Map of the provinces having migrant populations at study sites.

I. Background

          Malaria is the fifth leading cause of death from infectious diseases worldwide, some countries in the world have considered it as their national major public health problem. In 2011, according to the WHO's report, malaria is the fifth deadliest cause in some underdeveloped countries and received considerable concern due to its resistance to Artemisinin in Africa and Asia. It creates economic burdens for the governments and communities where it becomes an endemic disease, resulting in the vicious circle of poverty. In 2010, nearly 13% of the malaria cases were reported in Southeast Asia. The WHO's report in 2012 showed that the malaria confirmed cases were 57,423 in Cambodia; 567,452 in Myanmar; 24897 in Thailand; 17,904 in Laos and 45,488 in Viet Nam. Among of these, o­nly 5% clinical malaria cases were recorded in the Greater Mekong Subregion (GMS).

           The connection between border exchange and malaria transmission has been reported in some countries' borders including Thailand - Myanmar, Thailand - Cambodia, Laos - Yunnan (China) and Laos - Viet Nam. The results of some studies showed that the human movements poses a high risk of malaria transmission and drug-resistant malaria for the mobilised populations back and forth in malaria endemic areas. The malaria transmission is usually found in deep-lying and remote areas with the natural characteristics of the forest and the migrants' exposure to malaria not o­nly occurs o­n their migrating way but also in their workplaces, for examples gold mines areas of forest product exploitation. The mobilised people's infection of malaria is mainly due to their lack of knowledge and skills in protecting their health, including the minimum knowledge about the factors affecting their health, impacts of migration to their health. They live and work without essential material facilities and health-care conditions because of high cost of the private health care services. Consequently, they usually apply self-medication as geting sick and donot comply with any guidelines, which increases the risk of drug resistance or resistance to monotherapy Artemisinin. Some reports showed that thousands of people have travelled between malaria epidemic and non-epidemic areas everyday in the Greater Mekong Subregion.

           In Viet Nam, the Government and the World Health Organization (WHO) have launched the action plan for malaria control since 2000 with the objectives of reducing the malaria morbidity by 81% and malaria mortality by 86%. The National Malaria Control Program has implemented the National Malaira Control and Elimination Strategy from 2011 to 2020, consisting of vector control, treatment and distribution of long-lasting residual insecticide treated bed-nets. However, the results of these efforts have been affected by the resistance to Artemisinin along the borders between Vietnam and some neighbouring countries, typically in the West Highlands provinces of Dak Lak and Dak Nong where have the common border with Cambodia since 2009.

         Some recent reports showed that Dak Lak and Dak Nong are the two West Highlands provinces that have complicated movements of mobilised populations due to the following causes:

- Dak Lak and Dak Nong have huge area of natural forest, a large number of people from other provinces travel to these two provinces to search land for agriculture spontaneously, which makes the local authorities and the health sectors difficulty to control and manage these mobile population.

- Their incomes mainly come from agricultural activities, hired labour coming from other provinces accounts for a huge proportion, the people of these two provinces also have border exchanges with Cambodian people in trading and exchanging goods.

        In spite of the effort of the Vietnamese government and some international organizations, Dak Lak and Dak Nong are still the highly endemic provinces of malaria and the Vietnamese areas with the resistance of P. falciparum to Artemesinin.

         In order to provide a general description of the movement of mobilized people and some epidemiological characteristics of the connection between risk of malaria infection and mobilised groups' movement in Dak Lak and Dak Nong, thereby proposing several appropriate antimalarial measures for these populations, we carried out this survey with the targets as follows:

Specific targets:

1. To identify the demographic/ethnological characteristics of mobile population;

2. To identify the living location, movement patterns of the mobile population;

3. To identify the malaria prevalence of mobile population in the malaria endemic areas and provided health care services;

4. To analyse some relevant factors to malaria contracting risk;

5. To make the map of mobile population in studied site of Dak Lak and Dak Nong province.

· Participating units in the study:

- Major units: Staff of Department of Epidemiology, Institute of Malariology, Parasitology and Entomology Quy Nhon

- Other units:

1. Dak Nong Provincial Center of Preventive Medicine;

2. The Provincial Malaria Control Centre of Dak Lak;

3. Tuy Duc district Medical Center;

4. Dak R'Lap district Medical Center;

5. Buon Don district Medical Center;

6. Ea Sup district Medical Center;

7. Health Stations of Dak Buk So, Quang Truc, Dak Sin, Dak Ru, Ea Huar, Krong Na, Cu M'Lan and Cu K'Bang communes.

II. Duration and location

2.1. Duration: From October 2016 to November 2016

2.2. Location:

         Dak Lak and Dak Nong are the two Western Highland provinces which have common border with Cambodia. Simultaneously, both provinces are parts of the Artemisinin resistant areas (Dak Nong belongs to Tier 1, Dak Lak belongs to Tier 2).

         At 8 chosen communes distributing in 4 districts (2 communes are chosen in each district): Tuy Duc and Dak Rlap (Dak Nong); Ea Sup and Buon Don (Dak Lak).

1. In Tuy Duc (Dak Nong): Quang Truc (Zone V), Dak Buk So (Zone V).

2. In Dak R'Lap (Dak Nong): Dak Ru (Zone IV) Dak Sin (Zone V).

3. In Buon Don (Dak Lak); Krong Na (Zone V), Ea Huar (Zone IV).

4. In Ea Soup (Dak Lak); Cu M'Lan, Cu K'Bang (Zone V, according to epidemiological distribution 2014)

Fig 1: Administrative map of the study site

III. Some characteristics of the study sites:

3.1. Some characterisitcs of demographic and human movement:

- In addition to the major ethnic group of Vietnam (Kinh ethnic group), other ethnic groups also appear in those two provinces. The major ethnic groups of Dak Lak are E de, M'Nong and Jrai, other ethnic groups are: Tay, Nung, Muong, Dao, Thai, H'Mong, etc. The major ethnic groups of Dak Nong are M'Nong, Nung and H?Mong, other ethnic groups are Tay, Muong, Dao, Thai, etc.

- Dak Lak has a population of nearly 1,857,000 people in 2014. The number of people has migrated to Dak Lak in 2014 is 290,000 people of 67,000 households. Dak Nong has a population of 551,000 people in 2014. The number of people has migrated to Dak Nong in 2014 is 25,000 people of 5,700 households.

- The main economy of the two provinces is agriculture with some industrial trees such as cashew, rubber tree, coffee tree and pepper.

- The Preventive Medicine System inculudes: Provincial Center of Preventive Medicine/Provincial Center of Malaria Control/district Medical Center, commune Health Station, Village health workers, Private Health services.

- According to the report o­n the results of Malaria Control Activities of IMPE-Quy Nhon in 2015, among 1000 malaria cases, 779 cases are positive with malaria parasites; and 1 death case in Dak Lak. In Dak Nong, 380 malaria cases were reported, of which 379 cases infected with parasites and no death case was reported. The malaria control measures were deployed include: treating malaria parasite and vector control.

3.2. Some malarial epidemiological characteristics of those communes:

- High proportion of malarial mortality and morbidity;

- Artemisinin-resistant parasites appeared (zone 1 and zone 2, according to distribution of antimalarial drug resistance 2011);

- Have common border with Cambodia;

- Large number of mobile population.

IV. Methods of survey:

a. Sampling methodology:

- The mobile population arrived and settled in the settlement areas and in the clusters of houses. In some areas, this group lives in the same hamlet with the local people, which makes it difficult to estimate accurately the migrants or the migrating households. Therefore, the communes/hamlets/households and individuals in the study sites will not be chosen randomly.

- Sample size: It is estimated that there are about 300-600 mobile migrants/commune, about 45%-60% of these people will be picked to be interviewed. Hence, after rounding up, in each commune about 200 - 250 mobile migrants will be picked to be interviewed and have their blood sample taken.

- Respondents: the people who lived in the community in at least o­ne week to o­ne month and age from 15 - 60 years old.

b. Techniques of collecting data:

- Retrospective study of the malaria situation, inhabitant characteristics and some characteristics of mobile population.

- Face-to-face interview door by door to collect demographic data and some characteristics of the people.

- Blood examination to detect Malaria Parasite and rapid diagnostic Test to identify Malaria Parasite: Each commune (200-250 people) is equal to 40-60 households, of which 30% samples is tested by PCR method.

- Observing, describing, collecting data o­n mobile population and make the map of mobile population. All communes will be collected to make the map of mobile population by GPS technique.

V. Some applications of the study outcomes:

1. Identify some risk factors of the mobile population and provide recommendations for the Malaria Control Program for the mobile population and the impacts of human movement o­n the communities of the two provinces in the near future.

2. In Viet Nam, malaria has reduced, malaria mortality and morbidity rates have decreased since 2011, the Ministry of Health has issued Decision No. 1920/Q?-TTg o­n October 7^th, 2011 by the Prime Minister and National Malaria Control and Elinimation Strategy in the period of 2011 - 2020 towards 2030 (approved by the MoH), simultaneously attached with monitoring guideline in Malaria Control and Elinination that was signed o­n February 2^nd, 2016. The malaria morbidity and mortality rates in this mobile population is higher than that in other groups. It is very difficult to monitor and manager this mobile population, thus this activity is necessary to make the map of mobile population in Dak Lak and Dak Nong, Western Highland of Viet Nam 2016. This activity will be useful in monitoring mobile population and understanding the characteristics of the mobile population and distributing malaria control and elimination activities.

3. The goals of the National Malaria Control Program include: Reduce malaria mortality and morbidity rates and eliminate malaria by 2030 and implement real-time report cycle and case investigation. The malaria mortality and morbidity rates of the mobile population are highest in comparison with other groups.

This activity helps to monitor and understanding the migrating characteristic of the mobile population. Hence we can propose some measures to reduce malaria mortality and morbidity rates for this group and to distribute the malaria control activities to achieve the goals of the National Malaria Control and Elimination Program.

              See Next: Part II

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