In order to have updates o­n malaria situation in the field and find out difficulties and challenges in malaria prevention and elimination, o­n May 17, 2022, a collaborative mission between the Institute of Malariology, Parasitology and Entomology Quy Nhon (IMPE-QN) and World Health Organization (WHO) Representative's Office to Viet Nam visited and worked at the Heath Center of Krong Pa district (HC-KP), Gia Lai province.

Participants in the meeting included Assoc.Prof.Dr. Ho Van Hoang - Director of IMPE-QN, Dr. Mya Sapal Ngon - expert of WHO Viet Nam , Dr. Dinh Viet Buu - Director of HC-KP, and professional staff.

According to the HC-KP representative's report, the malaria patient index in Krong Pa district has been recently stable but not sustainable. The malaria cases have tended to increase on a seasonal basis, upon weather conditions of each year and at time with lots of people's movements into the forest (forest goers and field-hut sleepers). Specifically, in the years of 2014 - 2015, there were a dramatic increase in malaria cases; thanks to applying many interventions, this index fell in 2016; however, it raised again in September 2018 and has decreased from 2020 until now.

Table 1. The numbers of malaria patients in Krong Pa district from 2015 to present.

According to the statistic data in the first 4 months of 2022, there was a downward trend in malaria indexes compared with the same period of 2021; for examples, patients with malaria parasites decreased by 9 (34.61%); P.falciparum infected patients dropped by 7 (29 %); however, P.vivax cases went up by 2. The highest prevalence of malaria occurred among male workers (forest goers, field-hut sleepers) in the working age group (>15 years old), mainly in Chu Rcam, Ia Rsai, Ia Mlah communes. By early screening and detection and timely treatment of malaria cases, malaria infections were successful controlled, preventing from transmission in the community as well as in the farmhouses.

Table 2. Malaria incidence (MI) by month in 2022 vs. 2021 in Krong Pa district

The representative of HC-KP reported to the delegation the main difficulties in malaria control in the district as follows:

- Subjects who go into the forest and sleep in the field-huts have not been totally controlled yet;

- 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;

- Changes in climate and environment.

Participants to the meeting

From the above difficulties and challenges, HC-KP hoped to receive close attention and timely guidance from the leaders at all levels during the implementation of malaria control activities; at the same time, HC-KP also proposed the activities that need to be supported in the coming time such as training for district and commune staff o­n microscopic examination for malaria parasite detection; training o­n malaria reporting by eCDS-MMS software; screening populations in farmhouse areas for malaria detection because these are where malaria transmission occurs.

Dr. Dinh Viet Buu - Director of Krong Pa District Health Center in his speech at the meeting

            According to Assoc.Prof.Dr. Ho Van Hoang - Director of IMPE-QN, recent gains in malaria control in Krong Pa district is stable but not sustainable, depending o­n the weather and climate, the period of people's going to the forest and sleeping in the field-huts, and the malaria control interventions. Besides, Assoc.Prof.Dr. Ho Van Hoang pointed out the challenges of malaria control and elimination in Gia Lai province, including many pathogens in the community, resurgent malaria every 4 years (2019-2023), uncontrollable mobilised populations. 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. Therefore, it can be said that if malaria-endemic areas with fluctuating populations (i.e. free migrants, forest goers, field-hut sleepers and border-crossers) like Gia Lai are successfully controlled, Viet Nam will definitely achieve the goal of eliminating P. falciparum malaria by 2025.

Assoc.Prof.Dr. Ho Van Hoang - Director of IMPE-QN in his directive speech at the meeting

At the end of the meeting, Assoc.Prof.Dr. Ho Van Hoang suggested that HC-KP should develop an early malaria control plan; timely provide counselling for leaders at all levels in terms of deploying intervention methods such as spraying insecticides at the farmhouses, providing bed-nets, hammocks, and repellents; consolidate the operation of microscopy sites, the examination, detection and treatment of malaria cases at medical facilities; proactively monitor malaria epidemiology in villages and farmhouse clusters in order to well implement the objectives of the malaria elimination program.

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