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Commune Health Worker Vang Thi Hac at her health station in Pa Ve
Towards a malaria-free Viet Nam

As Viet Nam approaches elimination, malaria has become rare or non-existent in settled, ethnic majority villages but persists in geographically remote areas inhabited by ethnic minorities. Malaria control is facing a lot of difficulties because of uncontrollable mobilized populations such as forest goers and border crossers. Behavior change of minority groups - to alert populations to need to seek prompt diagnosis and treatment from available services, and to comply with full course of treatment - is challenging and requires persistent efforts using multiple channels with involvement of Commune Health Workers and Community Malaria Action Team members. Here are two typical examples of such engagement in two malaria hotpots of Viet Nam - Lai Chau and Gia Lai.

Commune Health Worker Vang Thi Hac: "It's my duty to take care of them"

Located in north-western Viet Nam, Lai Chau is a mountainous province bordering China. Moung Te District of this province is composed of 10 communes in which the local Lahu hill tribe resides. The district is facing the challenge of malaria transmission, as a lot of malaria cases were detected in one of its villages, starting from 2019. Since then, there has been an increase in the number of Plasmodium vivax (Pv) malaria cases in three communes of the district.

However, Vang Thi Hac, a 34-year-old commune health worker, has a positive view that they will conquer malaria through strong commitment. She has been working as a commune health worker and malaria focal person at Pa Ve' Su' Commune Health Centre for more than five years. Her responsibility as the malaria focal person is on top of her existing duties of providing health care for 12 communicable and noncommunicable diseases.

"Since I was young, I have been really interested in health and taking care of other people. I am committed to our people in this commune," she said. 

Pa Ve' Su' Commune Health Centre covers 12 villages which comprise 748 households with 2,931 population. Most of the residents in the commune make their living in malaria high-risk areas such as forests, mines and plantations in the areas where malaria is still prevalent. 

Viet Nam has pledged to eliminate malaria by 2030, as a shared goal among four other Greater Mekong Subregion countries (Cambodia, Lao PDR, Myanmar and Thailand). The country has made significant progress in malaria control and is on track to meet its vision. Malaria morbidity and mortality in Viet Nam decreased significantly between 2000 and 2020, with a 98.1% decline in malaria cases and a 99.3% decline in malaria deaths.

Despite the remarkable success, the country still has challenges to face in order to completely eliminate malaria. Malaria control is still challenging among the most 'hard-to-reach', such as forest-goers and mobile and migrant populations.

Pa Ve' Su' Commune detected the highest number of malaria cases in 2021 and the first half of 2022, with 32 and 21 cases, respectively. With financial support from the Global Fund, malaria prevention and control measures are being conducted in the district by the key stakeholders at all levels.

Dr Faisal Mansoor, Head of the Programme of UNOPS Asia Regional Health Cluster said, "We are very proud to see that Viet Nam has made remarkable progress in the fight against malaria. I would like to acknowledge the strong commitment by the Government, partners and other key stakeholders." 

"From wide distribution of long-lasting insecticidal bed nets, to mass drug administration and increased malaria testing, our partners are expanding malaria control efforts and eliminating the most deadly strain of malaria from the region."

Malaria testing has been speeding up with active case detection approaches in and around the villages with reported cases. About 90% of cases are found by active case finding activities. 

Mass drug administration (MDA), the administration of antimalarial treatment to every person living in a defined geographical area at the same time and often at repeated intervals, was conducted in the villages with reported cases. The first round of antimalarial chloroquine was provided to all the population from these villages, and around 70 per cent of the population is covered. To reduce the risk of getting malaria, long-lasting insecticidal nets (LLINs) are distributed to every household and health education sessions are conducted. 

To carry out these activities effectively, the role of commune malaria workers like Vang Thi Hac becomes critical. Vang is cooperating with 11 village health workers to conduct malaria activities in the villages.

"I am doing malaria outreach in the villages to conduct malaria testing, LLIN distribution and health education around prevention and symptoms," she said. 

 

Commune Health Worker Vang Thi Hac conducting malaria microscopy at her health station in Pa Ve' Su', Lai Chau Province, Viet Nam. Photo: ARHC

Vang has to go extra miles to reach the hard-to-reach population in her commune. Sometimes she faces challenges because of the road conditions. It takes at least three hours by motorbike to reach the villages, and Vang has difficulties because of chronic knee pain. "I will get to them no matter what. It's my duty to take care of them," she said with a smile.

It is important that patients adhere to malaria treatment. Vang has to visit the patient's household and call by phone every two days to check the status and treatment adherence.

She talks about the case of an 11-year-old child named Giang Ga Nu who is infected with malaria. Giang had to accompany his father to the forest and got sick upon his return. His mother brought him to the Pa Ve' Su' Commune Health Centre where he tested positive for malaria.  

"We really rely on the Commune Health Centre. We go directly to the Centre whenever our family member is sick. I was so worried about my son when I found out he had malaria. But the health worker provided comprehensive care and my son's condition is getting better. Now, he is on day 11 and will be fully recovered soon," said Ly Mul Huy, mother of the child.

"I am hopeful for a future without malaria in our area," Vang said. 

 

Pa Ve' Su' Village in Moung Te District under Lai Chau Province in Viet Nam. Photo: ARHC


From malaria patient to malaria fighter: Hiao Khanh's dedication to eliminating malaria in his Vietnamese community

Hiao Khanh, 29, is a member of the Community Malaria Action Team in Chu Rcam commune, Krong pa district, Gia Lai province, which is known for having the highest number of malaria cases in the country. In 2020, more than 200 cases were detected across the district.

As part of his responsibilities, Hiao Khanh is in charge of overseeing 2 villages in the area. He has been working in malaria prevention and control in his community since 2019, after he recovered from malaria.

"It was a near-death experience," said Hiao Khanh. "I had high fever before getting access to health care support. After that, I was motivated to help reduce sickness and deaths from malaria in my commune."

People in this community rely heavily on the forest to earn a living. They go into the forest to work, and sleep there, putting them at high risk of contracting malaria.

When it rains, the community's scattered forest settlements are nearly cut off, as dirt access tracks are flooded, and hairpin bends on steep terrain become slippery. Hiao Khanh and his team need to use motorbikes to reach different parts of the community to help protect people from malaria.

 

Community Malaria Action Team member Hiao Khanh after a meeting with members of the community. Source: WHO/Viet Nam

The team's main activities are to raise awareness about malaria prevention, provide protective items such as mosquito nets, identify people who might have malaria and then transport them to health care facilities for testing, and support adherence to treatment for forest goers.

The good news is that, with the right treatment, patients can now be cured in a shorter period of time. Previously, WHO recommended a 14-day course of antimalarial medicines to prevent a relapse of P. vivax malaria. Based on the latest evidence, WHO is now recommending a shorter (7-day) treatment option.

However, ensuring individuals stay on track with their treatment remains a challenge. Forest workers, for example, often prefer to return to work as soon as their fever subsides.

Part of Hiao Khanh's work is to find and persuade patients to come back for treatment. Communication is a crucial aspect of his team's work. They actively listen to people's concerns, respond to their queries, and emphasize the importance of completing the full treatment course. By doing so, individuals can make a full recovery, allowing them to return to work without any further complications or malaria-related interruptions.

"I hope to make people aware of malaria so that they are able to access health care services when they have symptoms," said Hiao Khanh. "Just a 'thank you' from my people is enough to give me strength to continue this job to eliminate malaria from my homeland."

 

During a community meeting in Gia Lai province, Viet Nam, a member of CMAT provides information about malaria prevention and control. Source: WHO/Viet Nam

Viet Nam is highly motivated to reach the goal of eliminating malaria for a healthy future, an aim shared by many countries in the Greater Mekong Subregion. However, Viet Nam still has malaria transmission in some remote or dangerous locations, such as forests, and in some mobile labor-intensive industries, like mines and plantations.

"We must really all work hard in the next few years to reach the last mile, ensuring we keep our focus on reaching the remotest communities. By doing this together, we can win this historic fight and achieve zero malaria in Viet Nam", said WHO's Representative in Viet Nam Dr Angela Pratt.

07/06/2023
(Recapitulated form raifund.org and who.int)  
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