contain + eliminate = no parasite

Malaria outbreaks continue in Lao PDR

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Despite the fall in malaria cases from the peak in 2012, outbreaks continue in Saravan and Champasack provinces with artemisinin resistance confirmed in Champasack and Attapeu.


There is an urgent need to control outbreaks of malaria in the southern provinces of the Lao People’s Democratic Republic and contain artemisinin resistance currently emerging there.

Dr Bouasy Hongvanthong, Director of the Centre for Malaria Parasitology and Entomology (CMPE), made this appeal at the technical consultation on improving access to malaria control services for migrant and mobile populations held in Hanoi, Viet Nam on 22 May 2014.

“Outbreaks have been happening since late 2011 in the southern provinces of Attapeu, Champasack, Saravan, Sekong, and Savannakhet, “ Dr. Bouasy told the meeting. “Despite the fall in cases in 2013 compared with 2012, the outbreak continues in Saravan and Champasack,” underlined Dr. Bouasy.

Since late 2011, malaria outbreaks began mostly in southern provinces, with Lao PDR reporting 17 deaths. In 2012, the number of deaths rose to 44 but fell to 28 in 2013. In 2009, only five deaths among 22 784 confirmed cases of malaria were reported in Lao PDR compared with 600 deaths and 70 000 confirmed cases in 1997. Between 2000 and 2011 Lao PDR had a rapid decline in malaria incidence and was in line to achieve its MDG goals.

Lao PDR malaria deaths

“The sharp rise in deaths and cases is attributable to increased population movement into areas of large infrastructural development projects, plantations and forests for economic reasons,” Dr. Bouasy pointed out. “Artemisinin resistance is now confirmed in Champasack and Attapeu provinces and we are developing an artemisinin resistance containment strategy,” he revealed.

In the outbreak response by CMPE and Health Poverty Action between 2012 and 2013 in Attapeu and the affected southern provinces, with financial support from WHO, the European Union, the Global Fund and USAID/PMI, 2 500 malaria patients were detected during an intensive screen and treat programme in identified malarious villages. Also, 28 900 long-lasting insecticide treated nets (LLINs) and 6,673 long-lasting insecticide treated hammock nets (LLIHNs) were distributed in Attapeu. In addition, using pooled contributions from donors, 12 673 LLIHNs were distributed at affected villages in the southern provinces.

“At the community level, 150 new village malaria workers were trained to carry out early diagnosis and treatment in villages in the high malaria transmission areas and indoor residual spraying (IRS) was carried out in 30 high-risk villages,” said Dr. Bouasy. Also, said Dr. Bouasy, village health volunteers (VHVs) that provide primary health care services, including diagnosis and management of basic diseases “have been reactivated to carry out early diagnosis and treatment of malaria.”

As part of an intensive health education campaign, CMPE and WHO jointly produced, during the 2012-2013 outbreak response, roadside banners, billboards and posters with malaria preventive messages in Lao, Chinese and Vietnamese languages. Lao PDR is a small landlocked country bordering Thailand, Cambodia, Viet Nam, China and Myanmar. While there is considerable out migration to neighboring countries there is also an increasing number of migrant workers entering Lao PDR from Viet Nam and China to work in development projects.

In late April a WHO team comprising members from the Emergency Response to Artemisinin Resistance (ERAR) regional hub and the Cambodia and Lao PDR country offices were in the capital Vientiane for a crucial one-day consultation to assist CMPE identify crucial areas for intervention to achieve malaria elimination, as it prepares to finalise the National Malaria Strategic Plan (NSP) 2015 – 2020.

The need to have cross border collaboration as a key strategy in the NSP was recommended by the ERAR regional hub. Lao PDR shares common borders with five Greater Mekong Subregion (GMS) countries and malaria remains particularly endemic in remote, forest and forest fringe areas, which often occur along these borders.

“Malaria is often more difficult to control in these border areas due to the more inaccessible terrain, and because of unknown population movements across the borders. Most of those crossing the borders are adult men engaged in plantation work, large infrastructure projects and forest activities that expose them to outdoor biting vectors,” Dr. Bayo Fatunmbi, a technical officer with the ERAR regional hub, told the NSP consultation.

ERAR also expressed its support and agreed to provide technical assistance for the development of an artemisinin resistance containment and elimination strategy in the NSP.

The relocation of local villagers and influx of labour migrants from surrounding provinces and countries continue to present challenges to those working in the field of malaria elimination, as Lao PDR continues to open its doors to foreign investors in many large-scale development projects including hydropower, mining, commercial agriculture, infrastructure and rural development.

“These rapid economic developments in Lao PDR are changing the patterns of malaria transmission,” said Dr. Bouasy.

“Population movements into the forest to clear the area for development, or in search of food and forestry products have to be addressed and these workers need to be educated on malaria prevention and how to seek treatment if they fall sick,” he added.

Health Poverty Action is currently carrying out a qualitative study to better understand the malaria care-seeking and preventive behaviors among the at- risk mobile and migrant populations in Pathoumphone and Taoy districts of Champasack and Saravan Provinces. This study will lead to the development of a behavior change communication strategy to improve the personal protection behaviors of the at-risk populations.

“There is currently a lack of understanding about mobile migrant populations in Lao PDR related to their migration patterns, frequency of forest related travel, work routines, knowledge and behaviours regarding malaria prevention and protection measures and treatment-seeking behaviours,” said Dr. John Holveck, the Lao PDR Country Director of Health Poverty Action.

CMPE’s Dr. Bouasy pointed out that engaging the private sector is crucial in providing diagnosis and quality treatment to mobile populations that are often located in remote areas and are difficult to target and access for surveillance. In Lao PDR, patients first sought care from private providers in 63% of fever cases. In particular, private retail outlets, such as drug shops and kiosks, play an important role in the provision of malaria medicines.

Funded by the Global Fund, with technical support from WHO, the Public Private Mix (PPM) for malaria diagnosis and treatment started in September 2008 in eight districts of four target provinces. The main objectives were to increase coverage of services and reduce the availability of counterfeit anti-malarials in the private sector. Initially a total of 98 private pharmacies and 10 physicians from private clinics were trained to use rapid diagnostic test kits (RDTs) and ACTs for diagnosis and treatment of uncomplicated malaria.

Today, the PPM initiative has been expanded to include expanded to include eight provinces, 22 districts, 17 clinics and 242 private pharmacies as part of the continuous efforts made by CMPE to extend its network and reach.

“This a great achievement in reaching out to local communities using the private sector,” said Dr. Bouasy.



Written by malariacontainment

June 19, 2014 at 10:31 am

Posted in Uncategorized

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