Cambodia Malaria Elimination Project 2 (CMEP2)

The Challenge

Cambodia has not experienced a confirmed malaria death since 2018 and the malaria cases have decreased by 97% between 2000 and 2022.

But challenges remain in preventing malaria re-introduction in elimination areas and scaling up elimination efforts nationally and within specific high-risk populations, such as forest workers and mobile and migrant populations.

Overview and Objectives

The Cambodia Malaria Elimination Project 2 (CMEP2) builds on URC’s nearly two decades of working with Cambodia’s National Center for Parasitology, Entomology, and Malaria Control to eliminate malaria and control the development and spread of drug-resistant malaria in the Greater Mekong Subregion.

The goal of CMEP2 is to eliminate malaria and prevent its re-introduction in target provinces, contributing to nationwide elimination and achievement of the Cambodia Malaria Elimination Action Framework 2: A Malaria-Free Cambodia and leading efforts towards self-reliance and sustained, self-financed malaria programming.

CMEP2 works to:

• Detect, effectively and safely treat, and follow up on all malaria cases and provide personal protection to high-risk populations;
• Strengthen national malaria surveillance and monitoring and evaluation systems appropriate for malaria elimination and control activities as well as prevention of re-introduction; and
• Build Cambodian health staff capacity to manage, intensify, and sustain malaria control and elimination efforts, especially at the provincial and operational district levels.

The activity works in six provinces: Pailin, Batambang, Pursat, Kep, Kampot, and Koh Kong – which are supported by PMI malaria elimination activities.

Achievements

In 2000, Cambodia experienced 129,167 malaria cases and 897 deaths. However, 2022 was the fifth year in a row without a malaria death in the country and cases declined to 4,053 – a 97% reduction from 2000.

CMEP2 continues to contribute to the reduction of malaria cases and move toward eliminating Plasmodium falciparum (Pf) malaria by 2023, and all species of malaria, including Plasmodium vivax (Pv), by 2025 and prevention of re-introduction and reestablishment (POR).

CMEP2 also is focusing on transition of ownership and responsibility for service delivery from the project to government counterparts. Operational districts increasingly plan, implement, and monitor activities, with the project providing technical assistance and capacity building. 

Highlights of the malaria situation in Cambodia and CMEP2 project achievements during its first two years include: 

• The malaria incidence rate decreased to 0.26/1,000 people in 2021 from 0.56/1,000 in 2020, according to the national malaria information system. No malaria deaths have been reported in Cambodia since 2018. This is despite an estimated 58% of the total population (9.3 million people) living in malaria-endemic areas in 55 operational districts within 21 provinces.
• For Pf malaria, incidence decreased to 0.02/1,000 in 2021, down from 0.05/1,000 in 2020. Pv incidence decreased by half to 0.24/1,000 people, compared to 0.51/1,000 in 2020.
• Every confirmed malaria case in the country was treated according to national treatment guidelines and 95% of the cases were handled by the 1-3-7 approach: case notification on day one, 100% case investigation/classification and response by day three, and foci investigation by day seven, then continued by foci management for any identified active foci.
• An unusual increase in Pf  cases in Pursat in 2022 triggered an immediate response by the project in close consultation with Cambodia’s national malaria program and other stakeholders. Among other project interventions in Pursat, CMEP2 introduced intermittent preventive treatment for forest goers (IPTf), implemented with an encouraging success rate on both coverage and adherence. Since last December 2022 till now, no single Pf malaria case occurred in Pursat.
• Through strengthening microscopy diagnosis, CMEP2 supported areas can detect the non-Pf/Pv malaria species, which cannot be detected by the current rapid diagnostic test (RDT). Those species include Plasmodium malaria (Pm) and Plasmodium knowlesi (Pk).
• The project conducted a social behavior change rapid assessment in the six targeted provinces in early 2023. The rapid assessment explores existing malaria SBC tools, messages, media, and approaches used by the CMEP2 and assesses the potential for innovative SBC tools, messages, media, and approaches to complement the above-mentioned inventory.