Testing for malaria while taking COVID-19 precautions in the Tanintharyi Region, Myanmar. Photo credit: URC

Defeat Malaria Activity

The Challenge

Like other countries in the Greater Mekong Subregion (GMS) of Southeast Asia, Myanmar has made remarkable progress in reducing malaria morbidity, mortality, and the threat of artemisinin resistance.

Despite these recent advances, malaria remains a leading cause of sickness and death in Myanmar. In 2018, the country’s malaria burden still accounted for 47% of reported cases in the GMS. Thus, there is an urgent need to eliminate malaria – particularly plasmodium falciparum malaria – from Myanmar. Eliminating this type of malaria from the GMS is likely to be the only way to halt the spread of multi-drug resistance and prevent the emergence of untreatable malaria.

Overview and Objectives

The USAID Defeat Malaria Activity draws on USAID’s investments in the Greater Mekong Sub Region – including through the USAID President’s Malaria Initiative (PMI) Control and Prevention of Malaria Project (CAP-Malaria), which also was managed by URC – as well as globally in malaria prevention and control, and ultimately elimination.

Defeat Malaria is a USAID and PMI activity that strengthens the local health systems to respond appropriately to changing malaria epidemiological situations, including multi‐drug resistance and insufficiently sensitive malaria testing in Myanmar. Defeat Malaria is completing this goal by working with the public and private sectors to ensure comprehensive, community‐based coverage of at‐risk populations with vector control and case management interventions.

Defeat Malaria works in regions of the country with high malaria incidence and hard-to-reach migrant groups. The project scales up proven interventions to ensure treatment compliance and identify cases of drug-resistant malaria using the public health system, village-based malaria workers, and private providers. 

The project’s approaches build capacity in early diagnosis and treatment, program management, and logistics. It also provides policy support to ensure an enabling environment to develop a model for eliminating malaria completely. Defeat Malaria is introducing innovations to accelerate successful treatment of drug-resistant malaria cases, integrated community case management, and real-time data reporting across the project.

URC is working with the Myanmar National Malaria Control Program (NMCP) and other government and non-government organizations to support policies that enable the development and implementation of malaria prevention and control models at the community level.

The project is implementing activities for a population of nearly 1.6 million people in 2,923 villages in 36 townships in Rakhine, Kayin, Tanintharyi, and Sagaing States/Regions.

Achievements

Testing and case finding: 915,316 people have been tested for malaria by village malaria workers (VMWs), private providers, mobile malaria workers, and mobile outreach teams supported by the Defeat Malaria; 14,260 positive cases were detected and 14,104 (99%) were treated, with virtually all of the cases following national treatment guidelines. In pilot elimination areas in FY 2019 and 2020, a total of 164 (or 93% of all) malaria cases detected were notified within 24 hours, of which 148 (or 88%) were investigated and responded to within seven days.

Health communication: 810,628 individuals have been reached through interpersonal communication and health talk sessions, including 116,706 migrant workers.

Local engagement and sustainability: 44 community support groups have been established in Rakhine State, Kayin State, and Tanintharyi Region. The project has implemented collaborative malaria elimination activities with the NMCP in Toungup, Ramree, and Munaung Townships of Rakhine State. The project supported the creation of Malaria Elimination Coordination Committees at the three townships and implementation malaria elimination plans of action.

Capacity building: 323 individuals have been trained as master mentors and general trainers on malaria elimination, community-based interventions, knowledge of other related diseases, and other skills; 7,526 VMWs, mobile malaria workers, and private providers received training on malaria parasitological diagnosis and case management. As malaria transmission declined in 2020, nearly 80% of the VMWs/private providers (PPs) deployed to the village level had not detected any malaria cases in a year. Therefore, VMWs/PPs have been further trained to become integrated community malaria volunteers (ICMVs), which provide more support to rural health centers and health staff. During FY 2020, 2,130 out of 2,168 VMWs/PPs (98%) have been transformed into ICMVs by receiving training on malaria diagnosis and case management for three days and other integrated diseases for two days.

Diagnostic and treatment commodities: 1,252,271 rapid diagnostic tests and 65,831 artemisinin-based combination therapy treatments have been distributed to Defeat Malaria storage sites to safeguard continuous and on-time delivery of malaria health care services.

Long-lasting insecticidal nets (LLINs): 961,428 LLINs have been distributed through mass and top-up distribution in villages and worksites, through antenatal clinics, to ethnic health organizations and to mobile and migrant populations.

Serving hard-to-reach populations: Defeat Malaria trained members of mobile worker populations to become mobile malaria workers. They are migrant workers, some of whom work in the remote forested worksites, who provide malaria prevention, diagnosis, and case management services. An ongoing formative assessment begun the project in March 2020 has found that forest goers had high acceptance and utilization of provided malaria prevention kits with LLINs and mosquito repellent.

Entomology: Twenty-seven vector borne disease control (VBDC) staff members attended entomological training in Sittwe in February 2020 with support from the project, the Rakhine State Health Director, the state VBDC Director, and an entomologist from the NMCP.

COVID: Defeat Malaria continued to implement project activities while adapting to COVID-19 guidelines from the Ministry of Health and Sports. The project: donated a total of 1,500 LLINs to COVID-19 quarantine centers in five townships; provided paper-based LLIN monitoring activity trainings to ICMVs with the involvement of communities; adapted training approaches to virtual platforms; replaced on-site supervision visits with short coaching at monthly small group meetings; and replaced case investigation in villages with tele-supervision by ICMVs.

Duration
2016–2022

Countries
Myanmar

Regions
Asia

Expertise
Health Service Delivery, Malaria, and Quality Health Systems

Funders
U.S. President’s Malaria Initiative (PMI) and USAID

Partners
American Refugee Committee, Duke Global Health Institute, Jhpiego, Myanmar Health Assistant Association (MHAA), Myanmar Nurse and Midwife Association (MNMA), and University of Maryland