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In Cambodia effective case management leads to decline in malaria deaths
Malaria is both preventable and treatable. Yet, in Cambodia, an estimated 1.6 million people are at risk of malaria and about half a million of these live in the high transmission forest areas. The disease is life threatening and needs early, accurate diagnosis and treatment, which can be difficult in remote areas that lack clinics, trained health care providers, technical assistance, or medicine. Between 2000 and 2015, the rate of new malaria infections declined globally by an estimated 37 percent. Over the same period, the global malaria death rate fell by 60 percent. Equally encouraging, an increasing number of countries have moved towards malaria elimination, including Cambodia.
The CAP – Malaria Project strives for systematic control of malaria in affected border regions of Myanmar (Burma), Cambodia, and Thailand, aiming to contain the spread of multi-drug resistant P. falciparum malaria in the Greater Mekong Sub-region. Two of the project’s strategic approaches include early diagnosis and appropriate treatment, particularly through community-level networks; and capacity building of local partners to manage malaria control activities, ranging from improved supportive supervision to increased laboratory capacity.
Effective malaria case management has proven successful in reducing mortality in many countries, including Cambodia. CAP-Malaria strengthens networks of village malaria workers (VMWs), and links them with the public health system for improved service provision and monitoring of cases. Trained VMWs are equipped with malaria rapid diagnostic tests (RDTs) to test people who are suspected of having malaria and treat them with antimalarials in their homes, ideally within 24 hours of onset of fever. VMWs can effectively reach communities in remote areas, particularly women, children, and mobile and migrant workers with malaria prevention education, RDTs, and treatment. VMWs refer complicated cases to health facilities for further follow-up and treatment. CAP-Malaria also provides training and job aids to health providers for case management, including severe malaria management. This improves laboratory services and supports their involvement in the national quality assurance system.
In Oda Meanchey Operational District (OD), one of CAP-Malaria’s target ODs, the lab at Anlong Veng health facility previously tested 5-10 malaria samples per day with a combination of negative and positive results. After case management and microscopy trainings conducted by CAP-Malaria, the health facility has seen an increase in the number of positive samples. This is not due to a higher number of infected individuals, but is the result of improved capacity of VMWs, health center staff, and laboratory workers and an increase in case detection and overall case management. CAP-Malaria-developed guidelines and job aids can be found in the health facility and are being followed by the staff.
From September 30 – October 1, 2015, Anlong Veng Hospital received three positive patients who visited the facility because they had fever and suspected malaria. All three patients tested positive for malaria and were placed on treatment the same day. Thanks to CAP-Malaria awareness activities and behavior change communication BCC conducted by VMWs, villagers are now more conscious of malaria symptoms and the need to be diagnosed early and placed on treatment. Not only did the three patients visit the clinic on their own accord, they also went early avoiding late stage or complicated malaria.