By Roseanne Gerin
Instances of malaria in remote and rural locations in Myanmar have fallen dramatically during a six-year period as a result of trained community health care workers providing a wider package of services along with screenings for the disease transmitted by mosquitoes in tropical regions, a study has found.
When local health care workers began offering more comprehensive services, including screenings and treatments for tuberculosis, respiratory tract infections, malnutrition, and diarrhea, along with malaria, the overall health of villagers improved as did malaria control, according to the study published on Oct. 22 by the online medical journal BMC Medicine.
Villages where health care workers provided malaria diagnosis and treatment saw a 70-percent drop in incidences of Plasmodium falciparum, the deadliest of the five species of malaria parasites that commonly infect humans, which is responsible for roughly half of all cases of the disease, Oxford University-affiliated researchers said in the study.
The villages, many of which have no formal health care clinics, also saw a 64-percent drop in Plasmodium vivax, a less virulent strain, they said.
“To maintain effective malaria control in hard to reach areas, village health workers were trained both to screen and treat malaria and to handle other common health care needs,” said study author Frank Smithuis, director of the Myanmar Oxford Clinical Research Unit and the NGO Medical Action Myanmar (MAM) in Yangon.
“This significantly reduced malaria transmission and kept patients coming in to be screened for malaria, which is essential if we are to eliminate malaria in Myanmar,” he said in a printed statement.
The study was based on a review of more than a half-million malaria rapid diagnosis tests conducted between 2011 and 2016 by more than 1,300 community health care workers, supported by MAM and Myanmar’s Department of Public Health under the Ministry of Health and Sports.
Offering villagers in isolated communities a package of basic and high-standard health care services is crucial to preventing resurgences of malaria, said Alistair McLean, the report’s lead author, in a printed statement.
The analysis was funded by six organizations — The Global Fund to Fight AIDS, Tuberculosis and Malaria; the 3 Millennium Development Goal Fund; Planet Wheeler Foundation; Kadoorie Charitable Foundation; DAK Foundation; and the Wellcome Trust.
Myanmar’s malaria burden
Incidences of malaria in Myanmar — the country in the Greater Mekong Subregion with the greatest burden of the disease — declined remarkably between 2010 and 2017, according to best estimate figures in the World Health Organization’s (WHO) latest “World Malaria Report.”
About 142,600 cases, resulting in 240 deaths, were recorded in 2016, down from roughly 2.16 million cases that led to 4,000 deaths in 2010, the report said.
The WHO has set a 15-year strategy for controlling and eliminating malaria by 2030, including reducing case incidents and death rates by at least 90 percent, ridding at least 35 countries of the disease, and preventing the reintroduction of malaria in countries that are malaria free.
Support and funding from the Myanmar government and international partners for the deployment of tens of thousands of community health care workers, the increased use of insecticide-treated bed nets by vulnerable populations, and significant efforts to improve access to artemesinin-based combination treatment have contributed to the decline of malaria in Myanmar, researchers say.
Derived from a plant used in ancient Chinese herbal therapy, artemisinin quickly reduces most malaria parasites, while a partner drug clears out remaining ones.
Private-sector companies have also joined government efforts in the long-running battle against malaria.
In Myanmar, YOMA Strategic Holdings Ltd., a Singapore-based investment holding company with an office in Yangon, teamed up in August with the Asia Pacific Leaders Malaria Alliance), an affiliation of Asian and Pacific heads of government, to work on eliminating malaria by 2030, state-run Global New Light of Myanmar reported.
The public-private partnership is conducting awareness campaigns and holding fundraising events around the country for the malaria elimination program, led by the Ministry of Health and Sports, the report said.
Despite a huge reduction in malaria cases and deaths in the Greater Mekong Subregion — an area bound together by the Mekong River that includes Cambodia, China’s Yunnan province and Guanxi Zhuang Autonomous Region, Laos, Myanmar, Thailand, and Vietnam — resistance to artemisinin and partner drugs have been reported in five countries, including Myanmar, posing a threat to continued progress towards malaria elimination.