CONTAINMENT

contain + eliminate = no parasite

Containing Malaria on the Move

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An interview with Dr. Doung Sochet, Director National Center for Parasitology, Entomology and Malaria Control.

Dr. Doung Sochet explaining to drug retailers, in Pailin, the government's ban on monotheraphies. Pix by WHO/sonny inbaraj

There is evidence of artemisinin-resistant malaria in Western Cambodia, particularly along the Cambodian-Thai border. What efforts are being made to reduce the morbidity and mortality rates there?

 

We have been working with different partners, especially with WHO, with funding from the Global Fund. We have deployed our people along the Cambodian-Thai border. We have also made big efforts to distribute long-lasting insecticide-treated nets (LLINs) to people in the area. We are also making concerted efforts to control the sale, by retail outlets and in the markets, of counterfeit and substandard anti-malarials in the targeted area that we call Zone 1. Besides that we are also doing mass screening of children, women and men in Zone 1 to diagnose and treat malaria. Our aim is to contain and eliminate artemisinin-resistant falciparum malaria in Zone 1.

The results have been very encouraging. It is an indication that our containment strategy is working in the high transmission areas. Let me give you an example. Previously when we first started mass screening of about 3,000 people we found over 100 positive falciparum malaria cases. Recently we did screening of the same size of people and only found only eight positive cases. This drop in the number of positive cases is very significant. In 2009, we had no deaths due to falciparum malaria in the area, especially in Pailin.

Counterfeit and substandard anti-malarials are one of the causes for the emergence of MDR-falciparum malaria. What are the efforts to eliminate these counterfeit and substandard drugs sold by the private sector and also enforce the ban on oral artemisinin monotheraphy?

We provide regular monthly trainings to all companies involved in the import and export of pharmaceutical products. We have also communicated to all pharmacies and drug-sellers of the Ministry of Health’s ban on monotheraphies. It is important to inform the drug-sellers first, before we do law enforcement with the Justice Police who go around inspecting pharmacies and other drug retail outlets. The drug-sellers have to be made aware of the dangers and the harm they could cause with the sale of fake anti-malarials and monotheraphies.

We raise this awareness by constantly putting out Information, Education and Communication (IEC) materials, which are distributed to communities, warning of the dangers of monotheraphies and the dangers of buying fake drugs. These IECs also inform the public that the government has banned the marketing and sale of “single-drug” artemisinin malaria medicines, in order to prevent malaria parasites from developing resistance to this drug.

The high use of artemisinin in Cambodia consists of monotheraphies provided through the private sector. This problem can be overcome if more Cambodians use health services provided by the government. Is this happening?

This is a key issue in our containment programme with WHO. Ten years ago our health structures were still weak because we lacked human resources at the grassroots level. Even our in-country health infrastructure was not strong enough. We did not have proper roads; we did not have health facilities in the remote areas. So we cannot blame people, at that time, for going to the private sector because the public sector did not have enough capacity. Also during that time people in the public sector were very poorly paid, and so there was not much commitment to provide services. So sick people just flocked to the private sector. Even if you went to the villages, the smallest drug retailer was able to provide some form of health service. But now things have changed. The government has committed more funds for health infrastructure. Health facilities have improved and there are more incentives now for public health workers. International donors have supported us in improving our health infrastructure.

We have created more access to the health facilities, now, for the people. And there is a concerted effort to encourage them to use government facilities, rather than to go to the private sector. We are also engaging the private sector and encouraging them to refer malaria cases to the government health centers.

One big concern is malaria on the move. How important is the role of village malaria workers or VMWs in the diagnosis and treatment of villagers in the hard-to-access areas?

About a decade ago, we had very poor health facilities in the villages. We had difficulty accessing people in the remote areas. Health workers had to walk for two to three hours to meet these mobile migrants who were in the forest. There were many instances where the health workers could not meet these people. Hence there was an urgent need to reach out to them. Because of this we decided to pilot a project where volunteers would be able to diagnose and treat malaria in their own communities. This has been successful.

The villagers themselves do the selection of the village malaria workers. They are the best people to know who is competent enough to be trained to do diagnosis and treatment. In each village, there is a male and female volunteer malaria worker. Once the village malaria workers are chosen by the people, we then step in and do the training. The aim is to contain and eliminate malaria at the village-level. The treatment is free, and now we have scaled it up to all provinces.

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Written by malariacontainment

September 10, 2010 at 10:10 am

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