CHAI experts meeting with IMPE-QN.

In the morning of May 17, 2016, the Institute of Malariology, Parasitology and Entomology Quy Nhon (IMPE-QN) gave a warm reception to the Clinton Health Access Initiative (CHAI), operating through the Bill, Hillary and Chelsea Clinton Foundation in Vietnam.

In order to better understand how to help Vietnam continue its progress in becoming malaria free and to explore the opportunities to enhance collaboration at regional level, CHAI offered a visit to and meeting with the Institute. The CHAI's mission members included Mr. Ngo Huy Dang (U.S citizen) - Country Director of CHAI in Vietnam, Dr. Cao Thi Thanh Thuy (Vietnam citizen) - Associate Director, Mr. Joseph Michael Novotny (U.S. citizen) - Malaria Regional Manage, and two malaria associates. The Institute representatives welcoming and working with the CHAI delegation were Assoc.Prof. Nguyen Van Chuong - Director, Assoc.Prof. Ho Van Hoang - Vice Director, Dr. Huynh Hong Quang, Ph.D - Vice Director and relevant department leaders.

O­n behalf of the delegation, Mr. Ngo Huy Dang - Country Director gave presentation o­n the current activities of CHAI in the field of malaria control in Vietnam. Since 2007, CHAI has provided direct management and technical support to governments around the globe to assist them in scaling up effective interventions for prevention, diagnosis, treatment, and surveillance. This work includes devising context-adapted, resource optimized plans; strengthening malaria programs; and accelerating progress towards malaria elimination. CHAI believes malaria elimination is possible with currently available tools throughout much of the world today, but it will require substantial investment in improving systems to identify where transmission is occurring, how parasites are moving across regions, and identifying the most sustainable, cost-efficient packages of interventions for specific contexts.

In an effort to work towards eventual elimination in all contexts, CHAI assists some of the countries with the highest malaria burdens in the world to procure and distribute affordable, effective drugs and improve the efficiency with which they implement preventative interventions. CHAI supports countries with moderate or evolving malaria burdens to scale up access to diagnostic testing to ensure limited resources are used effectively, and to target interventions to where they are truly needed. In lower burden countries in Central America, Southern Africa, and Southeast Asia, CHAI works to strengthen surveillance activities and devise new strategies for ending malaria transmission permanently.

CHAI is currently providing operational and management support to improve the effectiveness of malaria programs in Botswana, Cambodia, Cameroon, Guatemala, Haiti, Honduras, Kenya, Laos, Malawi, Mozambique, Myanmar, Namibia, Nigeria, South Africa, Swaziland, Tanzania, Uganda, Vietnam, Zambia, and Zimbabwe.

CHAI-supported successes have included:

• Preventing approximately 20,000 children from becoming sick with malaria in northern Nigeria through seasonal distribution of prophylactic drugs during the 2014 malaria season
• Supporting six countries in sub-Saharan Africa to switch to a superior treatment for severe malaria, which reduces mortality in children under 5 years old by over 20 percent
• Negotiating 50-75 percent reductions in the price of accurate rapid diagnostic tests to improve the treatment of suspected malaria in East Africa
• Piloting methods for increasing the availability of diagnostic testing in Tanzania, which has the potential to reduce unnecessary ACT use by millions of treatments
• Supporting the government of Swaziland to reach an all-time low malaria incidence of 84 locally acquired cases in 2013-2014
• Assisting Namibia to dramatically improve testing and reporting of malaria and reduce malaria from over 14,000 reported cases in 2011 to under 3,000 in 2013
• Completing a pilot to introduce mRDTs to Accredited Drug Dispensing Outlets (ADDO) in Tanzania. Study results showed that mRDT testing in ADDOs is a safe and effective way to dramatically increase malaria testing before treatment. Two-thirds of fever patients chose to purchase a malaria test, and over 80 percent adhered appropriately to the result. o­n the basis of these results, a national policy change has been approved by the relevant working group to permit the sale of mRDTs in ADDOs across the country.

Assoc.Prof. Nguyen Van Chuong - Director highly appreciated the CHAI's malaria activities in Vietnam. o­n behalf of the Institute, Dr. Chuong delivered an overall introduction of IMPE-QN and its malaria control and elimination plan period 2016-2020. In the past few years, IMPE-QN and the health sectors of the Central region-West Highlands provinces have devoted a great deal of efforts in the malaria control activities. In the five-year period (2011-2015) the nationwide malaria indexes have declined dramatically, particularly the morbidity and mortality rates decreased by nearly 60% and 80% respectively, and no malaria outbreak occured. Especially, the malaria indicators in Central Vietnam in 2015 have all reduced compared to 2011, namely malaria patients by 53.78% (7,644/16,539); malaria parasites by 42.71% (6,501/11,348); severe and complicated malaria by 84.38% (15/96); malaria deaths by 5 cases (1/6), no malaria outbreak occured.

However, Central region-West Highlands has had complicated malaria characteristics and high risk of malaria resurgence, especially in remote, mountainous and border areas. The people in some areas do not have awareness of self-protection against malaria infection, not actively go to medical facilities for examination and treatment as having fever, leading to severe complications and death. Almost malaria infected cases and malaria deaths in the whole country have mainly concentrated in the mobilized population groups such as free migrants, forest goers, border crossers, etc. P.falciparum has already developed resistance to the highly-effective antimalarial drug Artemisinine in Binh Phuoc, Dak Nong, Gia Lai, Quang Nam and Khanh Hoa; more dangerously, there is high risk of more widespread resistance due to medically uncontrollable movements. Beside that, there still exists many challenges in malaria control, for examples malaria mosquitoes change the ecological acitivities and resist insecticides, along with the impact of global climate changes that create reasonable conditions for malaria developing and increasing dramatically.

At present, IMPE-QN has drawn up a plan for malaria control and elimination in the period 2016-2020 and by 2030. The goals and targets of malaria control and elimination in the period 2016-2020 and by 2030 as follows:

By 2020:

-      To break off P.falciparum malaria transmission in drug-resistant areas;

-      To reduce rate of malaria parasites (MP) in highly-transmitted areas less than o­ne malaria case per 1000 malaria-endemic population;

-       No province in the active malaria control stage;

-       04 provinces o­n the alert for malaria resurgence;

-       08 provinces in the malaria elimination stage;

-       03 provinces entering the malaria pre-elimination stage in 2020.

By 2030:

-       To eliminate P.falciparum by 2025;

-       To eliminate malaria in 15 provinces of Central region-West Higlands by 2030.

Along with the above-mentioned goals and targets of malaria prevention and elimination, the Institute has also launched the malaria prevention strategy of the Central region-West Highlands period 2016-2020 with an update of WHO's Global Technical Strategy for Malaria period 2016-2030; to determine the stages of malaria prevention, elimination for the regional provinces and districts; to identify milestones to be achieved in each stage so as to apply measures of controlling and eliminating malaria conformable to each stage; to provide training for the provincial health workers so that each province could consider which stage it is currently in, elimination or pre-elimination, then planning the launching campaign for malaria elimination.

CHAI experts meeting with IMPE-Quy Nhon

The Institute staff members and CHAI experts also proposed and discussed some potential cooperation activities, such as enhancing monitoring systems: case monitoring (case reports, case investigations), drug-resistance monitoring (by PCR), entomological monitoring (species characteristics and composition, insecticides resistance, etc.), supervision of the ability to detect malaria cases, monitoring of diagnosis and treatment capacity of health staff at grassroots level, supervision of health communication and education in malaria control; improving the effectiveness of health communication and education activities by building communication materials (posters); providing training o­n mapping, data processing; carrying out research o­n new anti-malarial drugs (Tafenoquine), etc.

The visit has brought an opportunity for the cooperation between the Institute and the partner Clinton Health Access Initiative (CHAI) in the coming time.

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