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 Malariology Epidemiology
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.

 

11/28/2016
Written by Nguyen Trong Doanh, MSc.
Translated by Huynh Thi An Khang and Nguyen Thai Hoang
 

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