Lessons Learned from Cambodia Useful for Region
The lessons learned from the feedback at the meeting of the National Task Force of Cambodia will be useful to other countries in the Greater Mekong Sub-region in the push for a regional containment agenda towards the elimination of artemisinin-resistant falciparum malaria.
This was the message put forward by the Secretary of State for the Ministry of Health, His Excellency Chou Yin Sim, when he opened the third Cambodian Task Force meeting on December 3, 2010 at the Phnom Penh Hotel.
“The National Task Force of Cambodia provides national supervision to the Containment Project funded by the Bill & Melinda Gates Foundation,” he told the meeting attended by WHO, the National Malaria Control Centre (CNM), and their working partners.
“Elimination of resistant malaria parasites will remain out of reach unless we pay adequate attention to the delivery of health services, including good surveillance of remote areas and migrant populations. This cannot be done without the strengthening of health systems,” stressed H.E. Yin Sim.
H.E. Yin Sim pointed out the strategies that have been effective in the Containment Project.
“The strategies that have been found to be effective in the Containment Project have been the provision of free diagnosis and treatment by village malaria workers and the promotion of the use of LLINs (long-lasting insecticide treated nets) by populations at risk of malaria, especially those who stay overnight in the forest,” he told the meeting.
Another important strategy was the ban on monotherapies that H.E. Yin Sim said had proven to be effective in addressing the spread of multi-drug resistant falciparum malaria.
“The Ministry of Health is committed to eliminating monotherapies and perpetrators will be subjected to administrative measures and legal action,” he said.
“In Cambodia, a ban on monotherapies together with the Public-Private Mix initiative have achieved almost zero prevalence in artemisinin monotherapies as well as a significant reduction in fake and substandard drugs on the market,” said H.E. Yin Sim.
“I do hope this positive example and the lessons learned can be replicated in other countries in the region,” he emphasized.
To reduce drug pressure we also have to engage the private sector – it’s a partner we have to engage with and we are trying work with them and develop strategies to do so…
The US$22.5-million Containment Project funded by the Bill & Melinda Gates Foundation involves both Cambodia and Thailand. There are respective National Task Forces in both Cambodia and Thailand overseeing the project.
The international level oversight is through a panel of international malaria experts in the International Task Force. So far the International Task Force has held two meetings – the first in Phnom Penh in 2009 and the other in Hanoi in February 2010.
“The ultimate goal of the project is to contain the artemisinin-resistant malaria by removing selection pressure and reducing and ultimately eliminating falciparum malaria through a series of strategies,” said Dr. Najibullah Habib, WHO’s Malaria Containment Project Manager.
Stressed Dr. Habib: “If this resistance to artesunate spreads from this area to other regions or other countries, it constitutes not only a regional but a global public health issue. Therefore it’s an issue that goes beyond just Pailin or Western Cambodia or Zone One or Zone Two – it goes regionally and globally.”
Dr. Habib explained to the Task Force Meeting the zoning of the Containment Project.
“Zone 1 involves not just Western Cambodia but also some areas in Thailand as well. And that’s where we have our elimination strategy – to eliminate artemisin-resistant malaria. Zone 2 is a buffer zone to make sure the disease does not spread beyond the focal area. For Zone 3, we have now good news that Global Fund Round 9 activities are geared towards control in those areas including the whole of Cambodia.”
In order to reduce selection pressure, it is imperative to use artemisinin-derived drugs with other partner drugs in the treatment of falciparum malaria.
“In Zone 1 it is dihydroartemisinin-piperaquine (DHA-P); in Zone 2 it is artesunate plus mefloquine (A and M) and atovaquone – proguanil in Thailand,” Dr. Habib pointed out.
Dr. Habib also emphasized the importance of engaging the private sector in the Containment Project. “To reduce drug pressure we also have to engage the private sector – it’s a partner we have to engage with and we are trying work with them and develop strategies to do so.”
In summarizing the achievements of the Containment Project, Dr. Kheng Sim, Vice-Director of Cambodia’s National Centre for Parasitology, Entomology and Malaria Control (CNM) said 100% bed net coverage has been achieved in Zone 1 whilst Behaviour Change Communication activities have reinforced key personal protection messages.
The achievements of operational research in the Containment Project were also presented to the Task Force Meeting. Between May and October 2010, Focused Screening and Treatment (FSAT), a Polymerase Chain Reaction (PCR)-based method of identification and investigation of parasite carriers of Plasmodium Falciparum, was piloted in Pailin province. The primary objective of this operational research was to screen and treat the local residents of villages identified to bear the heaviest malaria burden from all malaria parasites.
WHO’s Dr. Stefan Hoyer told the Task Force Meeting that FSAT’s next steps include procurement of a ‘mobile molecular biology lab’ to allow for improved sampling and analysis.
“This will considerably reduce the delay between when PCR samples are collected and treatment,” he pointed out.