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World Malaria Day 2013: URC CAP-Malaria Project Takes an Unconventional Approach to Malaria Control in the Mekong
Traditional malaria control interventions are unlikely to be effective in fully eliminating malaria, reports an April article in the Lancet: "As countries reduce their malaria burdens, strategies that address the changing epidemiology, entomology, and anthropology need to be developed, validated, and adopted." One area on the verge of eliminating malaria is the Greater Mekong sub-region, which has seen a rapid drop in malaria cases during recent decades.
The Control and Prevention of Malaria Project (CAP-Malaria), funded by the President's Malaria Initiative (PMI) and implemented by URC in collaboration with Save the Children and Kenan Institute Asia, is working with governments and other malaria control partners to systematically control malaria in affected border regions of Thailand, Cambodia, and Burma (also known as Myanmar), aiming to contain the spread of multi-drug resistant malaria in the Greater Mekong Sub-region.
In Cambodia and Thailand, malaria is isolated in pockets of small geographical areas; found most often in adult men; and is more likely to be of the P. vivax species, which is harder to detect and treat. An additional complication is the emergence of resistance to artemisinin, a common anti-malarial drug. Another Lancet study, published last year, found an increase—from 0.6 percent of surveyed patients to 20 percent—in drug resistance along Thailand's border with Burma (Myanmar) during the decade of study research. According to the World Health Organization (WHO), artemisinin-resistant malaria has also emerged in southern and central Vietnam and in southeastern Myanmar.
The project has developed innovative approaches to reach vulnerable populations in pockets of continuing malaria. Vulnerable populations include not only the residents, but also temporary workers such as agricultural laborers and workers at development sites. These workers tend to be highly vulnerable to malaria and to lack access to local health services and can potentially spread malaria to their home communities in less-endemic areas. CAP-Malaria reaches out to migrant and mobile populations when they first arrive in the high-risk area on buses and taxis. The project has trained bus and taxi drivers to provide passengers with malaria information and given them materials such as a CD and DVDs with malaria messages interspersed with entertainment.
A taxi driver in Battambang placed a malaria sticker on his car to provide passengers and passers-by with malaria information. Photo by Lina Kharn.
To protect migrant and mobile workers, CAP-Malaria is applying a bednet lending scheme in collaboration with local employers. The project gives long-lasting insecticide nets (LLINs) to employers, who then lend the nets to their employees for the season. At the end of the season, the employer collects the LLINs and retains them for the next season's workers. CAP-Malaria also supports broader LLIN distribution campaigns in key geographic areas.
CAP-Malaria has trained malaria volunteers to provide malaria education and help community members recognize malaria symptoms, diagnose malaria, treat simple malaria, and refer severe cases, pregnant women, and children under five to health centers. The training urges volunteers to provide counseling on the importance of treatment adherence: poor adherence can result in drug-resistant malaria. Some volunteers are permanent residents in the area; others are long-term migrants themselves who are well connected with the migrant network and can better reach other migrants.
For more information, visit the CAP-Malaria project website.
CAP-Malaria trainer Dr. Bo Bo Thet shows migrant malaria workers in Ranong, Thailand, how to use a rapid diagnostic test. Photo by Darin Kongkasuriyachai.