The participants in the working session included Assoc.Prof. Ho Van Hoang, Director of IMPE-QN; Dr. Mya Sapal Ngon, Specialist of WHO Viet Nam; Dr. Faisal Mansoor, Head of the Programme Principal Recipient for The Global Fund at the United Nations Office for Project Services (UNOPS); Dr. Nguyen Dinh Nam, Coordinator of the RAI3E Project; Dr. Nguyen Dinh Thoan, Deputy Director of Khanh Hoa Department of Health; Dr. Nguyen Duc Tinh, Deputy Director of the Khanh Hoa Provincial Center for Disease Control; Dr. Le Thi Kim Lien, Deputy Director in charge of the Khanh Vinh District Health Center, along with other staff members.

According to the report from the Provincial Center for Disease Control, from 2018 to October 2023, Khanh Hoa province recorded 429 malaria cases. Specifically, in the first ten months of 2023, there were 164 cases, with Khanh Vinh district alone accounting for 154 cases. The provincial health sector has implemented various control activities such as epidemiological surveillance, entomological investigations, health communication campaigns, active case management, insecticide residual spraying, distribution of insecticide-treated nets, and blood sample testing.

Following the malaria elimination roadmap in Khanh Hoa province, in 2022, two locations, Nha Trang City and Cam Ranh City, successfully eliminated malaria. In 2023, it is expected that Dien Khanh and Van Ninh districts is recognized malaria-free. By 2025, three districts and towns, namely Cam Lam, Ninh Hoa, and Khanh Son, are targeted for elimination. Khanh Vinh district is projected to eliminate malaria by 2030.

The mission team worked at the Khanh Hoa Provincial Center for Disease Control

The working delegation worked with the Khanh Vinh District Health Center, and the results indicated a significant fluctuation in malaria cases over the years. Specifically, from 2018 to 2021, malaria cases recorded in Khanh Vinh District decreased annually. Notably, in 2021, o­nly 2 malaria cases were reported. However, in 2022, the number of cases increased significantly compared to 2021, with 11 malaria cases detected, peaking in November 2022 with 9 cases. In 2023, there was a substantial surge in malaria patients. As of November 7^th, 2023, 164 malaria patients were identified, with the peak occurring in July, recording 50 cases.

Table 1. Malaria situation in the recent 5 years and in the first 10 months of 2023

Remarks: The data shows a fluctuating trend in malaria cases in Khanh Vinh District, with a notable decrease in 2021 followed by a considerable increase in 2022 and a further rise in 2023.

So, currently, out of 14 communes in Khanh Vinh district, 11 have reported cases of malaria. Specifically, Khanh Thuong commune has 72 cases of malaria, Son Thai has 23 cases, Khanh Hiep has 13, Lien Sang has 10, Giang Ly has 9, Khanh Thanh has 8, Khanh Binh has 6, Khanh Trung has 5, Khanh Vinh town has 3, Cau Ba has 3, and Khanh Nam has 2. According to the report, among the 164 malaria cases, 18 cases are caused by the Plasmodium falciparum parasite, 58 cases by P. vivax, and 86 cases by P. malariae. There are 119 cases in individuals aged over 15 (72.56%) and 45 cases in individuals aged 15 and below (27.44%). There are 118 male cases (71.95%) and 46 female cases (28.05%).

The district has implemented numerous disease control measures, such as vector surveillance, case monitoring, epidemiological investigations, malaria focus investigations, and distribution and treatment of over 10,300 bed-nets and hammock-nets for pregnant women, households residing in hotspots, and forest-goers or workers. Additionally, they conducted insecticide residual spraying for nearly 1,500 households and forest huts, as well as performed blood tests o­n over 22,600 individuals. During the report to the working delegation, the Health Center representatives highlighted the primary difficulties faced by the district. These included the low compliance of residents with disease prevention measures, a relatively high proportion of people spending multiple days in forests or field huts, and challenges in accessing individuals involved in forestry and mining for health workers.

Given these challenges, the Center hoped to receive close and timely attention, as well as guidance from leadership at all levels during the implementation of malaria prevention and control activities. Additionally, the Center proposed several activities that require attention in the upcoming period. These activities include securing financial support for insecticide spraying and impregnation, procuring new microscopes for microscope points, ensuring yearly allocation of mosquito repellent cream and bed-nets/hammock nets, and providing support for mobile communication tools, computers, etc., to aid in malaria prevention and control efforts.

The working delegation met with the Khanh Vinh District Health Center

Assoc. Prof. Ho Van Hoang, the Director of IMPE-QN, has expressed significant concerns about the surge in cases caused by the Plasmodium malariae parasite in Khanh Hoa. The emergence of P. malariae, alongside P. vivax and P. falciparum, has exacerbated the malaria situation. Control of vectors is particularly challenging due to the presence of two primary forest malaria vectors, An. dirus and An. minimus. The majority of cases are linked to individuals entering the forest and spending nights in field-huts, where malaria prevention and control measures remain limited.

Additionally, the procurement of supplies for malaria prevention faces numerous difficulties due to the lack of specific guidelines. IMPE-QN has deployed multiple task forces for epidemiological investigations and vector surveillance to assess the situation and support malaria control activities in Khanh Vinh District. The Institute has also coordinated the supply of anti-malarial drugs from other provinces to Khanh Hoa province for the treatment of malaria patients there.

At this time, Assoc. Prof. Ho Van Hoang also hoped for financial and technical support from the World Health Organization and the RAI Project to address the malaria hotspots in Khanh Hoa. This assistance aims to effectively aid the locality in achieving the goal of eliminating malaria, aligning with the roadmap set to eliminate malaria in Viet Nam by 2030.

Dr. Mya Sapal Ngon, Specialist at WHO Viet Nam, acknowledged the efforts of central institutes and the healthcare sector in Khanh Hoa province for mobilizing local authorities and international organizations to invest in malaria control. Recognizing the challenges in procurement and bidding for insecticides and anti-malarial drugs, Dr. Ngon announced that WHO would provide support by supplying 376,000 Chloroquine tablets to aid in treating malaria patients in the province.

Furthermore, she proposed support for several essential activities in this area, specifically: (i) Active case detection: determining the frequency and timing for active case screening to avoid missing index cases, and intensifying active case detection in neighboring areas. (ii) Targeted Drug Administration (TDA): purposefully administering medicines to identified target groups. (iii) Case follow-up: monitoring malaria cases of all parasite species and ensuring patient compliance with treatment. (iv) Conducting competence assessments of malaria microscopists at the provincial level. (v) Providing training for data entry personnel using the eCDS-MMS software and implementing monitoring and surveillance activities.

Dr. Faisal Mansoor, the Head of the Program Unit at UNOPS, announced his intention to propose support for the purchase of new microscopes and the provision of training for laboratory technicians at microscope points within the programmatic planning of the Regional Artemisinin Resistance Initiative (RAI4E) for the years 2024 to 2026. Additionally, in relation to other proposals concerning non-health products, such as transportation means, potential collaboration with non-governmental organizations like Health Poverty Action (HPA) or Population Services International (PSI) is being considered to integrate these needs into the framework of their activities.

The working session at the Khanh Vinh District Health Center

At the conclusion of the working session, Assoc. Prof. Dr. Ho Van Hoang, Director of IMPE-QN, expressed high appreciation for the efforts made in malaria prevention and control within the province and district in the recent period. He simultaneously recommended that the healthcare sector in Khanh Hoa intensify its supervision of malaria prevention activities, bolster epidemiological investigations, surveillance, and communication in hotspots and neighboring areas.

The director emphasized the imperative need to enhance the functionality of microscopic points and improve the examination, detection, and treatment of patients at medical facilities. Additionally, CDC Gia Lai is urged to prepare an adequate supply of medicines, supplies, and insecticides for malaria prevention, control, and treatment. The focus should be extensive o­n malaria prevention and control, aiming to effectively achieve the goals outlined in the malaria elimination program.

The delegation visited the Khanh Thuong commune area to conduct o­n-site inspections and interview households that have recently experienced malaria.