CONTAINMENT

contain + eliminate = no parasite

WHO Implements Ambitious Project to Fight Malaria

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WORKING closely with the governments of Cambodia and Thailand, the World Health Organization has developed an ambitious cross-border malaria containment project in a bid to eliminate malaria resistant parasites and wipe out the mosquito-borne disease along the border areas of two countries.

Filter paper with blood from a Cambodian boy. Genomic DNA will then be extracted from the filter paper sample for PCR assays. Polymerase chain reaction (PCR) is a DNA-based molecular detection method that is more sensitive than rapid diagnostic tests and microscopy. Pix by WHO/sonny inbaraj

This $22.5-million project, funded by the Bill & Melinda Gates Foundation, uses a combination of prevention and treatment methods that have proven to be effective against malaria. The project strategy includes large-scale distribution of long-lasting insecticide-treated mosquito nets, free early diagnosis and treatment of malaria at the village level, 24-hour health facilities to diagnose and treat malaria and intensive surveillance of positive cases as well as other education programmes and innovative means to reach the mobile migrants.

Focussed Testing and Treatment (FSAT) aims to detect, and treat, any hidden cases of malaria in the village, even in people not showing signs of the disease.  It uses highly accurate technology – Polymerase Chain Reaction (PCR) – that can detect minute levels of parasite.

Early last year, WHO warned that parasites resistant to artemisinin had emerged along the Thai-Cambodian border, posing a serious threat to global efforts to control malaria. Artemisinin-based drugs are the most effective treatment against malaria and have made huge strides over the past decade in controlling the disease. WHO has been working intensely with the health ministries of Cambodia and Thailand, and other partners, to contain the resistant parasites, with the ultimate aim of eliminating them from the target zone.

Drugs based on artemisinin alone, rather than combined with other drugs, have been blamed for contributing to resistance. Because of this, the Cambodian Government has now banned the use of single-drug treatments for malaria.

The project has also made concerted efforts to stop the sale of fake and substandard drugs, which are believed to be a major contributing factor to the development of resistance. Through the project, drug inspectors have been trained, and now regularly conduct inspections aimed at uncovering outlets selling these drugs. The Ministry of Health in Cambodia has trained 250 “justice police” who regularly check pharmacies, shops and markets to try to ensure that only recommended malaria drugs are sold.

Activities are being implemented in the target zone, known as zone 1 that covers areas where artemisinin tolerance has already been detected, and in a much larger buffer zone, known as zone 2 where there is no evidence of tolerance yet, but the risk is also high. In Cambodia, zone 1 covers about 270,000 people in four provinces – all of Pailin and parts of Battambang, Pursat and Kampot.  In Thailand, about 110,000 people live in zone 1 – in the border areas of Trat and Chanthaburi provinces.

Zone 2 in Cambodia covers nine provinces with a total population of more than four million, while in Thailand zone 2 comprises seven provinces with a population of nearly seven million, about 150,000 of whom are living in malaria risk areas.

Cambodia is making dramatic progress. As of 14 September 2010, there were only two cases of falciparium malaria from 5,686 people screened in 16 villages in Pailin, which previously were the most affected in the border area. In the adjacent area in Thailand — Soi Dao and Pong Nam Ron districts of Chantaburi province — there was a similar trend, with incidence of falciparum malaria dropping from sixteen (16) to seven (7) from 2008 to 2009, the year before the cross-border project kicked in and the year after.

So far, more than half a million bed-nets have been distributed, including more than 260,000 in zone 1.  A further 200,000 existing mosquito nets have been treated with insecticide.  This distribution means that all villagers in zone 1 and all people in the high-risk villages in zone 2 are able to sleep under a mosquito net each night.

Meanwhile, the project has trained about 2,900 volunteer village malaria workers, or VMWs, in Cambodia and 326 in Thailand. These VMWs are fully trained and equipped to diagnose malaria in the village using a rapid diagnostic test and to provide the patients with the appropriate drugs for free. This strategy – providing free anti-malarial drugs in the village – also works to undermine the sale of fake and sub-standard anti-malarial drugs from the private sector where Cambodians have usually sought treatment.

In both Cambodia and Thailand, treatment for malaria is now available 24-hours a day through public health centres and VMWs.

Adding to the malaria containment effort, a pilot project known as Focused Screening and Treatment (FSAT) that aims to test every man, woman and child is underway in 20 malaria-affected villages in the target zone.  FSAT aims to detect, and treat, any hidden cases of malaria in the village, even in people not showing signs of the disease.  It uses highly accurate technology – Polymerase Chain Reaction (PCR) – that can detect minute levels of parasite.

Within days, after blood samples are taken, the results are sent back from the Pasteur Institute in Phnom Penh to teams operating in the village who then follow up each individual case to ensure every case is treated effectively. This means that an entire village can be screened and have very accurate results back in about four to five days. The fast turn around of results is very important for the follow-up of positive cases and appropriate treatment in a short space of time, before people move out of a village.

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Written by malariacontainment

September 10, 2010 at 10:15 am

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