Khanh Vinh District, located in the westernmost part of Khanh Hoa Province, is a mountainous and semi-mountainous region. It shares borders with Ninh Hoa Town and Ma Drak District (Dak Lak Province) to the north, Lam Dong Province to the west, Khanh Son District and Ninh Thuan Province to the south, and Dien Khanh District to the east. The district spans a total natural area of 1,165 km² and has a population of approximately 41,706 people, resulting in a low population density of about 36 people per km². Khanh Vinh comprises 13 communes and o­ne town, home to 15 ethnic groups. Ethnic minorities, including the Raglai, Ede, T'Rin, and several northern ethnic groups who have migrated to the area for settlement and business, make up nearly 75% of the population.

The region experiences distinct dry and rainy seasons, with an average annual temperature and humidity that, combined with the presence of numerous ponds, lakes, rivers, and streams, create ideal conditions for malaria vectors to thrive. As a result, diseases spread easily in this area.

The District People's Committee oversees and directs departments and local authorities across 14 communes and towns to implement and coordinate efforts in epidemic prevention, public health protection, and healthcare. The District Health Center manages and executes professional health activities, including medical examinations, treatment, disease prevention, population and development programs, with a focus o­n malaria prevention. Regarding malaria epidemiology, all communes and towns in the district are classified as severe malaria-endemic areas, as designated by Decision No. 1609/QD-BYT dated April 8, 2020, issued by the Ministry of Health regarding malaria epidemic zoning in Viet Nam for 2019.

Figure 1. Location of Khanh Hoa province and Khanh Vinh district in Khanh Hoa province

Despite years of active malaria prevention efforts and the implementation of comprehensive measures, which successfully reduced malaria cases and deaths, a resurgence of malaria outbreaks began in mid-2023. The district reported the highest number of cases nationwide, with 197 patients, and the situation has worsened in the first five months of 2024, with nearly 120 cases. This figure is significantly higher than the same period in 2023. Notably, the first four months of 2024, typically outside the peak malaria transmission season in this area, still saw a sharp rise in cases. As the main transmission seasons approach, the complexity and severity of the outbreak are expected to become even more unpredictable.

I. SITUATION OF MALARIA IN KHANH VINH DISTRICT IN THE LAST 5 YEARS AND IN 2024

From 2019 to 2022, the number of malaria cases in Khanh Vinh district decreased significantly. In 2021, during the peak of the COVID-19 pandemic, o­nly two cases were recorded. In 2022, the number slightly increased to 11 cases.

However, in 2023, the district experienced a malaria outbreak, with 199 cases reported. The outbreak began in June, peaking in July with 50 cases. Malaria cases were recorded across all communes and towns in the district. The hardest-hit areas included Khanh Thuong commune (81 cases), Son Thai (35 cases), Khanh Hiep (18 cases), Lien Sang (11 cases), Giang Ly (9 cases), and Khanh Thanh (8 cases).

From January 1 to July 17, 2024, a total of 158 malaria cases have been reported in Khanh Vinh district. These include 76 cases of Plasmodium falciparum, 21 cases of Plasmodium vivax, and 61 cases of Plasmodium malariae. High case numbers have been observed in the communes of Khanh Thuong, Khanh Phu, Khanh Dong, and Khanh Hiep.

Malaria Situation in Khanh Vinh District (2019-2024):

Between 2019 and 2022, malaria cases in Khanh Vinh district declined significantly. During the peak of the COVID-19 pandemic in 2021, o­nly two cases were recorded. In 2022, the number increased slightly to 11 cases.

In 2023, however, a malaria outbreak occurred, with 199 cases reported. The outbreak began in June and peaked in July with 50 cases. Malaria cases were documented across all communes and towns in the district, with the hardest-hit localities being Khanh Thuong commune (81 cases), Son Thai (35 cases), Khanh Hiep (18 cases), Lien Sang (11 cases), Giang Ly (9 cases), and Khanh Thanh (8 cases).

From January 1 to July 17, 2024, a total of 158 malaria cases were recorded in Khanh Vinh district. Of these, 76 were caused by Plasmodium falciparum, 21 by Plasmodium vivax, and 61 by Plasmodium malariae. The communes of Khanh Thuong, Khanh Phu, Khanh Dong, and Khanh Hiep reported the highest numbers of cases during this period.

II. SOME ACTIVE LOCAL MALARIA PREVENTION ACTIVITIES

2.1. Guidance and direction

2.1.1. District People's Committee

- Regarding direction and oversight

Since the outbreak of malaria, the Provincial People's Committee and District People's Committee have issued over 20 directives to implement proactive malaria prevention and control measures district-wide, mobilizing a multi-sectoral and inter-sectoral approach. These directives emphasize active coordination between agencies, units, and localities with the district health sector to carry out intervention activities effectively.

Key measures include prioritizing and enhancing propaganda efforts, health education communication (IEC), and behavior change communication (BCC). These initiatives aim to educate the public about malaria prevention methods, such as eliminating mosquitoes, using mosquito nets, and recognizing symptoms of malaria and other mosquito-borne diseases. People are advised against self-treatment at home or self-purchasing medication. Instead, they are encouraged to seek immediate care at the nearest medical facility for timely diagnosis and treatment.

The district has also organized and strengthened the Epidemic Prevention and Control Steering Committee, involving multiple departments, sectors, and organizations.

The District People's Committee regularly instructs the District Medical Center to follow the professional guidance provided by the Ministry of Health, the Khanh Hoa Department of Health, and the Khanh Hoa Center for Disease Control. Collaboration with central specialized agencies, such as the National Institute of Malariology, Parasitology, and Entomology (NIMPE) and the Institute of Malarioly, Parasitology, and Entomology Quy Nhon (IMPE-QN), is emphasized to implement malaria prevention measures, conduct zoning for timely outbreak containment, and ensure effective patient monitoring and treatment. The Medical Center is also required to provide daily reports to the People's Committee for o­ngoing oversight and timely decision-making.

- Regarding communication and outreach

- The District People's Committee has instructed the District People's Council Office and the People's Committee Office, District Health Center, District Culture-Information and Sports Center, and People's Committees of communes and towns to intensify efforts in writing and publishing news articles o­n malaria prevention. These articles are to be posted o­n the district's electronic information portal and broadcast o­n district and commune radio stations twice daily (early morning and evening) to ensure community awareness and engagement.

- The District People's Committee has actively collaborated with the Khanh Hoa Medical Center and the Khanh Hoa RAI3E Project Management Board, directing the District Health Center to implement a malaria prevention communication campaign under the theme: "Pooling all efforts to eliminate malaria in Viet Nam."

- Coordination efforts have been made with the Protestant Association of Cau Ba Commune, Ta Goc Village Chapel, and Da Ram Village in Khanh Thuong Commune to disseminate information, education, and communication (IEC) and behavior change communication (BCC) materials o­n malaria prevention to religious organizations and parishioners.

- In 2023, the District People's Council & People's Committee Office was allocated 75,000,000 VND to install five propaganda panels in malaria-prone communes, including Khanh Thuong, Son Thai, Giang Ly, Khanh Hiep, and Khanh Wall.

- For 2024, the District People's Committee plans to direct the District People's Council & People's Committee Office to install an additional nine billboards in the remaining communes across the district to further strengthen malaria awareness.

- Financial support of 135,309,000 VND was provided to the District Health Center in 2023 from the district's budget reserve to bolster malaria prevention and control efforts.

- The District People's Committee has instructed the Party Committees and Commune People's Committees to assign responsibilities to relevant departments and unions. These entities are to closely coordinate with Commune Health Stations in implementing localized disease prevention measures. Special attention is given to public information campaigns, immigrant management, and the monitoring, management, and treatment of malaria cases.

2.1.2. District Medical Center:

- Organized a meeting of the Steering Committee for Epidemic Prevention and Control to assign specific responsibilities to individuals, departments, and Commune Health Stations for effectively implementing epidemic prevention and control measures;

- Established two epidemic prevention teams to promptly respond to and manage outbreaks;

- Released official documents instructing affiliated units to enhance malaria prevention and control efforts across the district.

- Focused o­n early detection, appropriate treatment, and effective management of malaria cases. Severe cases were directed to higher-level medical facilities for specialized care.

- At the start of the year, developed a detailed action plan based o­n assigned targets and allocated specific objectives to relevant implementing units;

- In accordance with Directive No. 04/CT-UBND dated April 5, 2024, issued by the Khanh Hoa Provincial People's Committee, and Official Dispatch No. 1145/UBND-VX dated April 11, 2024, from the Khanh Vinh District People's Committee, formulated a comprehensive plan to enhance malaria epidemic control efforts in Khanh Vinh district for 2024.

- Through regular briefings, directed departments and Commune-Town Health Stations to:

· Enhance management, treatment, and monitoring of malaria cases.

· Improve disease outbreak surveillance and conduct communication campaigns.

· Test all individuals with fever or suspected malaria, with a particular focus o­n households frequently visiting forests or fields.

· Implement proactive measures to prevent and limit the spread of malaria within the community.

2.2. Technical expertise activities:

- Improved Examination, Diagnosis, and Treatment

· Enhanced examination, diagnosis, and treatment for malaria cases in line with Decision No. 3377/QD-BYT (dated August 30, 2023) by the Ministry of Health, providing detailed guidance o­n malaria diagnosis and treatment.

- Microscopy Activities

· By the end of the first quarter of 2024, the Department of Laboratory and Diagnostic Imaging, the laboratory at the Regional General Clinic, and microscopic sites conducted blood smear tests for all fever cases visiting medical facilities.

oA total of 4,273 tests were performed, a significant increase of 151.95% compared to the same period in 2023 (1,696 tests in Q1 2023).

oThese figures exclude tests conducted by working groups from the Institute of Malariology, Parasitology and Entomology Quy Nhon and the Provincial Center for Disease Control.

- Monitoring and Surveillance

·Implemented monitoring in accordance with Decision No. 4922/QD-BYT (dated October 25, 2021) by the Ministry of Health, providing guidelines for malaria surveillance and control.

·Investigated and reported cases through the infectious disease surveillance system, adhering to Circular 54/2015 of the Ministry of Health.

- Epidemiological Investigations

·Conducted over 20 rounds of disease outbreak investigations since the beginning of the year, including supervision rounds with the Provincial CDC and IMPE-QN.

·Nearly 4,000 individuals were tested, detecting multiple malaria cases caused by P. falciparum, P. vivax, and P. malariae.

- Specialized Testing and Treatment

·Collaborated with teams from the Departments of Treatment Research, Epidemiology, Molecular Biology, and Entomology to conduct blood smear tests.

oIdentified additional cases with asexual stage, schizonts, and Plasmodium malariae gametocytes.

oFocused o­n treatment and monitoring drug effectiveness using ACTs, chloroquine, and primaquine phosphate to treat symptoms, prevent relapses, and limit community spread.

- Vector Control Activities

· Residual Insecticide Spraying:

oIn 2023, residual spraying was conducted in 956 households, protecting 4,336 people, and in collaboration with Khanh Hoa Provincial CDC, insecticides were sprayed in 511 households, protecting 2,335 people.

oIn Q1 2024, residual spraying covered 416 households across various communes and hamlets, protecting 1,658 people and exceeding the target by 104%.

· Mosquito Net Impregnation:

oIn 2023, 8,259 bed nets were impregnated, protecting 16,517 people (82.59% of the plan).

oIn Q1 2024, 4,350 bed nets were impregnated, protecting 8,153 people (93.96% of the plan).

· Distribution of Mosquito Nets and Hammocks:

oIn 2023, distributed 800 mosquito nets and 1,300 hammocks with long-lasting chemical-treated net covers.

oIn Q1 2024, delivered 2,570 mosquito nets and 2,120 hammock sets to 12 communes and towns under the RAI4E Project (2024-2026), prioritizing malaria foci, mobile migrants, pregnant women, and households lacking adequate protection.

2.3. Risk communication (RC), behavior change communication (BCC) activities

- Actively produce and provide news articles o­n malaria prevention and control for dissemination through the District People's Committee, the District Center for Culture, Information, and Sports, and Commune People's Committees. These articles are broadcast twice daily o­n district and commune radio systems, with funding support from the RAI3E Project.

- In 2023, the unit installed a malaria prevention communication billboard in Giang Ly commune. Since the beginning of 2024, the Health Center has received and distributed communication materials to its affiliated units, including:

+Handbook of Health Centers for Malaria Prevention and Control: 98 copies (2023).

+RAI3E Project communication leaflets: 11,000 sheets.

+Posters titled "Let's Eliminate Malaria Together": 600 sheets.

+Malaria prevention and elimination leaflets titled "Responsibility of Each Person and Society as a Whole": 1,000 sheets.

- Develop and propose a commitment document with malaria prevention content to the District People's Committee for distribution to Commune People's Committees, encouraging residents to pledge their commitment to malaria prevention measures.

- In collaboration with the Central Institute of Malaria and Parasitology and the World Health Organization, successfully organized World Malaria Day (April 25, 2024) in Khanh Vinh district. The event featured participation from international organizations, medical units from within and outside the province, and representatives from the Central Highlands region.

2.4. Coordination with health units from central to provincial levels

- Since the beginning of the year, the Medical Center has collaborated with specialized units, including IMPE-QN and CDC Khanh Hoa, to conduct nearly 10 rounds of investigation and testing. These efforts have covered over 3,500 people, focusing o­n mobile populations, forest-farming workers, and high-risk groups. Several malaria cases were detected, involving three species: P. falciparum, P. vivax, and P. malariae.

- Coordinated with the District People's Committee Office, CDC Khanh Hoa, and the RAI3E Khanh Hoa Project Management Board to launch malaria prevention communication campaigns under the theme: "Pooling all efforts to eliminate malaria in Viet Nam."

- Collaborated with the Protestant Association of Cau Ba commune, the Ta Goc village chapel, and Da Ram village in Khanh Thuong commune to promote malaria prevention measures to religious organizations and parishioners.

- Engaged organizations, individuals, enterprises with workers in malaria-endemic areas, and pharmacies throughout the district. Meetings were organized to disseminate information, promote awareness, and secure commitments for active participation in malaria prevention and control efforts.

III. SITUATION OF DIAGNOSTIC EQUIPMENT AND MEDICINES FOR TREATMENT OF MALARIA

3.1. Equipment, supplies and rapid diagnostic testing tools (RDTs)

- Medical facilities and working groups are diligently ensuring the availability of essential diagnostic equipment, such as blood smear kits, Giemsa stain, microscopes, and rapid diagnostic tests (e.g., SD Bioline P/Pv HRP2/pLDH). All necessary supplies are maintained in stock at all times.

- In this area, three malaria species (P. falciparum, P. vivax, and P. malariae) are currently prevalent simultaneously. Many cases present with parasite densities below the detection threshold of microscopes, and even rapid tests often fail to identify P. malariae. This highlights the critical need for ultra-sensitive and specific diagnostic tools, particularly molecular biology methods or rapid tests capable of detecting Pf/PAN Plasmodium Antigen-type antigens, to ensure comprehensive diagnostic coverage.

3.2. Medicines for Malaria Treatment

Currently, the district health center maintains an adequate stock of essential antimalarial drugs for treating malaria patients. These include Quinine sulfate 250 mg, Artesunate vials 60 mg, Chloroquine phosphate 250 mg, Pyronaridine tetraphosphate-Artesunate (Pyramax R), and Primaquine phosphate 7.5 mg. All medications are in sufficient supply and remain unexpired.

However, it is crucial to continue monitoring the required quantities of treatment drugs, given the o­ngoing emergence of new cases involving all three malaria species. Ensuring a consistent supply of antimalarial drugs is vital to provide timely treatment, achieve high cure rates, and minimize complications and fatalities due to malaria in the district.

See Part 2

Other news »

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