………………………………………………………8(i) Artemether / Lumefantrine (Coartem) …………………………………………………………………9(j) Mefloquine (Lariam) …………………………………………………………………………………10(k) Mefloquine / Pyrimethamine / sulphadoxine (Fansimef) ……………………………………………11(l) Others Specify ………………………………………………………………………………………12
7. If you choose to use (a) and Or (b) above, do you give anti-histamines like ―(a) Chlorpheniramine (piriton)
1(b) Promethazine (phenergan)2(c) Mepyramine (Antisan)
3(d) Any other antihistamine Specify …………………………………………4
8. What in your opinion is the rationale for the above prescription?
(a) To prevent Pruritus
1(b) It is routinely used by other practitioners
2(c) Do you also give routinely
3(d) Because of its reversal properties
4(e) Because of its synergistic effect
5(f) Any other reason Specify ……………………………………………………………………6

２
０
７

9. The usual dosage you normally prescribe for suspected cases of malaria in mg/kg/day ―(a) Chloroquine ……………………………………………………………………………………………
(a) Amodiaquine (Camoquin) ………………………………………………………………………………
(b) Halofantrine (Halfan) …………………………………………………………………………………
(c) Pyrimethamine/ sulphadoxine (fansidar) ………………………………………………………………
(d) Pyrimethamine/ sulphamethoxazole (Malozone) ………………………………………………………
(e) Artesunate ………………………………………………………………………………………………
(f) Quinine …………………………………………………………………………………………………
(g) Trimethoprim/ sulphadoxine (Septrin) …………………………………………………………………
(h) Artemether / Lumefantrine (Coartem) …………………………………………………………………
(i) Mefloquine (Lariam) ……………………………………………………………………………………
(j) Mefloquine / Pyrimethamine / sulphadoxine (Fansimef) ………………………………………………
10. Would you prefer to give injections if you are prescribing Chloroquine?
11. How often do you prescribe the injection?
(a) Daily for 3 days
1(b) 8 hourly for 24 hours2(c) 6 hourly for 48 hours
3(d) 6 hourly for 36 hours
4(e) Others specify ……………………………………………………………5
12. If prescribing other antimalarial drugs, do you prefer injections to tablets-

Yes 1
No 2

Yes 1
No 2
13. If yes, how often for each of the drug mentioned below. Using the following answer for each of the drug you commonly prescribe?
(a) Always
1(b) Not at all2(c) Occasionally3(d) After a failed first prescription
4
Any other response state ……………………………………………………………………5
Amodiaquine (Camoquin)………………………………………………………………(1,2,3,4,5,)
Halofantrine (Halfan) …………………………………………………………………(1,2,3,4,5,)
Pyrimethamine / sulphadoxine (fansidar) ………………………………………………(1,2,3,4,5,)
Pyrimethamine / sulphamethoxazole (Malozone) ………………………………………(1,2,3,4,5,)
Artesunate ………………………………………………………………………………(1,2,3,4,5,)
Quinine …………………………………………………………………………………(1,2,3,4,5,)
Trimethoprim / sulphadoxine (Septrin) …………………………………………………(1,2,3,4,5,)
Artemether / Lumefantrine (Coartem) …………………………………………………(1,2,3,4,5,)
Mefloquine (Lariam) ……………………………………………………………………(1,2,3,4,5,)
Mefloquine / Pyrimethamine / sulphadoxine (Fansimef) ………………………………(1,2,3,4,5,)
14. How often do you request for laboratory investigation before prescribing Antimalarial drugs?
(e) Always
1(f) Not at all2(g) Occasionally3(h) After a failed first prescription
4(i) Any other response state …………………………………………………5
14. Do you have to prescribe antibiotics alongside with your antimalarial drugs?
(a) Always
1(b) Not at all2(c) Occasionally3(d) After a failed first prescription
4(e) Any other response- state…………………………………………………5
15. Which of the following groups of antibiotics would you have readily prescribed If your answer is any other than (b)above.
(a) Amoxicillin / any Penicillin
1

２
０
８

(b) Chloramphenicol2(c) Ciprofloxacin
3(d) Erythromycin
4(e) Septrin
5(f) Others Specify ………………………………………………………………………………6
16. Is it in your practice to give two different antimalarial drugs together while treating Malaria? ………………Yes 1
No 2
17. If yes, how often?
(a) Always
1(b) Occasionally2(c) After a failed first prescription
3(d) Any other response specify …………………………………………………………………4
18. Do you prefer specific combination, state them ………………………………………………………………………
19. Based on your experience would you advice combinations in future?
Yes 1
No 2
20. If yes, why? ―State reasons ……………………………………………………………………………………………

Tropical Medicine and Health Vol. 33 No. 4, 2005, pp. 209-215
Copyright! 2005 by The Japanese Society of Tropical Medicine

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DISCOVERY OF TWO MORE NEW SPECIES OF SIMULIUM(MONTISIMULIUM ) (DIPTERA: SIMULIIDAE) IN DOI INTHANONNATIONAL PARK, CHIANG MAI, THAILAND
HIROYUKI TAKAOKA１ and WEJ CHOOCHOTE２
Accepted 17, November, 2005

Abstract: Two more new black-fly species of the rare subgenus Simulium (Montisimulium) were discovered in Doi
Inthanon National Park, Chiang Mai, Thailand, where S . (M .) merga Takaoka and Choochote was known as the
only named species. These two new species, S . (M .) angkaense sp. nov. and S . (M .) laoleense sp. nov., are described on the basis of the pupal and/or mature larvae. Both new species are easily distinguished from S . (M .)merga by the pupal gill with 12 slender filaments, and from all the 16 known species with 12 pupal gill filaments
in other countries by the long and very long common basal stalk of the gill, respectively.
Key words: black fly, Simuliidae, Simulium, Thailand, new species, Montisimulium

Simulium (Montisimulium) Rubtsov is a small subgenus comprising 46 species [1], of which most species aremorphologically very similar in the adult stage and theiridentification depends upon the differences in the shape andarrangement of the pupal gills [2]. This subgenus is very
rarely collected because it often breeds in small temporary
watercourses in high mountains and emerges only in certain
months of the year. Most Montisimulium species are distributed in the Palaearctic Region and only five species havebeen reported from the Oriental Region [1]. In Thailand,
this subgenus was thus far represented by only one unnamed species, S . (M .) sp. G, known only by larvae collected at Ang Ka (2,460 m in altitude) in Doi Inthanon National Park, Chiang Mai [3]. In 2004, we were able to collect a few pupae, probably of S . (M .) sp. G, at Ang Ka, andwe described it as S . (M .) merga Takaoka and Choochotefrom reared adults, pupae and mature larvae, together withS . (M .) surachaii Takaoka and Choochote from a single female caught by a hand-net at the same locality [4].
Recently, we discovered several pupae and mature larvae of two more species of this subgenus in Doi Inthanon
National Park, bringing the total number to three (so far as
immature stages are concerned) in the same mountainous
area. Coexistance of more than two species rarely occurs
among the subgenus Montisimulium. Interestingly, it seems
likely that these three species of Montisimulium, of which
two utilize the same small streams, emerge at different
times of the year, i.e., S . (M .) laoleense sp. nov. in Febru-

ary and S . (M .) angkaense sp. nov. in March and April at
Siribhume Waterfall (1,400―1,500 m in altitude), and S .
(M .) angkaense sp. nov. in February and S . (M .) merga in
September through December at Ang Ka (2,460 m in altitude) according to our yearly surveys (unpublished data).
In this paper, we describe these two species as new toscience on the basis of the pupal and/or larval specimens.
The terms for morphological features used here follow
those of Takaoka [5]. Holotype and paratype specimens of
the new species are deposited at the Department of Infectious Disease Control, Oita University.
Simulium (Montisimulium) angkaense sp. nov.
DESCRIPTION. Female and Male. Unknown.
Pupa. Body length 3.2―3.5 mm. Head (Fig. 1A). Integument yellowish-brown, moderately covered with large
tubercles of various shapes each having several very minutenodule-like secondary projections on surface (Fig. 1B); antennal sheath moderately covered with smaller tubercles;
frons with 2 short stout simple dark trichomes on each side,
face with 1 long stout simple trichome with coiled apex (alittle over twice as long as frontal trichomes) on each side.
Thorax. Integument yellowish-brown, moderately covered
with tubercles similar to those on head except lateral andposterior surfaces with smaller simple tubercles, with 3 longstout simple trichomes with coiled apex mediodorsally, 2long simple trichomes (1 stout with coiled apex, 1 slender

1. Department of Infectious Disease Control, Faculty of Medicine, Oita University, Yufu City, Oita, 879-5593, Japan
2. Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand

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Fig. 1. Pupa of Simulium (Montisimulium) angkaense sp. nov. A, head integument with 2 frontal and 1 facial trichomes and with tubercles (right half, front view); B, large tubercles with secondary projections; C, basal portion of gill showing long common basal stalk and arrangement of 12 filaments(right side, outer view); D, enlargement of basal portion of gill filament showing many dark dots inouter cuticular layer; E, terminal hook (left side, end view); F, cocoon and pupa (dorsal view). Scalebars. 1.0 mm for F; 0.1 mm for C; 0.04 mm for A; 0.01 mm for B, D and E.

with uncoiled apex) mediolaterally, 1 long stout simple
trichome with uncoiled apex posterolaterally, and 3 stout
simple trichomes with uncoiled apex (1 long, 1 mediumlong, 1 short) ventrolaterally, on each side. Gill (Fig. 1C)composed of 12 slender thread-like filaments closely arranged in 2―4 groups of filaments: e.g., 2+[2+(1+2)+2+(1+2)] or [2+(1+2)]+2+[2+(1+2)] or [1+1+(1+2)]+2+2+(1+2)
or 2+2+[(1+2)+2]+(1+2), each group arising nearly at samelevel from long common basal stalk; all filaments light tomedium brown, subequal in thickness to one another but
somewhat different in length (2.5―3.5 mm long includingcommon basal stalk) and, with numerous brownish-black to
black small dots in surface cuticular layer at least on basal
3/4 (Fig. 1D), without annular ridges though annular furrows present irregularly. Abdomen. Dorsally, segments 1
and 2 weakly sclerotized and yellowish or yellowish-brown;
segments 1 and 2 sparsely tuberculate; segment 1 with 1long slender or stout simple dark hair with coiled or uncoiled apex on each side; segment 2 with 1 medium-longslender dark hair and 5 short dark spines on each side; segments 3 and 4 light yellow, each with 4 dark hooks and 1
short dark spine on each side; segments 5―9 covered withcomb-like groups of many minute spines on each side; segments 5 and 6 bare; segments 7 and 8 each with distinct
spine-combs directed backward in transverse row on eachside; segment 9 light yellow, with distinct horn-shaped terminal hooks (Fig. 1E). Laterally, segments 2―4 each with 3
short dark spines on each side; segment 9 without grapnellike hooklets on each side. Ventrally, segments 3―8 nearlytransparent and segment 9 weakly sclerotized and yellow;
segments 3―8 with comb-like groups of minute spines; segment 4 with 1 simple or bifid dark hooklet submedially anda few slender dark setae on each side; segment 5 with pairof bifid dark hooks submedially and a few slender setae oneach side; segments 6 and 7 each with pair of bifid innerand outer dark hooks and a few slender setae on each side.
Cocoon (Fig. 1F). Wall-pocket-shaped, thin, moderately
woven with no open spaces in webs, without anterodorsal

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Fig. 2. Mature larva of Simulium (Montisimulium) angkaense sp. nov. A, antenna showing 3 thin unpigmented annular bands on segment 2; B, mandible; C, hypostomium; D, Pharate pupal gill (left side,outer view). Scale bars. 0.04 mm for A and D; 0.02 mm for C; 0.01 mm for B.

projection, and slightly extending ventrolaterally; individual
threads invisible; 3.0―3.5 mm long by 1.8―2.4 mm wide.
Mature larva. Body length 6.5―6.8 mm. Body greyish, mottled with reddish-brown markings dorsally and laterally on segments 5―9 (Fig. 4A); abdomen, when viewed
dorsally, equally narrow from segment 1 to segment 4,
abruptly widened posteriorly from anterior margin of segment 5 to anterior margin of segment 6, then gradually narrowed toward segment 9; maximum width near border ofsegments 5 and 6 (though maximum width on segment 6
when viewed laterally). Cephalic apotome (Fig. 4D) yellow,
with well-defined positive head-spots, or dark yellow tolight brown (except narrow portions along both lateral margins light yellow), with positive head spots, of which posterolateral spots connected posteriorly to dark areas just anterior to posterior margin; lateral surface of head capsuledark yellow to light brown except eye-spot region clear
yellowish-white, with dark broad eyebrow and dark area
widely posterior to eye-spot region; 2 large and 3 small
spots near posterior margin and 1 small spot just below eyespot region positive, usually 2 large spots (and also all or 1
or 2 of 3 small spots) merged into dark background color;
ventral surface of head capsule (Fig. 4E) dark yellow to medium brown (though narrow area along anterior margin and/or large area medially somewhat lighter in some larvae),

with dark brown basal area on each side of postgenal cleft;
horizontal and round spots on each side of postgenal cleft
distinctively positive (these spots seemed to merge into dark
background color in a few larvae). Cervical sclerites composed of 2 small elliptical pieces, not fused to occiput, very
widely separated medially from each other. Antenna(Fig. 2A) consisting of 3 segments and apical sensillum,
much longer than stem of labral fan; proportional lengths of
1st, 2nd, and 3rd segments 1.0 : 1.0 : 0.8; all segments lightyellow, with 3 thin unpigmented annular bands on segment
2. Labral fan with ca. 34 main rays. Mandible (Fig. 2B)with mandibular serrations consisting of 2 teeth (1 large, 1
small); large tooth nearly at right angle to mandible on apical side; comb-teeth composed of 3 teeth, of which 1st
tooth longest, 2nd tooth subequal to, or slightly longer than,
3rd one; supernumerary serrations absent. Hypostomium(Fig. 2C) with 9 apical teeth in row; median and corner
teeth well developed; median tooth of 3 intermediate teethon each side smallest; lateral serrations weakly developed
anteriorly; 4―6 hypostomal bristles per side, lying slightly
divergent posteriorly from lateral margin. Postgenal cleft(Fig. 4E) very small, vestigial. Pharate pupal gill (Fig. 2D)with 12 thread-like filaments arising from long common basal stalk; each filament without transverse ridges but withnumerous brownish-black to black small dots in surface cu-

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ticular layer. Abdominal cuticle bare except both sides ofanal sclerite moderately covered with simple colorless setae.
Rectal scales present but scarcely visible. Rectal organ
compound, each of 3 lobes with 11―16 finger-like (except
apical 2 or 3 thumb- or nodule-like) secondary lobules.
Anal sclerite X-shaped, with anterior arms 0.8 times as longas posterior ones; sensilla absent on and just posterior to basal juncture area; accessory sclerite absent. Last abdominal
segment much expanded ventrally forming double bulges
on each side, visible as a large ventral papilla when viewed
from side. Posterior circlet with ca. 76 rows of up to 14
hooklets per row.
TYPE SPECIMENS. Holotype pupal exuviae, collectedfrom a small seasonal stream (water temperature 18.0°
C,
shaded, altitude ca. 1,400 m), Siribhume Waterfall, Doi Inthanon National Park, Chiang Mai, Thailand, 16. III. 2005,
by W. Choochote. Paratypes: 2 pupae, 2 pupal exuviae and8 mature larvae, same data and date as those of holotype; 1pupa, 1 pupal exuviae and 1 mature larva, same data as
those of holotype except date, 28. IV. 2005, and water temperature 24.0°
C; 1 pupal exuviae (only right gill), 1 maturelarva and 6 immature larvae, same data as those of holotype
except date, 13. III. 2004; 1 immature larva, same locality
as that of holotype but 100 m upstream (same data and dateas those of holotype of S . (M .) laoleense sp. nov.); 10 mature larvae and 60 immature larvae, Ang Ka (altitude 2,460m), Doi Inthanon National Park, Chiang Mai, Thailand, 28.
II. 2004, by W. Choochote.
ECOLOGICAL NOTES. The pupae of this new species
were found in small depressions formed on the surface ofrocks in a small forest stream of Siribhume Waterfall, whilelarvae of this new species were collected from fallen leaves
as well as the surface of rocks at both Siribhume Waterfalland Ang Ka. The pupae and/or mature larvae of this new
species were collected only in March and April at Siribhume Waterfall, and in February at Ang Ka. Associatedspecies were S . (M .) laoleense sp. nov., S . (Simulium)
doipuiense at Siribhume Waterfall, and S . (Gomphostilbia)
inthanonense, S . (Nevermannia) caudisclerum, S . (S .) setsukoae and S . (S .) suchariti at Ang Ka.
DISTRIBUTION. Thailand.
ETYMOLOGY. The species angkaense refers to Ang Ka,
where this new species was collected for the first time.
REMARKS. This new species is assigned to the subgenus
Simulium (Montisimulium) by the pupal gill with 12 threadlike filaments (Fig. 1C) and the larval postgenal cleft absent

or very small (Fig. 4E). This species is characterized by the
pupal gill with 12 thread-like filaments arising from thelong common basal stalk. The arrangement of gill filaments
separates this new species from all the 16 known species ofthis subgenus which have 12 filaments on the pupal gill [2,6―8]. The mature larva of this new species is readily distinguished from S . merga by the greyish body with reddishbrown markings dorsally on the abdominal segments 5―9(Fig. 4A), the head capsule almost entirely dark between
the eye-spot region and the posterior margin (this dark areaconnected to the marked dark eyebrow) (Fig. 4D), and theantenna with unpigmented annular bands on the second segment (Fig. 2A).
It should be noted that there is a possibility that thisnew species is conspecific to S . (M .) surachaii describedfrom a single female captured by a hand-net at Ang Ka, although this female was caught in July [4], different from thepossible emergence time (February) of S . (M .) angkaense
sp. nov. at Ang Ka.
Simulium (Montisimulium) laoleense sp. nov.
DESCRIPTION. Female, Male and Pupa. Unknown.
Mature larva. Body length 5.5―6.1 mm. Body lightyellow to greyish yellow (Fig. 4B); abdomen (Fig. 4B)
shaped as in S . (M .) angkaense sp. nov. Cephalic apotome(Fig. 4F) clear yellow except narrow portion along posterior
margin always darkened, with well-defined positive headspots, of which posterolateral spots usually connected posteriorly to dark narrow area in front of posterior margin; lateral surface of head capsule clear yellow, with no dark welldefined eyebrow (somewhat darkened at most near bothends if present); 2 large and 2 (or 3) small spots near posterior margin distinctively positive, and 1 small spot just below eye-spot region faintly or moderately positive; ventral
surface of head capsule (Fig. 4G) yellow, with dark basal
area on each side of postgenal cleft; horizontal and roundspots on each side of postgenal cleft distinctively positive.
Cervical sclerites composed of 2 small elliptical pieces, notfused to occiput, very widely separated medially from eachother. Antenna consisting of 3 segments and apical sensillum, much longer than stem of labral fan; proportional
lengths of 1st, 2nd, and 3rd segments 1.0 : 0.8 : 0.8; all segments not or only slightly pigmented, then pale annular
bands not visible, if any. Labral fan with ca. 32 main rays.
Mandible (Fig. 3A) with mandibular serrations consistingof 2 teeth (1 large, 1 small); large tooth nearly at right angle
to mandible on apical side; comb-teeth composed of 3 teeth,
shortened from 1st to 3rd; supernumerary serrations absent.
Hypostomium (Fig. 3B) with 9 apical teeth in row; medianand corner teeth well developed; median tooth of 3 interme-

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Fig. 3. Mature larva of Simulium (Montisimulium) laoleense sp. nov. A, mandible; B, hypostomium; C,
Pharate pupal gill (left side, outer view). Scale bars. 0.04 mm for C; 0.02 mm for B; 0.01 mm for A.

diate teeth on each side smallest; lateral serrations weakly
developed anteriorly; 4 or 5 hypostomal bristles per side, lying slightly divergent posteriorly from lateral margin. Postgenal cleft (Fig. 4G) very small, vestigial. Pharate pupal
gill (Fig. 3C) with 12 thread-like filaments arising fromvery long common basal stalk about 1.6 times as long asthat of S . (M .) angkaense sp. nov.; each filament withsharp transverse ridges and with numerous brownish-black
to black small dots in surface cuticular layer. Abdominal
cuticle bare except both sides of anal sclerite moderately
covered with simple colorless setae. Rectal scales present.
Rectal organ compound, each of 3 lobes with 13 or 14
finger-like secondary lobules. Anal sclerite X-shaped, withanterior arms 0.9 times as long as posterior ones; sensillaabsent on and just posterior to basal juncture area; accessory sclerite absent. Last abdominal segment much expanded ventrally forming double bulges on each side, visible as a large ventral papilla when viewed from side. Posterior circlet with ca. 78 rows of up to 14 hooklets per row.
TYPE SPECIMENS. Holotype mature larva, collectedfrom a small seasonal stream (width 0.5 m, water temperature 18.5°
C, shaded, altitude ca. 1,500 m) very slowly flowing in a forest, Siribhume Waterfall, Doi Inthanon National
Park, Chiang Mai, Thailand, 28. II. 2004, by W. Choochote.
Paratypes: 4 mature larvae and 20 immature larvae, samedata as those of holotype; 5 immature larvae, same locality
as that of holotype but 100 m downstream (same data anddate as those of holotype of S . (M .) angkaense sp. nov.).
ECOLOGICAL NOTES. The larvae of this new species
were found on fallen leaves in a small stream. Associatedspecies were S . (G .) inthanonense, S . (M .) angkaense sp.
nov., S . (S .) crocinum and S . (S .) doipuiense.
DISTRIBUTION. Thailand.
ETYMOLOGY. The species laoleense refers to Laolee, theMong’s name for Siribhume Waterfall, where this new species was collected.
REMARKS. This new species is also assigned to the subgenus Simulium (Montisimulium) as in the preceding species.
This new species is remarkable in having the pupal gillcomposed of 12 thread-like filaments arising from a very
long common basal stalk (Fig. 3C). Within this subgenus,
none of the known species has such a long common basal
stalk except one unnamed species, i.e., S . (M .) sp. C reported from India [9], which has, though, 14 pupal gill filaments per side. The mature larva of this species is somewhat similar in the body and antennal colors to S . (M .)２
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Fig. 4. Whole bodies and head capsules of mature larvae of three species of Simulium (Montisimulium) in
Doi Inthanon National Park. A―C, whole bodies (dorsal view); D―I, head capsules, D, F and H, dorsal view; E, G and I, ventral view; A, D and E, S . (M .) angkaense sp. nov.; B, F and G, S . (M .)laoleense sp. nov.; C, H and I, S . (M .) merga.

merga (Fig. 4C), but differs from the latter species by theill-defined eyebrow, the cephalic apotome with dark area
just before the posterior margin which is connected to theposterolateral spots (Fig. 4F), and the fifth abdominal segment lacking a pair of dark small markings dorsally(Fig. 4B). Simulium (M .) laoleense sp. nov. seems to berelated to S . (M .) angkaense sp. nov. in having the 12 pupal gill filaments but is easily distinguished from it by thelight yellow body color (Fig. 4B), the antenna without distinctive hyaline annular bands on the second segment, theill-defined faint eyebrow (Fig. 4F), and the pharate pupal
gill with a very long common basal stalk (Fig. 3C).

ACKNOWLEDGEMENTS
We are grateful to Mr. Surachai Tuamsomboon, Chief,
Headquarters of Doi Inthanon National Park, Wildlife andPlant Conservation Department, Ministry of National Resources and Environment, for his permission to conduct thissurvey inside the park. Our appreciation goes to Dr.
Yasushi Otsuka and Ms. Chiharu Aoki, Oita University, fortheir kind help in taking photographs of larvae and preparing Fig. 4. This work was financially supported by a Grant-

in-Aid from the Japan-US Medical Research Cooperation
Program (the fiscal year 2004).

REFERENCES
1. Crosskey RW, Howard TM. A New Taxonomic and Geographical Inventory of World Blackflies (Diptera: Simuliidae). 1997; 144 pp., The Natur Hist Mus, London.
2. Yankovsky AV. A Key for The Identification of Blackflies(Diptera: Simuliidae) of Russia and Adjacent Countries(former USSR). 2002; 570 pp., Zool Inst, Russian Academy of Sciences, Sankt-Petersburg.
3. Kuvangkadilok C, Boonkemtong C, Phayuhasena S. Cbanding in polytene chromosomes of six Simulium species(Diptera: Simuliidae) from Doi Inthanon National Park,
Northern Thailand. J Sci Soc Thailand 1998; 24: 215―230.
4. Takaoka H, Choochote W. Two new species of Simulium(Montisimulium) (Diptera: Simuliidae) from Thailand. Med
Entomol Zool 2005; 56: 21―31.
5. Takaoka H. The Black Flies (Diptera: Simuliidae) of Sulawesi, Maluku and Irian Jaya. 2003; xxii + 581 pp., Kyushu University Press, Fukuoka.
6. Okamoto M, Yoshida Y, Sato A, Shogaki Y. On Simulium(Eusimulium) kobayashii n. sp. Jpn J Sanit Zool 1958; 9:
183―186.

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7. Datta M. A new black fly species (Simuliidae-diptera) fromthe Darjeeling area, India. Proc Indian Acad Sci 1975; 81:
67―74.
8. Takaoka H. The black flies of Taiwan (Diptera: Simuliidae).
Pacific Insects 1979; 20: 365―403.

9. Datta M, Dey RK, Paul AK. Rare black fly species (Diptera: Simuliidae) of the subgenus Eusimulium Roubaud
from the Darjeeling area, India. Proc Indian Acad Sci
1975; 82: 92―99.

Tropical Medicine and Health Vol. 33 No. 4, 2005, pp. 217-218
Copyright! 2005 by The Japanese Society of Tropical Medicine

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Information of the first master course for Tropical Medicine in JapanINAUGURATION OF THE MASTER COURSE IN TROPICAL MEDICINEAT NAGASAKI UNIVERSITY: A MILESTONE IN TROPICAL MEDICALEDUCATION IN JAPAN.
OSAMU NAKAGOMI, MD, PhD１ and HIROSHI NAKAOKA, MBChB, MTropMed (Liverpool)２Abstract: We now live in a world where the threat of emerging and re-emerging infectious diseases crosses continental and national borders. In recognition of this trend the world realizes the importance of nurturing expertise in
the control of infectious diseases based on sound knowledge, experience, and evidence. The introduction of a Master of Tropical Medicine course at the Graduate School of Biomedical Sciences in Nagasaki University, Japan is expected to provide a whole new opportunity for eager doctors to acquire necessary knowledge and skills to combat
the world-wide burden of infectious diseases.
Key words: Master course; tropical medicine; infectious diseases

Year 2006 shall witness a new start to tropical medical
education in Japan when the Master Course of Tropical
Medicine, the first of its kind in this country, begins at theGraduate School of Biomedical Sciences, Nagasaki University. Since we shall take part in the course as course director and course coordinator, it should not be out of place for
us to briefly introduce this course in the context of tropical
medicine and international health at large.
Perhaps a few words may be necessary to clarify theuse of the word “tropical medicine”. In the 19th century
medicine became global as exemplified by the inaugurationof International Medical Congress in Paris in 1867. As anatural consequence of such globalization in medicine,
tropical medicine emerged and developed towards the endof the 19th century. The first tropical medical school, Liverpool School of Tropical Medicine in the United Kingdom,
opened in April 1899 followed by Tropical School in London six months afterwards. Globalization at that time period strongly mirrored the spirit of imperialism in which
great powers competed against each other in order to enlarge their colonies in Africa, Asia, the Americas and Oceania. Such imperial expansion was hampered by infectious
diseases prevalent in the tropics. Thus, the primary purposeof tropical medicine then was for better medical protectionof their nationals in the tropics where it was infamously
dubbed as the grave of white men.

While we recognize the dark side of the image that has
always accompanied the term tropical medicine, it is also
true that tropical medicine represented the passion andgoodwill of the doctors heading for steaming tropical countries where a full range of maladies flourish.
After a short period of optimism in the middle of the20th century that many of the infectious diseases would beovercome before the turn of the millennium, we are now
facing the threat incurred by a number of emerging and reemerging infectious diseases. The speed at which these infectious diseases spread from one country to another has
been accelerating due to ever-expanding economic activities
and international travels. Such evolvement has brought
tropical medicine back into the limelight and the world now
demands experts with knowledge and enthusiasm to combat
this current trend. In addition, a further reflection on the issue reveals that the role that tropical medicine is expected toplay will not differ much from the one that it played a century ago. In other words, tropical medicine is again playing
a vital role to assure the health of the people living in thedeveloped countries, and for this reason developing expertise in tropical medicine has significant merits in developed
countries as well as in developing countries.
The Graduate School of Biomedical Sciences at Nagasaki University is the only school in Japan that runs a
PhD course specializing in emerging infectious diseases andtropical medicine. Furthermore, the Institute of Tropical

1
Proposed Course Director and 2Proposed Course Coordinator Master Course in Tropical Medicine, Graduate School of Biomedical Sciences,
Nagasaki University
1-12-4 Sakamoto, Nagasaki 852-8523, Japan２
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Medicine at this University has been playing a central rolein medical research in the tropics, human development andprovision of human resources for disease control programs
overseas. We are launching a Master course in Tropical
Medicine in this prestigious venue with the intent of contributing to the global efforts to reduce the burden of tropical and infectious diseases. To achieve this goal, we will
provide students with opportunities to attain a broad rangeof skills and knowledge relating to tropical medicine by introducing a structured program maximizing the utility ofteaching resources available at the Institute of Tropical
Medicine. Specifically, we will place emphasis on acquisition of knowledge required for management and control of
infectious diseases backed up by solid foundation of microbiology and advanced molecular biology tools.
The details of the course can be obtained by visiting
our website at: http://www.mdp.nagasaki-u.ac.jp/eng/index.
html (see Section ‘Student Center’). We describe below theoutline of this 12-month course due to commence in April
2006 with students recruited from countries world-wide(the course will be taught in English). We are targeting
medical doctors with at least two years of clinical experience who have strong interests in infectious diseases occurring primarily in the tropics or have future plans of working
in tropical countries.
The course consists of three components: a) lectures,
tutorials and practicals (laboratory practices); b) overseas
clinical training; and c) a research project (Master dissertation).
a) Lectures, Tutorials and Practicals (from April to July
2006)

Lectures and practicals aim to cover essential knowledgeof clinical infectious diseases with frequent reference torelevant information of microbiology (including virology), parasitology, and entomology. There are epidemiology and public health sessions designed for building up
basic skills in study design, data management and medical statistics. The course will hold a series of tutorial sessions for discussion on clinical cases and disease outbreaks with particular emphasis on diagnosis, treatment,
prevention and control.
b) Overseas Training (August 2006)
All students will attend overseas training for four weeks
where they will have exposure to real clinical cases in thelocal hospitals by attending ward rounds and outpatient
clinics and having clinical case discussions. In addition,
students will visit community health facilities, ministry
offices, internationally recognized research groups, andinternational governmental and non-governmental organizations.
c) Research Project (from September 2006 to March2007)
All students will be assigned to conduct a research project under the supervision of professors and will submit a
Master dissertation.
In closing, we are in the process of reaching the firstmilestone in the tropical medical education in Japan with
the imminent establishment of the Master Course in Tropical Medicine at Nagasaki University. In modern tropical
medicine now is the time when opportunities are greaterthan ever.