CONTAINMENT

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Archive for April 2011

CONTAINMENT issue No:3

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Written by malariacontainment

April 22, 2011 at 4:59 pm

Cambodia Launches National Plan to Eliminate Malaria by 2025

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Prime Minister Hun Sen: pushing for malaria elimination. Photo by Associated Press

Prime Minister Hun Sen revealed that the Royal Government of Cambodia has launched a national strategic plan to eliminate malaria in the country by 2025.

“This national strategic plan, from 2011 to 2025, is an important reference document, which indicates a clear path, phase by phase and a clearly defined goal — that is a Cambodia without malaria,” he told the 32nd National Health Congress held in Phnom Penh on 15 March.

Meanwhile, the premier said that he understood that malaria remains an immediate public health concern and an economic burden among Cambodians. He added that there are still Cambodians falling sick due to malaria and unable to work, but there were relatively few deaths from the mosquito-borne disease.

Cambodia’s Health Minister Mam Bun Heng said the number of people getting sick or dying from malaria has decreased in almost all the provinces. He said that the number of deaths from malaria in Cambodia fell by 53.8 percent in 2010, compared with the previous year.

The Health Minister said the National Health Congress had discussed the disease and was determined to implement the national strategic plan to eliminate malaria in Cambodia by 2025.

Premier Hun Sen stressed that malaria could be eliminated and reminded the National Health Congress that Cambodia had been successful in eliminating polio, even when the country was still divided between areas controlled by the government and the Khmer Rouge.

“Fortunately, the Khmer Rouge [forces] were integrated into the government, so we tried to send the polio vaccine immediately to those areas previously controlled by the rebels,” he said, adding: “So Cambodia was declared polio-free in 2002.”

The Prime Minister reiterated that Cambodia would work in the next 15 years towards the eradication of malaria in the country by using the national strategic plan.

“I hope that all parties involved, including the Health Ministry of the Royal Government of Cambodia and the development partners will use this national strategic plan as a compass for effective implementation,” he said.

The premier said he acknowledged that malaria cases had substantially decreased in general. “But, we need a series of campaigns and activities so that malaria will go down [further] towards the zero rate of malaria transmission by the year 2025,” he added.

“For me, I am optimistic that by 2020 or 2021 [malaria] should be gone completely,” he told Cambodian health officials attending the National Congress.

Moeun Chhean Nariddh

Written by malariacontainment

April 15, 2011 at 1:06 pm

Responding to Day 3 Falciparum Malaria Positives in Real-Time

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Malaria Consortium, with the support of the Bill & Melinda Gates Foundation-funded Containment Project, is pioneering a Day 3 positive alert system in Ta Sanh district, western Cambodia, using mobile phone and web-based technology to facilitate response in real-time. CONTAINMENT’s Sonny Inbaraj reports.

Diagram showing how a text message from the Ta Sanh Health Centre gets disseminated with FrontlineSMS. Source:WHO/Sonny Krishnan

EFFECTIVE containment of multi-drug resistant falciparum malaria depends on timely acquisition of information on new cases, their location and frequency. This is to plan interventions and focus attention on specific locations to prevent an upsurge in transmission.

Response in western Cambodia’s Ta Sanh district involves combining the process of positive diagnoses through microscopy of Day 3 positives at the Ta Sanh health centre from blood slides sent by Village Malaria Workers, to an alert system using mobile phone and web-based technology to help pinpoint potential outbreaks of malaria and target interventions to foci where parasite reservoirs are likely to be present.

The proportion of patients who still carry malaria parasites on the third day of treatment is currently the best measure available of slow parasite clearance and can be used as a warning system for confirmation of artemisinin resistance.

In Ta Sanh, the Village Malaria Workers or VMWs play a crucial role in the early detection and treatment of the killer falciparum malaria. In September 2010 the USAID-funded Cambodia Malaria Prevention and Control Project (MCC), implemented by University Research Co., LLC (URC), trained these VMWs to prepare blood slides from those who tested positive for falciparum malaria from rapid diagnostic tests. They were also trained to carry out a three-day directly observed treatment (DOT) of the Pf cases with the co-formulated ACT dihydroartemisinin – piperaquine.

Chou Khea, a 21-year-old Village Malaria Worker, trained by MCC in Ta Sanh district’s remote Ou Nonoung village tells CONTAINMENT how she carries out DOT.

“Immediately after a villager tests positive for falciparum malaria in a rapid diagnostic test (RDT), I prepare the blood slides. Then I give the drugs, which the villager has to take in front of me,” says Khea.

“On Day 2 and Day 3, I’ll go to the villager’s house and make sure that the drugs are again taken in my presence,” she adds. “After 72 hours from the first intake of the anti-malaria drugs, I’ll be at the villager’s house again to take his or her blood sample for preparing another blood slide.”

Chou Khea then takes the Day Zero and Day 3 slides, together with the used RDT, to the Ta Sanh Health Centre 30-kilometres away from her village.

“I usually take a motor-dop (motorcycle taxi) to the health centre. But most of the motor-dop drivers are reluctant to use the track to health centre in the rainy season because of the slippery mud. Also many of them are scared of the wild animals and land-mines in the area,” she tells CONTAINMENT with concern. “I hope to have my own motorcycle soon, so that I’ll be able to transport the slides and RDTs faster,” she adds with a smile.

A validation, from the database, of the SMS sent from the Ta Sanh Health Centre. Pix WHO/MERG

At the Ta Sanh Health Centre, the Day 3 slides are examined by a microscopist and if asexual malaria parasites are seen they are graded as positive. The microscopist immediately sends out an SMS on a mobile phone, using a dedicated number, to a database indicating the village code and the sex of the patient.

Malaria Consortium pioneered the use of this alert system in Ta Sanh, with support from Cambodia’s National Centre for Parasitology, Entomology and Malaria Control (CNM) and the World Health Organization’s Malaria Containment Project funded by the Bill & Melinda Gates Foundation.

Malaria Consortium’s Information Systems Manager Steve Mellor explains the use of cellular text messaging (SMS) as a viable tool to send alerts and map Day 3 positives in real-time on Google Earth.

“We use FrontlineSMS, an open-source software, that enables users to send and receive text messages with groups of people through mobile phones,” Mellor tells CONTAINMENT.

“FrontlineSMS interfaces with an MS Access database system that was developed to host the SMS data and to provide validation on the data received and to send an automatic reply to the sender containing any validation errors found, or to confirm that the data has been accepted,” he adds.

There are plans to upscale this mobile phone and web-based alert system with InSTEDD, an innovative humanitarian technology NGO, to map all Day Zero cases…

Day 3 positives, in the Access database, mapped in real-time on Google Earth. Pix/Malaria Consortium

In the Access database, a script interfaces with Google Earth and maps out the locations of the Day 3 positives based on the village code. The mapping on Google Earth is essential as it gives a clear visualisation of the terrain and helps CNM, WHO and the USAID-funded Cambodia Malaria Prevention and Control Project (MCC) to plan coordinated interventions in terms of case follow-up on Day Zero and Day 3 and carry out epidemiological and entomological investigations.

“All this happens in real-time and alert text messages are sent out simultaneously to the operational district malaria supervisor, the provincial health department, CNM and the administrators of the database,” Mellor points out.

There are plans to upscale this mobile phone and web-based alert system with InSTEDD, an innovative humanitarian technology NGO, to map all Day Zero cases. Malaria Consortium and CNM are also in direct talks with Mobitel, one of Cambodia’s main telecommunication carriers.

“We are in negotiations with Mobitel for a free number and also free SIM cards to be distributed to health centre staff and village malaria workers,” Mellor reveals. “After all, this is for a public good.”

Besides plans to map all Day Zero cases, Malaria Consortium is also exploring the possibility of sending alert messages in Khmer script.

“This will be a breakthrough and we hope this will help facilitate a quick response mechanism from CNM and other partners,” says Mellor.