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 Malariology Epidemiology
Characteristics of malaria infection in mobilised population groups

In recent years, the rates of malaria morbidity (malaria patients, malaria parasites) and malaria mortality have tended to decrease low nationwide, but malaria still exists in uncontrollable mobilised population groups in West-Highlands, Central and Southeast (free migrants, forest goers, mountain-field doers, etc.). In order to effectively prevent and eliminate malaria, it is necessary to grasp the characteristics of malaria infection in these groups.

Besides, even though the burden of malaria has decreased, the malaria control is still facing some new challenges, such as drug-resistant malaria parasites, insecticide-resistant malaria mosquitoes, border malaria, particularly in mobilised groups and uncontrollable migrants. The main groups at risk in the forests and foothills are:

The ethnic minority groups living in or near forests, who practise nomadic farming cultivation (burn off land for cultivation);

Villagers and farmers living at the edge of forest, including newcomers and forest planters;

Farm workers, especially people working in rubber plantations at night, who are often seasonal workers and migrants mainly;

People who have been relocated to forests or forests' edges as refugees or workers for development projects such as construction of dams;

- People going into the forest in a short time such as the security forces, loggers, miners, tourists and many other subjects;

Military forces and police being deployed in border areas;

People who live or work in coastal areas and engage in agriculture, aquaculture, fishing or smuggling.


 

These groups can be distinguished by the degree and various forms of their movements, as well as by their legal or illegal status. There might be an overlap as classifying them; for example, people from ethnic minority groups may be farmers working at forest's edge or plantation workers.

In recent years, the ethnic minority groups with agricultural nomadic practices have occupied the largest number and the most important part in the burden of malaria in the GMS. These families, mainly male members spend days or weeks absent from the villages to take care of plots of forests, do forest products harvesting or hunting.

Therefore, the malaria transmission cycle can continue to be maintained in the community, even if the spread of malaria had been cut off. The communities doing nomadic farming are gradually disappearing (although in Myanmarthey still account for more than 2 million people) and most of the remainders are fully offered long-lasting impregnated nets (LLINs) and community-based case management services.


 

Migrants are not necessarily in deep-lying and remote areas. The mobility involves multiple demographic groups, local authorities and the interference between economy and society, which has been proved to be increasingly important. When the malaria elimination in Greater Mekong Subregion (GMS) moves to the final stage, the main concern will be the risk of imported malaria from other countries, especially from malaria-endemic areas in Bangladesh and northeast India bordering Myanmar. Compared to the migration flows in the GMS, the border-crossing movements from Myanmar to these two countries and vice versa are relatively few.

 

The malaria control in Myanmar is making progress; the risk-determining factors in this country are similar to those in the GMS. The progress in malaria elimination in the GMS will stimulate the similar efforts in eliminating malaria in Bangladesh and northeast India, thereby reducing injuries to Myanmar.

The development of worldwide air travel can increase the risk of imported malaria. For example, China is having to deal with P. falciparum malaria imported from Africa, and travels between African and the capitals of Southeast Asian countries are also increasing. In the context of preventing drug-resistant malaria, there currently exists the two matters: migrants from western Myanmarsang move to other countrieslike Bangladeshand possiblyto areasat risk ofmalaria; soldiers appoint to Africatoperform peacekeeping and stability missions or military training and exchanges.

The decline in malaria burden in the GMS over the past decade has been due to the investment in malaria control, and also resulted in the change of the social contexts such as reduction of deforestation and poverty. Although the economic growth is hoped to reduce the risk of malaria in migrants, other factors such as inequality, the demand for forest products harvesting and infrastructure projects lying near or in forestal areas could sustain the risk of malaria due to population movements, and this risk is supported by the development of transportation networks and open borders.

In a short time, the important interventions that can be implemented by governments include improving regulations o­n and coercing and preventing all illegal activities such as illicit logging, requiring the companies licensed to operate in or near forestal areas to consult and cooperate with the health sector.

Security problems and political instability remain the most serious risk. This situation is being improved in the GMS, but only a negative change can also imperil the efforts of malaria elimination and reverse the recent achievements of malaria control.

 

A special focus o­n the mobilised population groups and refugees must be guaranteed for other reasons: these groups often seek treatment from private or unofficial health facilities, increasing risks of taking substandard and counterfeit drugs, drugs being used as monotherapy, especially oral artesunate monotherapy 50mg. The artemisinin resistance prevention programs in Cambodia, Myanmar, Thailand and Vietnam include the special intervention measures on mobilised population groups such as impregnated bed-nets distribution campaigns, establisment of screening points and provision of diagnosis and treatment services at these groups' workplaces.

03/02/2016
Written by Dr. Huynh Hong Quang
(Translated by Huynh Thi An Khang)
 

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