To obtain the latest information regarding the malaria situation in Central Vietnam and identify obstacles and complexities in malaria control and elimination efforts, a joint mission to Gia Lai province was undertaken o­n May 08-09, 2023. This collaborative site visit involved the Institute of Malariology, Parasitology, and Entomology Quy Nhon (IMPE-QN) and the World Health Organization (WHO) Representative's Office in Thailand, Switzerland, and Viet Nam.

The WHO representatives included Dr. Charlotte Rasmussen, Technical Officer in Drug resistance from the Global Malaria Programme based in HQ-WHO, Dr. Maria Dorina Bustos, WHO Malaria Technical Officer, based in Bangkok, Thailand, and Dr. Tran Cong Dai, Technical Officer in Malaria and Vector-Borne Diseases, based in Viet Nam. The representatives of IMPE-QN included Dr. Huynh Hong Quang, Vice Director, and officer of International Cooperation Section.

The team worked with Centre for Disease Control of Gia Lai province (CDC Gia Lai), and the results showed a decreasing trend in malaria cases from 2020 to April 2023. Particularly, in the first four months of 2023, there was a significant decrease in malaria patients compared to the same period in 2022 (72%, 07/25). No severe cases or deaths due to malaria were reported. However, the number of malaria patients and malaria parasite infections (Plasmodium species) remained high compared to other provinces in Central Vietnam. Malaria parasites were concentrated in the districts of Krong Pa, K'bang, Ia Pa, and Dak Doa, with a resurgence of P. vivax in 2021, which should be a concern. The main affected group consists of uncontrollably mobilized populations, including forest goers/wokers involved in logging and forest products exploitation.

Chart 1: Comparison of malaria cases in the first four months of 2023 and the first four months of 2022 by locality.

Chart 2: Malaria cases by month from 2022 to April 2023.

In Krong Pa district, there was a downward trend in malaria indexes compared with the same period of 2022; for examples, patients with malaria parasite infection decreased by 10 (66.66%); P.falciparum infected patients dropped by 10 (66.66%). There have been no cases of P. vivax for the past two years. The highest prevalence of malaria occurred among male workers engaged in forest-related occupations (forest goers, field-hut sleepers) in the working age group (>15 years old), mainly in Chu Drang, Ia Dreh, Ia Rsao, and Ia Mlah communes. The decrease in malaria incidence in Krong Pa district during the first four months of 2023 is partly attributed to the weather, as the early end of rainfall in late 2022 and the absence of rainfall in early 2023 have delayed the start of seasonal work, resulting in less people going into the forest and sleeping overnight in the field-huts. Additionally, the impact of vector control measures implemented in these temporary shelters since October 2022 has also contributed to the decline.

Table 1. Malaria incidence (MI) by month in 2023 vs. 2022 in Krong Pa district

The team worked at the Krong Pa District Health Center

Lastly, the mission team visited and worked with Chu R'Cam Commune Health Station (CHS) of Krong Pa district, where IMPE-QN is conducting drug resistance research. Here, the team members reviewed the research files, had direct exchanges with the staff of this unit, and examining the records, checking the conditions, equipment, supplies, antimalarial drugs, and available workforce in charge of malaria control. The results showed that malaria control activities have been implemented by Chu R'Cam CHS with positive results. Specifically, regular monitoring and supervision of the diagnosis and treatment of malaria patients at the facility have been carried out according to the Ministry of Health's guidelines in 2020. Active surveillance of malaria epidemiology in key malaria-prone villages and hamlets, investigation of malaria foci, and intervention in clusters of farmhouses in malaria-endemic communes have also been conducted. Every year, Long-Lasting Insecticidal Nets (LLINs) are distributed to the entire population, and long-lasting insecticide impregnated hammock nets are provided to forest-goers (supported by the RAI3E project).

The team visited and worked with Chu R'Cam Commune Health Station

Through monitoring and evaluating the actual situation of malaria at various levels in Gia Lai province, the following observations were made:

1. The locality has implemented malaria control activities and intervention studies with funding from the international projects such as RAI3E, HPA, and SCDI, facilitating broader and deeper deployment of malaria control work.

2. Malaria cases have decreased sharply in Gia Lai (by 72%). There have been no severe cases or deaths due to malaria.

3. The implementation of malaria control activities is not consistent and sometimes interrupted (RAI3E project has just been launched in early April 2023); regulations governing spending o­n insecticide spraying and epidemiological supervision have not been officially approved; there is a shortage of insecticides to be used in malaria foci interventions and for indoor residual spraying in high-risk areas.

4. Malaria-endemic areas account for 73.63%, in which remote, deep-lying, and border communes considered as hyperendemic areas with complex malaria epidemiology, facilitating disease development and transmission. The habitat is diverse and suitable for the development of malaria-transmitting mosquito species. The main malaria vectors in Gia Lai are An. minimus and An. dirus.

5. People's economic conditions are still difficult, and they have to base themselves o­n forests and fields to make a living. Vast area of upland forest is difficult to control. The management of people who go to the forest, exploit forest products and sleep overnight in the field-huts is a big challenge facing Gia Lai province and the whole country.

The delegation took a commemorative photo with the staff of Chu R'Cam Commune Health Station

At the end of the site visit, Dr. Huynh Hong Quang, Deputy Director of IMPE-QN, highly appreciated the efforts in implementing malaria control across the province. He also recommended that Gia Lai provincial healthcare sector should strengthen supervision and monitoring of malaria control activities, enhance malaria epidemiological investigations, communication, and surveillance in key areas, and consolidate the operation of microscopy points, the examination, detection and treatment of malaria cases at medical facilities. CDC Gia Lai needs to focus extensively o­n malaria prevention and control to prevent any resurgence of the disease. The provincial healthcare sector strives to achieve the goal of eliminating P. falciparum transmission by 2025, and work towards eliminating transmission of all human malaria by 2030, contributing to the local socio-economic development.

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