CONTAINMENT

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Archive for July 2011

AFRIMS Mobile Units Help Detect Malaria

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CONTAINMENT’s Nat Sumon accompanied an Armed Forces Medical Research Institute for Medical Science (AFRIMS) mobile unit to a remote location on the Thailand side of the border to screen soldiers for malaria.

Thai soldiers line up for blood samples to be taken from them by the AFRIMS mobile unit. Pix by WHO/ Nat Sumon

Over the course of history, in times of war, more soldiers have died from malaria than in direct combat. During the Vietnam War (1962–1975), malaria felled more combatants during the war than bullets. The disease reduced the combat strength of some units by half.

Over 40,000 cases of malaria were reported in U.S. Army troops alone between 1965 and 1970 with 78 deaths. The U.S. Army established a malaria drug research program when U.S. troops first encountered drug resistant malaria during the war. In 1967, Chinese scientists set up Project 523 – a secret military project – to help the Vietnamese military defeat malaria by developing artemisinin based anti malarial formulations.

For the Thai army, malaria still remains a threat despite the drastic fall in cases of falciparum malaria – the most fatal form of the mosquito-borne disease. According to 2010 Royal Thai Army statistics, 572 soldiers contracted malaria along the Thai-Cambodian border and constituted one-fourth of overall malaria patients seeking treatment in the area.

Many Thai soldiers used to harsh tropical jungle conditions are well aware of protective measures. If they fall sick, they are instructed to go either to local malaria clinics or local hospitals to have their blood tested on a weekly basis.

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Written by malariacontainment

July 21, 2011 at 3:44 pm

Respondent-Driven Sampling on the Thailand-Cambodia Border: Can Malaria Cases be Contained in Mobile Migrant Workers?

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Respondent driven sampling methodology, for hidden populations, is an effective strategy to study the migrant populations from Myanmar and Cambodia on the Thailand-Cambodia border, write Amnat Khamsiriwatchara, Piyaporn Wangroongsarb, Julie Thwing, James Eliades, Wichai Satimai, Charles Delacollette and Jaranit Kaewkungwal in the Malaria Journal.

There is substantial population movement across the Thai-Cambodian border that is largely driven by economics. Migrants from both Cambodia and Myanmar settle for varying periods of time in Thailand, often in search of work. The International Organization of Migration reported that Thailand has attracted increasing numbers of migrant workers, mostly from neighbouring countries with over one million registered migrant workers entering the country since 2004.

Migrant workers in Chantaburi on the Thailand side of the Thai - Cambodian border. Pix by WHO/Nat Sumon

Channels for migration, in particular labour migration, are defined by the policy of the destination country, usually in response to the demand of domestic labour markets for foreign workers. When the supply through established channels does not match the demand, irregular migration dynamics develop, and migrants enter illegally and undocumented.

While various government ministries attempt to collect data on migrant workers, they usually have information on the number of registered migrants and those applying for work permits, but little information on the unregistered migrants. The true size of the migrant worker population in Thailand, in particular of irregular migrants, is notoriously difficult to quantify.

Rather than classifying migrant workers as documented or undocumented, the Thailand Ministry of Public Health defines migrants who have been in Thailand for more than six months as M1, and migrants who have been in Thailand for less than six months as M2.

Both M1 and M2 migrants are eligible to receive diagnosis and treatment for malaria free of charge at malaria clinics in border zones. Patients who cross the border for a day to seek treatment at the border clinics are counted among the M2. Migrants in Thailand account for a higher proportion of cases than Thai citizens, especially among the M2 migrants.

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Radio Program in Chantaburi Offers Life-Saving Advice on Malaria Prevention

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The ‘Love Your Health’ radio program hosted by the head of the Malaria Clinic in Khaeng Harng Maew District, Chanthaburi is a community favourite. CONTAINMENT’s Nat Sumon tells why.

Anukoon Charunthup, the presenter of “Rak Sukaphab” or “Love Your Health”. Pix by WHO/Nat Sumon

If you live in Khaeng Harng Maew district, Chanthaburi, where there is only one strong radio frequency, your favorite entertainment channel would definitely be the local radio network FM95.75.

Among the variety of programs carried by FM95.75, the most popular slot seems to be a one-hour health program every Wednesday called “Rak Sukaphab” or “Love Your Health”.  Undoubtedly the listening audience, attracted by the easy-listening music, tune in faithfully every Wednesday to the health program that has helpful tips on how to lead a healthy lifestyle.

“Love Your Health” also has a call-in facility that allows listeners to interact with the presenter Anukoon Charunthup, who is also head of the Malaria Clinic in Khaeng Harng Maew District, Chanthaburi. The program allows listeners to phone in to ask any health-related questions they might have.   And as an indication of the radio program’s popularity, the station’s phone is always ringing off the hook.

Anukoon tells CONTAINMENT that he began hosting the “Love Your Health” radio program about five years ago when the local radio network was just launched.

“Chantaburi is no stranger to vector-borne diseases,” he says. “The health topics that I cover in my radio program range from malaria, dengue and other mosquito-borne diseases.”

Anukoon’s radio program is important for Khaeng Harng Maew residents especially during the rainy season. “It’s the rainy season when diseases like malaria and dengue are rife and I use the radio program to disseminate preventive messages and tips on how listeners will be able to protect themselves from falling sick,” he adds.

But there is a humourous side to Anukoon, too. He tells CONTAINMENT that malaria is also known as “khai-mae-yai-bua” in Thai, which means “fever that pisses your mother-in-law off!”

Anukoon explains. “When you have malaria, you can’t work to feed your family, and that’s when the mother-in-law becomes cross because her daughter and grandchildren would have to go hungry.”

The Malaria Clinic head in Khaeng Harng Maew District made it clear that the most vulnerable group to malaria are male wage earners.

“Because of this, my program gives advice on where these workers would be able to get mosquito repellents and insecticide-treated bed nets to prevent themselves from getting malaria,” adds Anukoon. The “Love Your Health” radio call-in program also tells these workers where the locations of the malaria clinics are and assures them that diagnosis and treatment is free of charge.

Though Anukoon believes that local people are very acquainted with malaria, its symptoms, and vector control and prevention measures, he, however, tells CONTAINMENT that they need to be reminded of the dangers of malaria during the rainy season.

Anukoon has been presenting “Love Your Health” for about five years and is now building up the capacity of his staff to co-host the show to add diversity to the radio program and also fill in as main presenters when he has to travel outside the district for meetings and workshops.

“My hope is that by building up the capacity of my staff as presenters, they would in turn be able to start their own malaria radio shows if they are promoted and transferred out of the district,” he explains.

But wearing two hats at one time can be tiring for Anukoon. “I frequently get calls from listeners asking me where I was in the previous week, for instance, because they didn’t hear my voice on radio,” he explains.

But the rewards are always gratifying. “Every week I get e-mails and calls from listeners telling me how much they enjoyed my show and how useful the health messages were to them,” says Anukoon. “That’s enough to keep me going.”

Written by malariacontainment

July 21, 2011 at 11:22 am

From Music to Malaria: Rural Radio Key for Malaria Education

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CONTAINMENT’s Moeun Chhean Nariddh profiles a popular interactive radio program on malaria education broadcast from Battambang.

Soeum Chamnan , the radio presenter in Battambang. Pix by WHO/sonny krishnan

As the sun sets in a late afternoon in Cambodia’s Battambang province, many housewives, shopkeepers, farmers and others stay glued to their radio sets to listen to music and songs played from FM radio stations along both sides of the Steung Sangke – a legendary river that was embroidered in many fond Khmer love songs and romantic music from the 1960s and 1970s.

Before too long, this entertainment comes to an abrupt end on the Chamkar Chek National Radio as the clock strikes 5pm.

Unlike the DJs at other private stations who continue playing music or singing karaoke songs along with their listeners, Soeum Chamnan at Chamkar Chek Radio is now engaged in a more serious radio show. She changes from entertaining her audience to helping save lives of people who are at risk of getting malaria.

For an hour from 5pm to 6pm, every Friday, Chamnan’s task is to coordinate a radio talk show, jointly produced by the USAID-funded Malaria Control in Cambodia, Equal Access and the National Malaria Control Center, during which listeners pose questions to experts about how to protect themselves and get treatment for the mosquito-borne disease. The radio program is also fully funded by USAID.

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Written by malariacontainment

July 21, 2011 at 10:42 am

Dr. Char Meng Chuor: ‘We Need Community Support to Eliminate Malaria’

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CONTAINMENT recently spoke to Dr. Char Meng Chuor the new Director of the National Center for Parasitology, Entomology and Malaria Control (CNM).

Dr. Char Meng Chuor. Pix by WHO/sonny krishnan

One big concern is malaria on the move. How important is the role of village malaria workers or VMWs in the early diagnosis and treatment of mobile migrant workers?

Yes, indeed, malaria on the move among mobile migrant workers is worrying. But first let me clarify one thing on terminology. I like to refer to the village malaria workers as community health workers because they can also work on other diseases at the community-level. At present in each health centers there are only seven to eight full-time health staff as first-line health workers. And as you know most of the villages are far from the health centers. So we need these community health workers to support the work of the health centers.

When Khmer people fall sick, they end to seek treatment from the nearest source available to them. And most often, these community health workers are nearest to them. For that reason they are so important in the fight to contain multi-drug resistant malaria. These community health workers not only carry out early diagnosis and treatment, but they also provide vital information to the mobile migrant workers on how they can protect themselves against malaria.

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?

First of all, we have to ensure that communities must have access to genuine medicines. This is essential. We can ban oral monotherapies, but if sick people do not know where to get effective anti-malarials, we will go back to square one. Secondly I need to emphasize the importance of law enforcement. The elimination of malaria by 2025 is a government priority and so it’s important that legislation is in place for the law enforcers to start the crackdown of counterfeit malaria medicines.

But let us not forget that we have to also work with the private sector through partnerships. We are now drafting the strategy for the public-private mix, in terms of malaria. We’re still in the learning process, when it comes to dealing with the private sector. But there’s a lot of donor goodwill to provide technical assistance. The chink in the armour is the private sector because most Khmers when they fall sick go to the pharmacies or drug stores first. We have to convince the private sector on why they need to be good and responsible providers to prevent a public health emergency that could cross borders.

What are the lessons learnt from the Containment Project, and how can these lessons be used as we move from malaria control to elimination?

CNM has been implementing the containment project since January 2009, and we have many lessons to share. The first and most important lesson is that it is possible to reduce malaria incidence in the target zones through good management and implementation of proven strategies in malaria control, such as high-level coverage of long-lasting insecticide treated bed nets, provision of free diagnosis and treatment at the community level, and engagement of the community through malaria education and awareness programs. CNM, through the support of the Bill and Melinda Gates Foundation and the assistance of technical partners such as WHO, Institute Pasteur and Malaria Consortium, and others, has helped us achieve this.

We have also found that, when malaria cases begin to decrease, the role of systematic gathering of health information, including malaria surveillance and response becomes very important. As malaria cases decrease in Cambodia and we are on our path towards elimination, we need to strengthen surveillance systems to capture information on cases up to the village level, and also concentrate on responding to increases in cases through distribution of bed nets and indoor residual spraying.

Another lesson learned is the need to engage and work closely with the private sector in order to be informed of those malaria cases treated by the private sector, in pharmacies and private clinics, and to provide incentives to the private sector to help in the fight against the sale and manufacture of artemisinin monotherapies, as well as fake and substandard drugs.

Also, we need to be sure to have the full support and participation of communities in the fight against artemisinin-resistant malaria, and also move towards elimination. This can be facilitated through wide-ranging media awareness campaigns, community mobilization through local community organizations and distribution of information, education and communication materials, as well as advocacy by involved leaders and authorities.