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Fulltext Who would get measles in Petaling District? A trend analysis of measles outbreak from 2014-2018

Mohamed Paid Yusof, Idayu Badilla Idris, Nur Ashiqin Abd Rahman, Raudah Abd Rahman, Wan Rosmawati Wan Ismail

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):67-72.
MyJurnal

Introduction: Measles outbreaks are endemic in Southeast Asia. A possible reason for such outbreaks is low vaccine coverage. In Malaysia, there is a lack of studies on measles outbreaks. The urban district of Petaling in Selangor, Peninsular Malaysia, reported a high number of outbreaks in 2014–2018. Thus, we analysed the trend of mea- sles outbreaks and identify the common characteristics of measles cases in Petaling District. Methods: This was a cross-sectional study using secondary data from the Petaling District Health Office online surveillance system. Data from 2014 until 2018 from the e-Measles and eWabak systems were extracted, and the trend and common character- istics of measles cases were analysed. Results: A total of 48 outbreaks involving 124 cases were reported during the period investigated. The outbreaks showed an increasing trend from 2.1% in 2014 to 37.5% in 2016, and decreased slightly from 29.2% in 2017 to 27.1% in 2018. The common characteristics were age 1 to

Matched MeSH terms: Asia, Southeastern
Hepatitis B and hepatitis C in southeast and southern Asia: challenges for governments

Wait S, Kell E, Hamid S, Muljono DH, Sollano J, Mohamed R, et al.

Lancet Gastroenterol Hepatol, 2016 11;1(3):248-255.
PMID: 28404097 DOI: 10.1016/S2468-1253(16)30031-0

In 2015, the Coalition to Eradicate Viral Hepatitis in Asia Pacific gathered leading hepatitis experts from Bangladesh, India, Indonesia, Malaysia, Pakistan, the Philippines, and Thailand to discuss common challenges to the burden posed by hepatitis B virus (HBV) and hepatitis C virus (HCV), to learn from each other's experience, and identify sustainable approaches. In this report, we summarise these discussions. Countries differ in their policy responses to HBV and HCV; however, substantial systemic, cultural, and financial barriers to achievement of elimination of these infections persist in all countries. Common challenges to elimination include limited availability of reliable epidemiological data; insufficient public awareness of risk factors and modes of transmission, leading to underdiagnosis; high rates of transmission through infected blood products, including in medical settings; limited access to care for people who inject drugs; prevailing stigma and discrimination against people infected with viral hepatitis; and financial barriers to treatment and care. Despite these challenges, promising examples of effective programmes, public-private initiatives, and other innovative approaches are evident in all countries we studied in Asia Pacific. The draft WHO Global Health Sector Strategy on Viral Hepatitis 2016-21 provides a solid framework upon which governments can build their local strategies towards viral hepatitis. However, greater recognition by national governments and the international community of the urgency to comprehensively tackle both HBV and HCV are still needed. In all countries, strategic plans and policy goals need to be translated into resources and concrete actions, with national governments at the helm, to enable a sustainable response to the rising burden of hepatitis B and C in all countries.

Matched MeSH terms: Asia, Southeastern/epidemiology
Mitochondrial DNA diversity in Southeast Asian populations

Schurr TG, Wallace DC

Hum Biol, 2002 Jun;74(3):431-52.
PMID: 12180765

In a previous study of Southeast Asian genetic variation, we characterized mitochondrial DNAs (mtDNAs) from six populations through high-resolution restriction fragment length polymorphism (RFLP) analysis. Our analysis revealed that these Southeast Asian populations were genetically similar to each other, suggesting they had a common origin. However, other patterns of population associations also emerged. Haplotypes from a major founding haplogroup in Papua New Guinea were present in Malaysia; the Vietnamese and Malaysian aborigines (Orang Asli) had high frequencies of haplogroup F, which was also seen in most other Southeast Asian populations; and haplogroup B, defined by the Region V 9-base-pair deletion, was present throughout the region. In addition, the Malaysian and Sabah (Borneo) aborigine populations exhibited a number of unique mtDNA clusters that were not observed in other populations. Unfortunately, it has been difficult to compare these patterns of genetic diversity with those shown in subsequent studies of mtDNA variation in Southeast Asian populations because the latter have typically sequenced the first hypervariable segment (HVS-I) of the control region (CR) sequencing rather than used RFLP haplotyping to characterize the mtDNAs present in them. For this reason, we sequenced the HVS-I of Southeast Asian mtDNAs that had previously been subjected to RFLP analysis, and compared the resulting data with published information from other Southeast Asian and Oceanic groups. Our findings reveal broad patterns of mtDNA haplogroup distribution in Southeast Asia that may reflect different population expansion events in this region over the past 50,000-5,000 years.

Matched MeSH terms: Asia, Southeastern
Southeast Asian mitochondrial DNA analysis reveals genetic continuity of ancient mongoloid migrations

Ballinger SW, Schurr TG, Torroni A, Gan YY, Hodge JA, Hassan K, et al.

Genetics, 1992 Jan;130(1):139-52.
PMID: 1346259

Human mitochondrial DNAs (mtDNAs) from 153 independent samples encompassing seven Asian populations were surveyed for sequence variation using the polymerase chain reaction (PCR), restriction endonuclease analysis and oligonucleotide hybridization. All Asian populations were found to share two ancient AluI/DdeI polymorphisms at nps 10394 and 10397 and to be genetically similar indicating that they share a common ancestry. The greatest mtDNA diversity and the highest frequency of mtDNAs with HpaI/HincII morph 1 were observed in the Vietnamese suggesting a Southern Mongoloid origin of Asians. Remnants of the founding populations of Papua New Guinea (PNG) were found in Malaysia, and a marked frequency cline for the COII/tRNA(Lys) intergenic deletion was observed along coastal Asia. Phylogenetic analysis indicates that both insertion and deletion mutations in the COII/tRNA(Lys) region have occurred more than once.

Matched MeSH terms: Asia, Southeastern
Fulltext Key informant interview on antimicrobial resistance (AMR) in some countries in the Western Pacific region

Lee Y, Wakabayashi M

Global Health, 2013;9:34.
PMID: 23889997 DOI: 10.1186/1744-8603-9-34

The World Health Organization (WHO) selected antimicrobial resistance (AMR) as the theme for World Health Day 2011. The slogan was "Combat Drug Resistance - No action today, no cure tomorrow" A six-point policy package was launched as a core product for World Health Day. It aimed to stimulate extensive and coherent action to overcome the many challenges presented by antimicrobial resistance.

Matched MeSH terms: Asia, Southeastern
Southeast Asian tropical medicine and parasitology network

Waikagul J

Parasitol Int, 2006;55 Suppl:S297-300.
PMID: 16326132

The SEAMEO TROPMED Network is a regional cooperative network established in 1967 for education, training and research in tropical medicine and public health under the Southeast Asia Ministers of Education Organization. The Network operates through four Regional Centers with respective areas of specialization and host institutions: Community Nutrition/Tropmed Indonesia; Microbiology, Parasitology and Entomology/Tropmed Malaysia; Public Health/Tropmed Philippines; and Tropical Medicine/Tropmed Thailand. To train health workers, to support research on endemic and newly emerging diseases, and to advocate relevant health policies are the main functions of these centers. SEAMEO TROPMED Network in collaboration with the Faculty of Tropical Medicine, Mahidol University and other institutions has regularly organized the Seminar on Food-borne Parasitic Zoonoses every 3-5 years over the past 15 years. The Faculty of Tropical Medicine has organized the annual Joint International Tropical Medicine Meeting since 1996. Full papers of the presentations at these two meetings have been published as supplementary issues to the Southeast Asian Journal of Tropical Medicine and Public Health, an in-house journal of SEAMEO TROPMED Network. Recently, the Parasitology Association of ASEAN Countries has rotated the hosting of the ASEAN Congress of Parasitology and Tropical Medicine. These institutional and conference networks will enable closer links, to promote the health of people in the Southeast Asian region.

Matched MeSH terms: Asia, Southeastern
Intestinal fluke infections in Southeast Asia

Waikagul J

Southeast Asian J. Trop. Med. Public Health, 1991 Dec;22 Suppl:158-62.
PMID: 1822877

Twenty-three species of intestinal flukes reported in man in Southeast Asia are assigned to seven families: Echinostomatidae, Fasciolidae, Heterophyidae, Lecithodriidae, Microphallidae, Paramphistomatidae and Plagiorchiidae. The majority of species belongs to the Heterophyidae and Echinostomatidae families. Common species are Fasciolopsis buski, Echinostoma ilocanum, E. malayanum, E. revolutum and Haplorchis yokogawai. The countries where large number of species were reported are Thailand (14 species), Philippines (12 species), Indonesia (8 species) and Malaysia (4 species). Only one species was recognized in Laos, and Vietnam. Several species reported in man in the other regions, were reported in animals in Southeast Asia. It is possible that these are present in humans but have not yet been reported.

Matched MeSH terms: Asia, Southeastern/epidemiology
Maternal influences on low birth weight

Tin TT, Thida M, Maung MM, Wai KT

Malays J Reprod Health, 1994 Jun;12(1):32-7.
PMID: 12320337

PIP: To identify the maternal risk factors associated with low birth weight in Malaysia, the records of the 2613 infants delivered at North Okkalapa General Hospital from January to September 1990 were reviewed. The incidence of low birth weight during the 9-month study period was 21.1%; 18.1% of these cases were attributable to intrauterine growth retardation and 3% were associated with preterm births. Univariate analysis identified the following risk factors as significant: age under 20 years (.001), parity 1 (.001), maternal height of 145 cm or under (.01), maternal cigarette smoking (.01), maternal education of 8 years or less (.001), parity 5 or above (.05), and maternal age of 35 years and above (.05). A last birth interval of 1 year or less and more than 3 years was associated with an odds ratio exceeding 1, but the correlation with low birth weight was not significant. These risk factors should be used to design maternal health programs aimed at reducing the incidence of low birth weight.

Matched MeSH terms: Asia, Southeastern
A new species of Tapiena (Orthoptera: Tettigonioidea: Phaneropterinae) from Brunei Darussalam (Borneo, Southeast Asia)

Tan MK, Wahab RBHA

Zootaxa, 2018 Apr 20;4413(1):193-196.
PMID: 29690128 DOI: 10.11646/zootaxa.4413.1.9

There are now more than 28,000 described orthopterans globally (Cigliano et al., 2018) and this figure is likely to increase in the future. The same is true for Southeast Asia, where we are still at a stage of discovering species new to science, and this is partly an artefact of incomplete sampling (Tan et al., 2017a). In one of the most popular biodiversity hotspots, i.e., Borneo, is the Kuala Belalong Field Studies Centre. It is located in the primary lowland and ridge dipterocarp forests of the Ulu Temburong National Park, Brunei Darussalam. Recent collection of orthopterans in the area led to the discovery of several new species of katydids (Tan et al., 2017b; Tan Wahab, 2017a) and crickets (Tan et al., 2017c; Tan Wahab, 2017b). Here, we describe another new species of katydid, from the genus Tapiena Bolívar, 1906. Tapiena currently consists of 26 species (Tan et al., 2015) and is distributed around Asia and even Africa. In Borneo, only one species is known: Tapiena incisa Karny, 1923 from Sarawak (see Karny, 1923). The new species Tapiena paraincisa sp. nov. represents the second species described from Borneo.

Matched MeSH terms: Asia, Southeastern
Fulltext Hepatitis A virus: declining seroprevalence in children and adolescents in Southeast Asia

Kunasol P, Cooksley G, Chan VF, Isahak I, John J, Loleka S, et al.

Southeast Asian J. Trop. Med. Public Health, 1998 Jun;29(2):255-62.
PMID: 9886108

The prevalence of hepatitis A virus (HAV) in a country largely reflects its standards of hygiene and socioeconomic conditions. Countries which undergo socioeconomic development show major change in HAV prevalence from high to low endemicity, and this is largely reflected in patterns of age-related seroprevalence. This paper presents age-related HAV seroprevalence patterns of SE Asian countries, and highlights how these patterns have changed over recent decades. Singapore, Thailand and Malaysia have experienced a decline in childhood and adolescent HAV seroprevalence, typical of countries which undergo socioeconomic development. By contrast, India has remained a country of high endemicity, with almost universal seroconversion in childhood. The Philippines and Vietnam show age-related seroprevalence patterns typical of high to moderate endemicity, while Indonesia shows significant regional variation in HAV seroprevalence. Populations within countries which exhibit major improvements in endemicity and age related HAV seroprevalence patterns are at risk of HAV epidemics, and a paradoxical increase in incidence tends to occur as seroconversion shifts from children to adults. The residents of these countries, a significant number of whom are at-risk, would benefit from a program of vaccination, as would non-infected individuals visiting high-risk areas.

Matched MeSH terms: Asia, Southeastern/epidemiology
New Mycomya species from South-East Asia (Diptera, Mycetophilidae)

Väisänen R

Zootaxa, 2014.
PMID: 24943632 DOI: 10.11646/zootaxa.3815.4.4

Mycomya Rondani specimens from the islands of South-East Asia, i.e. Malaysia, Indonesia and the Philippines, are revised. The paper includes a key to the Mycomya species of the South-East Asian islands. The following six new species are described: M. shimai sp. n. from Java, Indonesia, M. pongo sp. n. from Sabah, Malaysia, and M. apoensis sp. n., M. nakanishii sp. n., M. paraklossi sp. n. and M. yatai sp. n. from Mindanao, the Philippines. The holotypes of M. klossi Edwards from Borneo, Malaysia, and M. minutata Edwards from Sumatra, Indonesia, were examined and their genitalia are described. M. occultans (Winnertz) is recorded from Java, Indonesia.

Matched MeSH terms: Asia, Southeastern
Fulltext Plasmodium knowlesi and Wuchereria bancrofti: Their Vectors and Challenges for the Future

Vythilingam I

Front Physiol, 2012;3:115.
PMID: 22557977 DOI: 10.3389/fphys.2012.00115

Malaria and filariasis still continue to pose public health problems in developing countries of the tropics. Although plans are in progress for the elimination of both these parasitic vector borne diseases, we are now faced with a daunting challenge as we have a fifth species, Plasmodium knowlesi a simian malaria parasite affecting humans. Similarly in peninsular Malaysia, filariasis was mainly due to Brugia malayi. However, we now see cases of Wuchereria bancrofti in immigrant workers coming into the country. In order to successfully eliminate both these diseases we need to know the vectors involved and introduce appropriate control measures to prevent the diseases occurring in the future. As for knowlesi malaria it is still uncertain if human to human transmission through mosquito bites is occurring. However, P. knowlesi in human is not a rare occurrence anymore and has all the characteristics of a pathogen spreading due to changes in the ecosystem, international travel, and cross border migration. This has created a more complex situation. In order to overcome these challenges we need to revamp our control measures. This paper reviews the vectors of malaria and filariasis in Southeast Asia with special emphasis on P. knowlesi and W. bancrofti in Malaysia and their control strategies.

Matched MeSH terms: Asia, Southeastern
Fulltext Plasmodium knowlesi infecting humans in Southeast Asia: What's next?

Jeyaprakasam NK, Liew JWK, Low VL, Wan-Sulaiman WY, Vythilingam I

PLoS Negl Trop Dis, 2020 12;14(12):e0008900.
PMID: 33382697 DOI: 10.1371/journal.pntd.0008900

Plasmodium knowlesi, a simian malaria parasite, has been in the limelight since a large focus of human P. knowlesi infection was reported from Sarawak (Malaysian Borneo) in 2004. Although this infection is transmitted across Southeast Asia, the largest number of cases has been reported from Malaysia. The increasing number of knowlesi malaria cases has been attributed to the use of molecular tools for detection, but environmental changes including deforestation likely play a major role by increasing human exposure to vector mosquitoes, which coexist with the macaque host. In addition, with the reduction in human malaria transmission in Southeast Asia, it is possible that human populations are at a greater risk of P. knowlesi infection due to diminishing cross-species immunity. Furthermore, the possibility of increasing exposure of humans to other simian Plasmodium parasites such as Plasmodium cynomolgi and Plasmodium inui should not be ignored. We here review the current status of these parasites in humans, macaques, and mosquitoes to support necessary reorientation of malaria control and elimination in the affected areas.

Matched MeSH terms: Asia, Southeastern/epidemiology
Fulltext Pteropine orthoreovirus: An important emerging virus causing infectious disease in the tropics?

Tan YF, Teng CL, Chua KB, Voon K

J Infect Dev Ctries, 2017 Mar 31;11(3):215-219.
PMID: 28368854 DOI: 10.3855/jidc.9112

INTRODUCTION: Pteropine orthoreovirus (PRV) is an emerging zoonotic respiratory virus that has spilled over from bats to humans. Though initially found only in bats, further case studies have found viable virus in ill patients.
METHODOLOGY: PubMed was queried with the keywords of Nelson Bay orthoreovirus OR Pteropine orthoreovirus OR Melaka orthoreovirus OR Kampar orthoreovirus, and returned 17 hits.
RESULTS: Based on prevalence studies, the presence of PRV has been reported in Malaysia and Vietnam, both developing countries. Other case reports also provide further evidence of the presence of PRV in the Southeast Asian region. Despite the absence of PRV in their home countries, travellers from Hong Kong and Japan to Indonesia have returned to their countries ill with this virus, indicating that local communities in Indonesia might be affected by this virus.
CONCLUSIONS: This work aims to bring to light this emerging zoonotic respiratory virus circulating among developing countries in Southeast Asia. To improve the understanding of PRV of the medical and scientific community in the Southeast Asian region, this work introduces the general features of PRV, reports of imported PRV, prevalence, and clinical features of PRV. Gaps in knowledge about PRV have also been identified in this work, and we hope that future studies can be undertaken to improve our understanding of this virus.

Matched MeSH terms: Asia, Southeastern/epidemiology
A call for more research and global collaboration in South-East Asia to address challenges of DMT access and MS management in the region

Vijayasingham L, Viswanathan S

Mult Scler, 2019 01;25(1):130-131.
PMID: 30132396 DOI: 10.1177/1352458518797290
Matched MeSH terms: Asia, Southeastern
Fulltext Management of Idiopathic CNS inflammatory diseases during the COVID-19 pandemic: Perspectives and strategies for continuity of care from a South East Asian Center with limited resources

Viswanathan S

Mult Scler Relat Disord, 2020 Sep;44:102353.
PMID: 32653804 DOI: 10.1016/j.msard.2020.102353

The Covid-19 pandemic poses a grave health management challenge globally of unprecedented nature. Management of idiopathic Central Nervous system inflammatory disorders (iCNSID) such as Multiple sclerosis, Neuromyelitis optica and its spectrum disorders and related conditions during this pandemic needs to be addressed with affirmative and sustainable strategies in order to prevent disease related risks, medication related complications and possible COVID-19 disease associated effects. Global international iCNSIDs agencies and recent publications are attempting to address this but such guidance is not available in South East Asia. Here we outline prospectively qualitatively and quantitatively novel strategies at a tertiary center in Malaysia catering for neuroimmunological disorders despite modest resources during this pandemic. In this retrospective study with longitudinal follow-up, we describe stratification of patients for face to face versus virtual visits in the absence of formal teleneurology, stratification of patients for treatment according to disease activity, rescheduling, deferring initiation or extending treatment intervals of certain disease modifying therapies(DMT's) or immunosuppressants(IS), especially those producing lymphocyte depletion in MS and the continuation of IS in patients with NMO/NMOSD. Furthermore, we highlight the use off-label treatments such as Intravenous immunoglobulins/rituximab,bridging interferons/Teriflunomide temporarily replacing more potent DMT choices,supply challenges of IS/DMT's and tailoring blood watches and neuroimaging surveillance based on the current health needs to stave off the pandemic and prevent at risk patients with iCNSID/health care workers from possibly being exposed to the COVID-19.

Matched MeSH terms: Asia, Southeastern
Climacteric and menopause in seven South-east Asian countries

Boulet MJ, Oddens BJ, Lehert P, Vemer HM, Visser A

Maturitas, 1994 Oct;19(3):157-76.
PMID: 7799822

The menopause is universal, but what about the climacteric? In an attempt to answer this question, a study was conducted in seven south-east Asian countries, namely, Hong Kong, Indonesia, Korea, Malaysia, the Philippines, Singapore and Taiwan. Samples of approximately 400 women in each country were questioned about a number of climacteric complaints, incontinence and dyspareunia, consultation of a physician, menopausal status and several background characteristics. Special care was taken to overcome linguistic and cultural problems, and the data collected were kept as objective as possible. From the results obtained we were able to show that the climacteric was indeed experienced in south-east Asian countries, although in a mild form. The prevalence of hot flushes and of sweating was lower than in western countries, but was nevertheless not negligible. The percentages of women who reported the more psychological types of complaint were similar to those in western countries. The occurrence of climacteric complaints affected perceived health status. A physician was consulted for climacteric complaints by 20% of the respondents, although this was most frequently associated with the occurrence of psychological complaints and less so with that of hot flushes and sweating. The median age at menopause (51.09) appeared to be within the ranges observed in western countries. Ethnic background and age at menarche were found to have a significant influence on age at menopause. The study clearly demonstrated that climacteric complaints occur in south-east Asia. The findings suggest, however, that vasomotor-complaint-related distress might be 'translated' into psychological complaints, which are more frequently considered to warrant consulting a physician.

Matched MeSH terms: Asia, Southeastern/epidemiology
Fulltext Geographical and social isolation drive the evolution of Austronesian languages

Padilla-Iglesias C, Gjesfjeld E, Vinicius L

PLoS One, 2020;15(12):e0243171.
PMID: 33259529 DOI: 10.1371/journal.pone.0243171

The origins of linguistic diversity remain controversial. Studies disagree on whether group features such as population size or social structure accelerate or decelerate linguistic differentiation. While some analyses of between-group factors highlight the role of geographical isolation and reduced linguistic exchange in differentiation, others suggest that linguistic divergence is driven primarily by warfare among neighbouring groups and the use of language as marker of group identity. Here we provide the first integrated test of the effects of five historical sociodemographic and geographic variables on three measures of linguistic diversification among 50 Austronesian languages: rates of word gain, loss and overall lexical turnover. We control for their shared evolutionary histories through a time-calibrated phylogenetic sister-pairs approach. Results show that languages spoken in larger communities create new words at a faster pace. Within-group conflict promotes linguistic differentiation by increasing word loss, while warfare hinders linguistic differentiation by decreasing both rates of word gain and loss. Finally, we show that geographical isolation is a strong driver of lexical evolution mainly due to a considerable drift-driven acceleration in rates of word loss. We conclude that the motor of extreme linguistic diversity in Austronesia may have been the dispersal of populations across relatively isolated islands, favouring strong cultural ties amongst societies instead of warfare and cultural group marking.

Matched MeSH terms: Asia, Southeastern
Fulltext Gene-Diet Interactions on Metabolic Disease-Related Outcomes in Southeast Asian Populations: A Systematic Review

Sekar P, Ventura EF, Dhanapal ACTA, Cheah ESG, Loganathan A, Quen PL, et al.

Nutrients, 2023 Jun 29;15(13).
PMID: 37447274 DOI: 10.3390/nu15132948

Diabetes and obesity are chronic diseases that are a burden to low- and middle-income countries. We conducted this systematic review to understand gene-diet interactions affecting the Southeast Asian population's risk of obesity and diabetes. The literature search was performed on Google Scholar and MEDLINE (PubMed) search engines independently by four reviewers who evaluated the eligibility of articles based on inclusion criteria. Out of 19,031 articles, 20 articles examining gene-diet interactions on obesity and/or diabetes-related traits met the inclusion criteria. Three (Malaysia, Indonesia, and Singapore) out of eleven Association of Southeast Asian Nations (ASEAN) countries have conducted studies on gene-diet interactions on obesity and diabetes. From the 20 selected articles, the most common interactions were observed between macronutrients and genetic risk score (GRS) on metabolic disease-related traits in the Malay, Chinese, and Indian ethnicities. Overall, we identified 29 significant gene-diet interactions in the Southeast Asian population. The results of this systematic review demonstrate ethnic-specific gene-nutrient interactions on metabolic-disease-related traits in the Southeast Asian population. This is the first systematic review to explore gene-diet interactions on obesity and diabetes in the Southeast Asian population and further research using larger sample sizes is required for better understanding and framing nutrigenetic approaches for personalized nutrition.

Matched MeSH terms: Asia, Southeastern
Fulltext Tramadol: a valuable treatment for pain in Southeast Asian countries

Vijayan R, Afshan G, Bashir K, Cardosa M, Chadha M, Chaudakshetrin P, et al.

J Pain Res, 2018;11:2567-2575.
PMID: 30425567 DOI: 10.2147/JPR.S162296

Background: The supply of controlled drugs is limited in the Far East, despite the prevalence of health disorders that warrant their prescription. Reasons for this include strict regulatory frameworks, limited financial resources, lack of appropriate training amongst the medical profession and fear of addiction in both general practitioners and the wider population. Consequently, the weak opioid tramadol has become the analgesic most frequently used in the region to treat moderate to severe pain.

Methods: To obtain a clearer picture of the current role and clinical use of tramadol in Southeast Asia, pain specialists from 7 countries in the region were invited to participate in a survey, using a questionnaire to gather information about their individual use and experience of this analgesic.

Results: Fifteen completed questionnaires were returned and the responses analyzed. Tramadol is used to manage acute and chronic pain caused by a wide range of conditions. Almost all the specialists treat moderate cancer pain with tramadol, and every one considers it to be significant or highly significant in the treatment of moderate to severe non-cancer pain. The reasons for choosing tramadol include efficacy, safety and tolerability, ready availability, reasonable cost, multiple formulations and patient compliance. Its safety profile makes tramadol particularly appropriate for use in elderly patients, outpatients, and for long-term treatment. The respondents strongly agreed that tighter regulation of tramadol would reduce its medical availability and adversely affect the quality of pain management. In some countries, there would no longer be any appropriate medication for cancer pain or the long-term treatment of chronic pain.

Conclusions: In Southeast Asia, tramadol plays an important part in the pharmacological management of moderate to severe pain, and may be the only available treatment option. If it were to become a controlled substance, the standard of pain management in the region would decline.

Matched MeSH terms: Asia, Southeastern

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