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Health staff helping the people to treat bed-nets with insecticides. |
Results of malaria epidemiological survey in Cu Jut District, Dak Nong province from 06-13 November 2016
Under the direction of the Ministry of Health and with the financial support ofthe Asian Development Bank (ADB) Project on malaria prevention; in order to achieve the ADB Project objectives and contribute in reducing the burden of malaria, the Project Management Unit of IMPE Quy Nhon had appointed the mission team to conduct the epidemiological surveillance in Cu Jut District, Dak Nong province.
Participants in the task: 1. MSc. Nguyen Trong Doanh, Department of Training, Team leader; 2. BSc. Dinh Viet Hung, Department of Training; 3. BSc. Vu Thi Phuong Thao, Department of Epidemiology; 4. BSc. Pham Thi Thu Thao, Department of Training; 5. Ms. Le Dong Y Nhi, Department of Training. There were also the medical staff of Provincial Preventive Medicine Centre of Dak Nong, Cu Jut District Health Center, Health Station of Dak Drong, Ea Po, Dak Wil commune participating in the task. Surveillance contents: - Malaria situation in the monitoring sites from 2015 to the first 9 months of 2016; - The diagnosis and treatment of malaria at all levels; - The system of microscopic points; - Activities of vector control at all levels; - The information reporting system (IRS). Duration: 06-13 November 2016 I.OVERVIEW Dak Nong is a severely-hit malaria province of the Central-Western Highland region, it borders Cambodia; the people usually have forest-related activities such as exploiting forest and native products, especially border exchanges which makes it difficult to control this group. In 2016, the number of malaria cases and malaria parasites of the province declined by 51.14% and 51.31% respectively; no severe malaria cases and deaths were recorded; however, the situation still develops unexpectedly. Cu Jut is a remote mountainous district of the province, locates 110km from the center of Dak Nong province. It has acommon border of 14 kilometres long with Cambodia, covers an area of 720.29 square kilometres; it has a population of 96,980, including 19 ethnic minorities. The district has a town and 7 communes including 129 hamlets. The district's climate changes irregularly, especially in the rainy season, which creates favorable conditions for the emergence of diseases such as malaria, fever dengue; the dry season is hot and dry, some of the households still don't have running water. Dak Drong is a remote and deep-lying commune, about 16 kilometres far from the regional center, covers an area of 5,880 hectares, it has a population of 15,100 with 10 brother ethnic groups living in concord, most of them are of ethnic minorities. The commune's economy is weak, the road traffic system is weakening and the people's awareness of disease prevention is still low. It accounts for a high proportion of the district's malaria infections, most of the malaria cases are the people with forest-related activities. Dak Wil is a remote border commune, locates 20 kilometres apart from the district center, with an area of 42,140 hectares. It populated by 9,658 people of 11 brother ethnic groups residing in 1,987 households of 15 hamlets and 2 villages of native ethnic minorities). It has a large area on which Dong Phu rubber company has been set up and has provided jobs for many temporarily residing workers. The economic and social status of the commune: agriculture plays as the decisive role in the commune?s economy, the people's economic conditions and intellectual standards are unequal in the hamlets, income per capita is low, the proportion of poor household is still high, many habits and customs are still underdeveloped. Eapo is a commune tier III of Cu Jut district with the total area of 9,931 ha, the commune's terrain is relatively flat, the road traffic system is constructed with asphaltic concrete; some hamlets locate far away the commune center, which makes the transportation become difficult. The total population is of 12,156, of which male population is of 6,101 and female population is of 6,055. The number of households is 2,725, ethnic minority people: 8,197. II. RESULTS 1. Malaria situation in the monitoring sites from 2015 to the first 9 months of 2016 1.1. Malaria situation in Dak Nong province from 2015 to the first 9 months of 2016 Table 1: Several major malaria indicators of Dak Nong No. | Indicators | First 9 months of 2015 | First 9 months of 2016 | % (+/-) | 1 | Malaria patients | 305 | 149 | -51.14 | 2 | Severe and complicated malaria | 0 | 0 | | 3 | Malaria deaths | 0 | 0 | | 4 | Malaria parasites | 304 | 148 | -51.31 | | -P. falciparum, mixed infections P. falciparum | 94 | 75 | | | -P. vivax | 210 | 73 | | 5 | P. falciparum infections treated with ACT | 94 | 75 | |
Remarks: The first 9 months of 2016 witnessed a downward trend in malaria indicators in comparison with the same period of last year, with both indexes of malaria patients and malaria parasites lowering by more than 50%. Table 2: Malaria parasites by month in 2015 and the first 10 months of 2016 | Jan. | Feb. | Mar. | Apr. | May | June | July | Aug. | Sep. | Oct. | Nov. | Dec. | 2015 | 92 | 37 | 46 | 39 | 26 | 21 | 18 | 10 | 15 | 19 | 31 | 25 | First 10 months of 2016 | 33 | 14 | 17 | 16 | 16 | 13 | 13 | 14 | 13 | 15 | | |
Remarks: - Malaria patients occurred in all the months of the year; - Malaria patients decreased drastically during the first 10 months of 2016 compared with the same periods of 2015.  | Firgure 1: Malaria parasites by month in 2015 and the first 10 months of 2016 |
1.2. Malaria situation in Cu Jut distict from 2015 to the first 9 months of 2016
Table 3: Malaria parasites by month in 2015 and the first 9 months of 2016 | Jan. | Feb. | Mar. | Apr. | May | June | July | Aug. | Sep. | Oct. | Nov. | Dec. | 2015 | 47 | 21 | 18 | 14 | 06 | 05 | 05 | 03 | 03 | 10 | 13 | 07 | First 9 months of 2016 | 06 | 04 | 02 | 0 | 03 | 01 | 01 | 02 | 03 | | | |
Remarks: There was totally 22 malaria parasites (05 P. Faciparum & 17P. Vivax) found in Cu Jut district in the first 9 moths of 2016, which tended to decrease against the same period of 2015. Table 4: Malaria parasites in three communes in 2015 and the first 9 months of 2016 No. | Communes | 2015 | first 9 months 2016 | P.f | P.v | P.f | P.v | 1 | Dak DRong | 09 | 11 | 01 | 02 | 2 | Dak Wil | 03 | 08 | | 02 | 3 | Eapo | 03 | 12 | | 04 | | Total | | | | |
Remarks: Malaria parasites in 3 communes reduced. In the first 9 months of 2016, Dak Drong had 03 malaria parasites (01 P. Faciparum & 02 P. Vivax), Dak Wil 02 (02 P. Vivax); Eapo 04 (04 P. Vivax). 2. The diagnosis and treatment of malaria at all levels The inspection results of case-records of the Cu Jut district general hospital and treatment activities at communal level showed that all levels of treatment have complied with the guidelines for diagnosis and treatment of malaria issued in 2013 by the Ministry of Health. 3. The system of microscopic points 3.1. Operations of microscopic point in Cu Jut district The center has a microscopic point with the examination laboratory of 25 square meters in area, full of light, Olympus binocular microscope allocated in 2014, fitted withessential equipment to ensure full operations. The technician used to be trained atIMPE Quy Nhon. The data recordsare noted clearly and precisely andstored completely; the microscopic point does the periodic sending of slides to the upper level for inspection. Table 5: Results of testing the technician's capacity with the sample slide set in Cu Jut district No. | Inspected slide | Answer | Result | Mark | 1 | FVTG | FVTG | Right | 2 | 2 | VTG | (-) | Wrong | 0 | 3 | FT | FT | Right | 2 | 4 | (-) | (-) | Right | 2 | 5 | (-) | (-) | Right | 2 | | Total | | | 8 |
Remarks: The result of the quality of slide examination was 8/10 marks 3.2. Operations of microscopic point in Dak Drong commune The station has a microscopic point with Nikon binocular microscope allocated in 2006. There is no separate examination laboratory and essential equipment to ensure full operations. The technician is a nurse, who used to be trained in medical examination for one month in the district health centre. The data recordsare noted clearly and precisely andstored completely; the microscopic point does the periodic sending of slides to the upper level for inspection. Table 6: Results of testing the technician's capacity with the sample slide set in Dak Drong commune No. | Inspected slide | Answer | Result | Mark | 1 | FVTG | (-) | Wrong | 0 | 2 | VTG | VTG | Right | 2 | 3 | (-) | (-) | Right | 2 | 4 | FT | FT | Right | 2 | 5 | (-) | VTG | Wrong | 0 | | Total | | | 6 |
Remarks: The result of the quality of slide examination was 6/10 marks. 3.3. Operations of microscopic point in Dak Wil commune The station has one microscopic point withPrimo Star (German) binocular microscope allocated in 2015. There is no separate examination laboratory and essential equipment to ensure full operations. The technician is a general practician, who used to be trained in medical examination for one month in the district health centre. The data recordsare noted clearly and precisely andstored completely; the microscopic point does the periodic sending of slides to the upper level for inspection. Table 7: Results of testing the technician's capacity with the sample slide set in Dak Wil commune No. | Inspected slide | Answer | Result | Mark | 1 | (-) | (-) | Right | 2 | 2 | FT | FVTG | Wrong | 1 | 3 | FVTG | FT | Missing forms | 1 | 4 | (-) | (-) | Right | 2 | 5 | VTG | VTG | Right | 2 | | Total | | | 8 |
Remarks: The result of the quality of slide examination was 8/10 marks. 3.4. Operations of microscopic point in Eapo commune The station has one microscopic point with Primo Star (German) binocular microscope allocated in 2015. There is no separate examination laboratory and essential equipment to ensure full operations. The technician is a general practician, who used to be trained in medical examination for one month in the district health centre. The data recordsare noted clearly and precisely andstored completely; the microscopic point does the periodic sending of slides to the upper level for inspection. Table 8: Results of testing the technician's capacity with the sample slide set in Eapo commune No. | Inspected slide | Answer | Result | Mark | 1 | VTG | VTG | Right | 2 | 2 | (-) | (-) | Right | 2 | 3 | FVTG | FT | Missing forms | 1 | 4 | FT | VTG | Wrong | 0 | 5 | (-) | (-) | Right | 2 | | Total | | | 7 |
Remarks: The result of the quality of slide examination was 7/10 marks. 4. Activities of vector control at all levels Table 9: The control of malaria transmitted mosquitoes in Eapo commune No. | Hamlet | Protection by bed-nets impregnation | Time | No. of households | No. of inhabitants | No. of nets | Vol. of ICON (ml) | 1 | Tan Tien | 114 | 576 | 155 | 2170 | 24-25 May 2016 | 2 | Tan Thanh | 50 | 240 | 123 | 1722 | 24-25 May2016 | 3 | Hamlet 1 | 119 | 506 | 92 | 1288 | 24-25 May 2016 | 4 | Dak Thanh | 119 | 508 | 157 | 2198 | 24-25 May 2016 | 5 | Ba Tang | 118 | 441 | 61 | 854 | 24-25 May 2016 | 6 | Hop Thanh | 85 | 401 | 218 | 3052 | 24-25 May 2016 | 7 | Cao Lang | 100 | 460 | 182 | 2548 | 24-25 May 2016 | 8 | Nam Thanh | 109 | 498 | 120 | 1680 | 24-25 May 2016 | Total | 814 | 3630 | 1108 | 15512 | |
Remarks: The results of the insecticide impregnation of bed-nets in Eapo commune in 2016 showed that 1108 bed-nets were treated, 3630 people have been protected. The impregnation of existing bed-nets was done across the commune according to schedule. Table 10: The control of malaria transmitted mosquitoes in Dak Wil commune No. | Hamlet | Protection by bed-nets impregnation | Time | No. of households | No. of inhabitants | No. of nets | Vol. of ICON (ml) | 1 | Hamlet 1 | 106 | 496 | 251 | 3514 | 22 July 2016 | 2 | Hamlet 2 | 105 | 472 | 92 | 1288 | 2 May 2016 | 3 | Hamlet 3 | 68 | 280 | 171 | 2394 | 22 July 2016 | 4 | Hamlet 4 | 96 | 428 | 66 | 924 | 4 May 2016 | 5 | Hamlet 5 | 75 | 393 | 181 | 2534 | 22 July 2016 | 6 | Hamlet 6 | 167 | 685 | 50 | 700 | 6 May 2016 | 7 | Hamlet 9 | 210 | 929 | 316 | 4424 | 7 May 2016 | 8 | Buon Knha | 70 | 354 | 43 | 602 | 8 May 2016 | 9 | Doi May | 150 | 713 | 40 | 560 | 9 May 2016 | 10 | Buon Trum | 167 | 685 | 62 | 868 | 10 May 2016 | 11 | Hamlet 7 | 88 | 421 | 167 | 2338 | 22 July 2016 | Total | 1302 | 5856 | 1439 | 20146 | |
Remarks: The results of the insecticide impregnation of bed-nets in Dak Wil commune in 2016 showed that 1439 bed-nets were treated, 5856 people have been protected. The whole commune got the impregnation of existing bed-nets according to plan. Table 11: The control of malaria transmitted mosquitoes in Dak Drong commune No. | Hamlet | Protection by bed-nets impregnation | Time | No. of households | No. of inhabitants | No. of nets | Vol. of ICON (ml) | 1 | Hamlet 2 | 97 | 552 | 96 | 1344 | 26 May 2016 | 2 | Hamlet 3 | 130 | 557 | 181 | 2534 | 11 July 2016 | 3 | Hamlet 6 | 160 | 670 | 158 | 2212 | 26 May 2016 | 4 | Hamlet 7 | 121 | 567 | 62 | 868 | 11 July 2016 | 5 | Hamlet 8 | 165 | 790 | 93 | 1302 | 26 May 2016 | 6 | Hamlet 9 | 123 | 525 | 64 | 896 | 26 May 2016 | 7 | Hamlet 11 | 135 | 575 | 61 | 854 | 27 May 2016 | 8 | Hamlet 13 | 162 | 778 | 12 | 168 | 27 May 2016 | 9 | Hamlet 14 | 130 | 530 | 212 | 2968 | 11 May 2016 | 10 | Hamlet 15 | 362 | 1575 | 84 | 1176 | 27 May 2016 | 11 | Hamlet 16 | 165 | 726 | 178 | 2492 | 11 July 2016 | 12 | Hamlet 17 | 169 | 835 | 230 | 3220 | 11 July 2016 | 13 | Hamlet 19 | 196 | 1315 | 151 | 2114 | 27 May 2016 | 14 | Hamlet 20 | 225 | 1449 | 103 | 1442 | 27 May 2016 | 15 | Buon U | 107 | 455 | 37 | 518 | 27 May 2016 | 16 | Company C4 | | 81 | 81 | 1134 | 27 May 2016 | Total | 2447 | 11980 | 1803 | 25242 | |
Remarks: The results of the insecticide impregnation of bed-nets in Dak Drong commune in 2016 showed that 1,803 bed-nets were treated, 11,980 people have been protected. The impregnation of existing bed-nets was done across the commune according to schedule. 5.The information reporting system (IRS) 5.1.Figure processing in Cu Jut district, Dak Nong province Table 12: Units reporting malaria control situation in Cu Jut district, Dak Nong province Year | Total required spells of reporting | Month | Total reporting units | % | Jan. | Feb. | Mar. | Apr. | May | June | July | Aug. | Sep. | Oct. | Nov. | Dec. | 2014 | 108 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 100 | 2015 | 108 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 100 | First 9 months of 2016 | 81 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | 09 | | | | 09 | 100 |
Remarks: The statistical figures have kept completely in the district health center; 100% units have given the monthly reports on malaria control. The total number of district units having monthly reports is 9; there were 81 spells of reporting in the first 9 months of 2016, accounting for 100%. 5.2. Statistical processing in Cu Jut district, Dak Nong province Table 13: Surveillance results of statistical processing in Cu Jut district, Dak Nong province Year | Malaria patient | Severe malaria case | Malaria dealth | Reported (R) | Inspected (I) | Disparity rate (R/I) | Reported (R) | Inspected (I) | Disparity rate (R/I) | Reported (R) | Inspected (I) | Disparity rate (R/I) | 2014 | 337 | 337 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2015 | 152 | 152 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | First 9 months of 2016 | 22 | 22 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Total | 511 | 511 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Remarks: The inspection results of statistical data reported from 2014 to the first 9 months of 2016 in Cu Jut district Health Centre showed that there was no disparity detected; the reported data were accurate and adequate. The total number of reported patients was 511 and that of inspection was 511, thus disparity rate 0%. 5.3. Statistical processing in 3 communes of Dak Drong, Dak Wil and Eapo of Cu Jut district Table 14: Surveillance results of statistical processing in Dak Drong commune Year | Malaria patient | Severe malaria case | Malaria dealth | Reported (R) | Inspected (I) | Disparity rate (R/I) | Reported (R) | Inspected (I) | Disparity rate (R/I) | Reported (R) | Inspected (I) | Disparity rate (R/I) | 2014 | 60 | 60 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2015 | 20 | 20 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | First 9 months of 2016 | 03 | 03 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Total | 83 | 83 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Remarks: The inspection results of statistical data reported from 2014 to the first 9 months of 2016 in DakDRong Commune Health Station showed that there was no disparity detected; the reported data were accurate and adequate. There were03 malaria cases in the first 9 months of 2016. Table 15: Surveillance results of statistical processing in Dak Wil commune Year | Malaria patient | Severe malaria case | Malaria dealth | Reported (R) | Inspected (I) | Disparity rate (R/I) | Reported (R) | Inspected (I) | Disparity rate (R/I) | Reported (R) | Inspected (I) | Disparity rate (R/I) | 2014 | 23 | 23 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2015 | 11 | 11 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | First 9 months of 2016 | 02 | 02 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Total | 36 | 36 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Remarks: The inspection results of statistical data reported from 2014 to the first 9 months of 2016 in Dak Wil Commune Health Station showed that there was no disparity detected; the reported data were accurate and adequate. There were 02 malaria cases in the first 9 months of 2016. Table 16: Surveillance results of statistical processing in Eapo commune Year | Malaria patient | Severe malaria case | Malaria dealth | Reported (R) | Inspected (I) | Disparity rate (R/I) | Reported (R) | Inspected (I) | Disparity rate (R/I) | Reported (R) | Inspected (I) | Disparity rate (R/I) | 2014 | 54 | 54 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2015 | 15 | 15 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | First 9 months of 2016 | 04 | 04 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Total | 73 | 73 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Remarks: The inspection results of statistical data reported from 2014 to the first 9 months of 2016 in Eapo Commune Health Station showed that there was no disparity detected; the reported data were accurate and adequate. There were 04 malaria cases in the first 9 months of 2016. IV. CONCLUSIONS - The malaria situation has been stable and showed a downward trend in Dak Nong province, Cu Jut district and three inspected communes; - All levels have deployed the diagnosis and treatment of malaria, microscopic point system, vector control and information reporting system completely and correctly. V. RECOMMENDATIONS Based on the results of the epidemiological survey and monitoring in three communes: Dak Drong; Dak Wil; Eapo of Cu Jut district, the mission team has some recommendations: - To establish and equip the communal health stations with essential laboratory to promptly detect malaria parasites. To provide more training courses for the staff in charge of microscopic points; - To strengthen the detection and treatment of parasite-infected patients; - To focus on providing stand-by treatment medicines and directions for use of those drugs for the objects that usually have forest-related activities; - To continuously and closely monitor vectors and malarial epidemiology, especially in the context of unexpectedly changing weather; to take initiative in monitoring the malaria situation closely to timely response in case of malaria patients and parasites increasing; - To enhance the health education and communication for the community, especially improve the people's awareness of sleeping under bed-nets to avoid mosquito bites.
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