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Part 1. Malaria in the Central Highlands region in 2019-Risks and challenges

In the past few years, despite many difficulties, the malaria control and elimination (malaria control) program in Vietnam in general and the Central-Central Highlands in particular has achieved many results in reduction of mortality, control epidemic risks and maintainance of sustainable factors. However, Central Highlands region continues to face challenges and difficulties due to the complex malaria characteristics in this region compared to other provinces in the North and the South.

In 2019, malaria prevention has brought a lot of progress towards the goal of eliminating malaria by 2030. But this is always the "hot spot" of malaria in the country when the majority of cases are infected and Malaria deaths are concentrated in this area.

Malaria index increased slightly

According to the statistics in 2019 of the Quy Nhon Institute of Malaria, Parasitology and Insects compared to the same period in 2019 (Table 1), the whole Central-Central Highlands region, the number of cases in 2019 increased 22.39%, 10 Malaria cases increased by 2 cases compared to the same period in 2018 (in 2018, there were 8 cases of malaria). However, there were no deaths and malaria outbreaks.

Compared to the same period in 2018, the BNSR of the whole region in 2019 increased by 22.39%, of which the Central region increased 47.71%, and the Central Highlands increased by 12.05%. Some provinces with a high number of malaria cases were: Phu Yen 106.44% (from 326 cases to 673 cases); Binh Thuan 200.98% (from 102 cases to 307 cases); Gia Lai 59.67% (from 1106 to 1766 cases). Particularly in Dak Lak province, although in 2018, the malaria situation changed. However, in 2019, the province's malaria cases decreased by 16.03% (from 786 cases to 660 cases).

In 2019, P. falciparum dominated with 71.22%, P..vivax accounted for 28.01%, combined with 0.73%, and P.malariae accounted for 0.05%. Particularly in Quang Nam province, the structure of malaria parasites p.vivax dominated with the rate of 98.73%.

Evaluation on the results of malaria prevention activities in 2019

General direction

Due to the malaria situation in 2018, there are many complicated developments, with the forecast for 2019 there is an increase in malaria in some provinces, so from the beginning of 2019, the Institute has sent many documents to the Department of Health, TTCDC / TTPCSR / Preventive Medicine Center and provincial hospitals warned of the risk of malaria, directed to strengthen malaria control measures in localities; At the same time, VAST leaders and related faculties / departments have directly directed malaria control in provinces with fluctuating malaria situation such as Phu Yen, Gia Lai, Dak Lak, Dak Nong ...

Focus on directing and implementing measures to control malaria fluctuating areas (free migrants, going to the forests, sleeping on the fields and border exchanges), the grassroots health network has actively participated. Malaria control activities. However, early detection, diagnosis and timely treatment and management of malaria patients at grassroots are still facing many difficulties, especially in the Vietnam-Laos and Vietnam-Cambodia border areas due to the border cooperation. gender in malaria control is not yet effective and frequent.

- The Institute has established 03 teams to respond quickly according to Decision 5894 / QD-BYT on the issuance of "Instructions for setting up and operating the quick response team".

- In 2019, with the support of the RAI2E Project, it will focus on malaria surveillance in key areas and border areas, and control malaria increase in Dong Xuan, Son Hoa, and Song Hinh districts (Phu Yen). ); Bac Binh and Ham Thuan Bac districts (Binh Thuan); Krong Pa, Ayunpa, Ia Pa (Gia Lai) districts; Krong Nang, Ea Kar (Dak Lak).

- Strengthen directing to improve the quality of malaria control measures, including spraying chemical residues, impregnating nets, focusing on areas with high risk of epidemics. Epidemiological surveillance in key areas and monthly briefings from lower levels to higher levels between communes, districts and provinces are regularly maintained, so that information is analyzed, promptly controlling the increase in malaria. and the risk of outbreaks.

Malaria vector prevention

The Institute has provided spraying and impregnating chemicals, ensuring that the provinces properly implement the conservation spraying plan for some key community areas. In 2019, the Central-Central Highlands region sprayed protective chemicals for 245,933 people, impregnated 282,824 screens for 569,490 people, and protected with LLINs for 249,184 people.

- The vector surveillance was carried out at 11 points in 7 provinces and monitored the vector's sensitivity to insecticides.

Diagnosis, treatment and management of malaria drugs

- The Institute has provided enough essential antimalarial drugs according to the 2019 plan to help the early treatment of patients as indicated. Promote the performance of microscope points in combination with using rapid diagnostic test to limit SRAT and TVSR. At the same time, the Institute regularly sends a delegation to oversee the diagnosis and treatment at all levels of treatment, in order to gradually maintain the advantages of sustainable factors and overcome the remaining points in diagnosis and treatment, case management;

Communication, education and socialization of malaria control

Effective communication and education is one of the sustainable factors that reinforce the achievements of malaria control, so this work is interested and implemented in localities. Celebrate the World Day for Malaria Control April 25 in Phu Yen province.

Training and retraining

- Coordinate with Tay Nguyen University, Hue University of Medicine and Pharmacy, Military Medical Academy 103, Institute of Malaria-parasite-Private teaching specialized in parasite and guide graduate students. The Institute is affiliated with the Da Nang University of Medical Technology and Pharmacy to offer the Bachelor of Medical Engineering for both learning and working systems. Funded by CHAI and RAI2E Project, the Institute has organized training courses on how to deploy eCDS-MMS software throughout the region, and has organized 01 training course to issue certificates of medical insect technique and management of chemicals, insecticides used in the household and medical sectors.

Scientific research

- In 2019, the Institute has accepted 1 ministerial-level scientific research project and 19 basic and applied basic scientific research projects in the fields of epidemiology, insects, and drug-resistant malaria parasites. , intestinal parasites and protozoa, genital tract, molecular biology.

- Maintain scientific activities of the specialized faculties and the entire Institute once a quarter / quarter to update the scientific staff of the Institute on specialized information as well as the disease control situation in the country. and the world.

Some causes and challenges in malaria prevention and elimination

Although malaria indicators have decreased deeply, it is not really sustainable, especially in the Central-Central Highlands region with natural characteristics and favorable climate for malaria to circulate and develop year round; Accordingly, the feverish focus areas are also mountainous, remote, and border areas where ethnic minorities live, difficult economic circumstances, high poverty rate, low literacy. and there is no sense of self-protection against malaria, when there is a fever, it is not active to go to health facilities for examination and treatment, leading to serious complications and death. Along with that, population mobility is difficult to control (free migrants, people going to the forest, doing farming / sleeping on the fields, people exchanging borders, working as seasonal workers in malaria endemic areas. ...), the annual malaria statistics show that most of malaria cases and deaths in the country every year are mainly concentrated in these subjects.

In 2019, some causes and factors that increase malaria in the Central-Central Highlands are as follows:

- Increase the number of people entering the forest, mainly men, of working age, adults go to the forest to find forest orchids, bamboo shoots, honey, crabs to sell ... (a few women, adults participate in the forest but mainly take bamboo shoots and leave during the day). Through surveys in the key malaria districts in Krong Nang and Ea Kar districts of Dak Lak province, it was found that over 90% of the cases in the increase were related to "fake crane" orchid trips.

- People go into Ea So National Nature Reserve in groups of 5-6 people, each group goes for about 5-6 days, only erect a sketchy tents with tarpaulin, without walls. There are no adequate protective measures such as vector prevention or patient protection and do not carry antimalarial drugs, so this at-risk population has a very high rate of malaria.

- People do not or very little use long-term chemical-impregnated nets (LLINs) received from the Program / Project at their home when they sleep to prevent mosquito bites, but they usually buy pink nets. There are different colors around the ceiling to use but these nets are not impregnated with chemicals and these families do not bring them to health workers for impregnation in the spraying campaigns in the community, so there are absolutely no Effective protection against vector.

- The at-risk groups of people when going into the forest do not have appropriate protective equipment, and when going back, they do not come to check for malaria parasites at the malaria sites or at medical facilities;

- Most patients with malaria due to P. vivax infection alone or in combination have P. vivax when being treated at the grassroots level usually only 3 days in hospital (at the district health center) or outpatient treatment, the compliance with use the 14-day total primaquine phosphate drug is not complete, so it also contributes to a possible recurrence;

The village health network (VHW) has developed in number and is often trained, but the quality of its operation is ineffective. Some localities are the focus of malaria, but the participation of the VHWs in detecting and encouraging patients to go to health facilities is still not high, especially reaching groups of people who go to the forest. sleep on the field.

On the other hand, in some provinces where drug resistance is increasingly widespread, researching effective regimens to treat malaria as well as parasitic diseases is not only an urgent solution, but also. It is a requirement to train a contingent of specialized staff capable of treating patients and controlling epidemics right from the grassroots level;

A major challenge that often occurs in the malaria prevention process is to develop a subjective mindset when the epidemic is being pushed back, which not only happens in the community but also in managers when the program is in place The threat of malaria is eradicated, resources are cut or provided dripping does not meet implementation needs, lack of attention and direction in low malaria regions.

Some suggestions

- Strengthen malaria epidemiological surveillance, implement active anti-malaria measures, especially focusing on areas with high malaria and frequent fluctuations.

- Expand investigation, proactive screening and treatment of all malaria cases (cases) and handle the disease when first discovered;

- Monitoring mobile population groups (farming, going to forest and exploiting forest and native products) .Focus surveillance, focusing on areas with known drug-resistant malaria;

- Minimize the number of malignant malaria cases and deaths caused by malaria in high-risk groups, mobile populations through risk communication, behavior change in malaria control and early detection, timely management. time of the cases;

- Minimize the number of malignant malaria cases and deaths caused by malaria in high-risk groups, mobile populations through risk communication, behavior change in malaria control and early detection, timely management. time of the cases;

- Improving the quality of microscope points, checking, urging and reminding glass points that are ineffective; Improving the detection, diagnosis and treatment of malaria through quality assessment diagnosis and treatment by superior levels, and at the same time, all levels must regularly check and review essential malaria drugs at all levels, avoid drug shortage and malaria drugs at the commune level to the central level; Strengthen checking the work of taking blood smears or testing the rapid diagnosis of malaria; check books, reports of BNSR during the month at regional clinics / commune health stations to manage and monitor cases; substantially assess the local malaria situation. This is the basic database to report to the district, provincial and central levels to assess the most accurate data and monitor malaria developments;

- Combine militia medicine in malaria prevention, especially in militia medical stations and border guard medical stations along border lines;

Thus, although there are many difficulties in malaria prevention and elimination, especially the impacts of climate change, in 2019, thanks to the investment and guidance of the Ministry of Health, The PC program The efforts of malaria specialized staff and the entire health sector, provinces in the region and Quy Nhon Malaria-Malaria Institute have quickly coordinated epidemiological surveillance activities. direct malaria control measures to prevent epidemics from occurring in the region, minimizing the damage caused by malaria.

Editorial staff  


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