Workshop on preliminary summing-up of malaria control and elimination in the first 6 months of 2015: the start of malaria elimination goal
The workshops on evaluating the prevention of malaria, parasitic and vector-borne diseases in the first 6 months of 2015 and launching the workplan of the last 6 months of 2015 were held by the institutes of malariology, parasitology and entomology (Ministry of Health-MoH) in North Vietnam on 24 July 2015, in South Vietnam on 27 July 2015 and in Central Vietnam on 28 July 2015. From the positive results of the malaria situation in the last 5 years, especially in the first 6 months of 2015, the first steps towards the goal of eliminating malaria by 2030 have been launched.
Assoc.Prof. Nguyen van Chuong, Director of IMPE-Quy Nhon in his opening speech at the workshop on preliminary summing-up of the control and elimination of malaria and helminthiasis in the first 6 months of 2015 and launching the workplan of the last 6 months of 2015 in Central Vietnam
Malaria patients reduce in the country, increase in West-Highland and Southeast Vietnam
According to the comparative results of malaria indexes in the first 6 months of 2015 against the same period last year by the National Institute of Malariology, Parasitology and Entomology (NIMPE), malaria patients decreased by -3.90% (10,062/11,032), severe and complicated malaria cases decreased by 35.71% (18/28), malaria deaths didnot increase (1/1), but malaria parasites increased by 3.16.9%, mainly in the severely-hit areas of malaria; no malaria outbreaks occured in the whole country. It is a very positive signal when in the first 6 months of 2015 malaria patients increased just in two "hot spots" of the country over the same period in 2014: West Highland +26.11% (2,763/2,191) and Southeast +66.59% (1,366/820), meanwhile this index of other areas was lowered, including the key areas of malaria in Central Vietnam -22.1% (1,872/2,404), the forth zone -18.6% (1,201/1,476), northern mountainous area -6,73% (2,023/2,169), northern midland & lowland -30.7% (1,276/1,842) and the Mekong Delta -22.3% (101/130).
West-Highland remains "hot spot" of malaria in the country.
In the Central-West Highland, as reported by the Institute of Malariology, Parasitology and Entomology Quy Nhon (IMPE Quy Nhon), malaria patients increased by 1.66% (4,395/4,468), mainly in the West-Highland +33.54% (Gia Lai +75.86%, Dak Nong +43.96%, Dak Lak +17.51%) and Phu Yen +40.07%. The remaining 11 provinces are lower in the rate of malaria infection cases such as Quang Tri -63.64%;. Danang City -56.25%; Ninh Thuan -52.24%; Kon Tum -40.77%; Thua Thien-Hue -33.54%; Quang Nam -32.33%; Khanh Hoa -23.03%; Quang Ngai -22.64%; Quang Binh 22.51%; Binh Dinh -22.34%; Binh Thuan -11.76%. Especially, although Central-West Highland is a major region responsible for 90% of the country's malaria deaths, in 6 first months of 2015 no malaria fatality was found (0/1) and severe and complicated malaria also dropped by 50% over the same period last year.
Thus, the decrease in malaria morbidity in the first 6 months of 2015 has continued the downward trend within the last 10 years, particularly the last 5 years (2010-2015) in the "hot spots" in the Central coastal areas, West-Highlands and Southeast, which shows a relatively stable control over malaria situation, allowing a positive view on the goal of eliminating malaria in the near future.
Surveillance and detection of malaria parasites are regular works in the community.
Malaria parasites increase in most of malaria-endemic areas, causing high risk of malaria transmission
The report of NIMPE showed that the whole country's malaria parasites in the first 6 months of 2015 increased by 16.9% (5,623/4,810) against the same period last year, the highest in Southeast + 82.5% (1,219/668), West Highlands +36.7% (2,468/1,806), the forth zone +40,3% (223/159), northern midland & lowland northern mountainous area -6,73% (2,023/2,169), northern midland & lowland +32% (33/25); but the index declined by-28,1% (41/57) in northern mountainous, Central -22.1 (1,566/2,009) and the Mekong Delta -15.1% (73/86). In descending order, 10 provinces with highest number of malaria parasites are Gia Lai (1,462), Binh Phuoc (1,103), Dak Lak (485), Khanh Hoa (384), Phu Yen (311), Dak Nong (261), Ninh Thuan (220), Quang Binh (204), Nghe An (130), Quang Nam (81).
As for malaria parasite structure, P.vivax 53%, P.falciparum 43.69%, the rest 3.31 % is coordinated vivax + P. falciparum. Especially, there is a reversal in the Central and West-Highlands: P.vivax becomes dominant instead of P. falciparum, e.g: in the first 6 months of 2015 P. vivax 56.87%, 2014 (45%), 2013 (39%).
Forest-goers and field-hut sleepers are uncontrollable mobile populations at present.
The rate of malaria parasites (pathogen index), one of three natural elements of malaria transmission, has still been found in almost malaria-endemic areas, while the malaria major vectors (An.minimus, An.dirus, An.epiroticus) have still existed, making malaria outbreaks to be more likely to recur in the areas with uncontrollable mobile populations (people going into the forest, sleeping in the field-huts, crossing border). Especially, despite improved malaria situation, the malaria parasites of Central-West Highland in the first 6 months of 2015 accounted for 68% of the whole country (3,872/5,623), thereby the priority activities of malaria control have been mainly concentrated in this region.
tMicroscopic examination to detect malaria parasites.
Workplan for last 6 months of 2015 and activities towards malaria elimination goal
To enhance surveillance of severely-hit areas of malaria infection; to direct malaria control effectively, especially areas with increased malaria indexes, mobilised populations, floods and disasters, deep-lying and remote areas; to focus on supervision and direction of malaria hotspots (Ninh Hoa); to proactively investigate to identify risk factors; to strengthen implementation of malaria posts.
Insecticide spraying is one of the effective anti-malaria measures.
To monitor malaria vectors and vector control, ensure the coverage and quality of insecticides spraying and impregnation in vector control, conduct health education and communication of guidelines on the proper use of long-lasting insecticide-treated nets (LLIN) and allocate one person one net instead of two persons one net, monitor malaria vectors to detect insecticide-resistant mosquitoes; to enhance the quality of diagnosis and treatment of malaria cases; to provide supplies, chemicals, antimalarial drugs promptly; to ensure the prescribed statistical reporting through the software "Malaria Information System" and set up the plan of malaria control in 2016 under the guidance and direction of the Ministry of Health.
According to the plan, the Global Fund Malaria Control Project is being ended in late 2015 and the RAI Project will be ended in 2016, so the provinces should take advantages of these granted fundings to strengthen malaria prevention activities at localities. on the basis of malaria epidemiological stratification in 2014 with the malaria-endemic area population of about 11 million and risk of exposure to malaria mostly concentrating in mobilised population groups, it is needed to maintain the current management mechanism of medical goals, especially epidemic infectious diseases, and proactively set up the workplan for 2016 based on the malaria epidemiological stratification in 2014 (estimated budget of 60 to 70 billion); to conduct the activity 'Evaluation on malaria control in 5 years 2011-2015 in Vietnam' based on the sample interview of the managers from central to local levels, at the same time to carry out the evaluation of malaria situation in 30 severely-hit districts of malaria under seven major economic areas of the country.
The activities towards malaria elimination target have also been launched and the first activity has been to consider the malaria elimination criterion in the locality through a survey of 30 key districts in 7 economic areas of the country (about to be carried out) and the results of practical malaria epidemiological stratification in 2014 (made public already). First, to conduct pilot survey in some localities achieving the WHO's reduction target of malaria transmission: the North (Hoa Binh province) and the Central (Thua Thien-Hue province); after obtaining the results from the pilot districts, the malaria elimination criterion will be set up as prescribed by WHO and submitted to the Ministry of Health for approval. Then, to consider recognizing which provinces to be meet the criterion. After being recognized as malaria elimination provinces, it is nescessary to maintain proactive surveilance, vector control and operation fundings. Some models of malaria elimination in Sri-Lanka and China have achieved certain success from this basis, thus the provinces should try and compare their local capacities with the malaria elimination criterion to strive for meeting these criterion.
APMEN VII: Vietnam demonstrates strengthened regional commitment for a malaria-free Asia Pacific by 2030
The malaria control and elimination strategy in Vietnam has been implementing since 2012 with an aim towards elimination of malaria by the year 2030 according to WHO's strategy for malaria elimination in the Greater Mekong subregion (2015-2030); especially, at APMEN Business and Technical Meeting in March 2015, Vietnam has made commitment to complete this strategic goal. Although a number of activities aimed at eliminating malaria has been started, there are still lots of difficulties and many things to do to reach the goal over the next 15 years, in which the most worrying problem currently is of antimalarial drug resistance; therefore, in order to achieve the goal of eliminating malaria by 2030, Vietnam should deal effectively with Artemisinin resistance, a first-line effective drug in treating malaria.