I. Background

Dak Nong is a mountainous province of the West-Highland, having high rate of malaria morbidity. In recent years, thanks to the investment of Malaria Control Program in Vietnam as well as the support of World Health Organization (WHO), Global Fund, etc., rate of malaria morbidity and mortality had reduced significantly and no malaria outbreak occured.

According to the statistics of first months of 2015, malaria patients of Cu Jut district increased 46.05% compared with the same period of 2014. Malaria patients were mainly mobilised people who come from other areas as well as the people of Cu Jut district going to malaria-endemic areas of other regions. With the aim of surveying and evaluating of malaria situtation and proposing control measures, the support of WHO, the IMPE-Quy Nhon appointed the mission to Cu Jut district to carry out some of activities:

-      To detect malaria patients among mobilised people at 3 communes of Dak Drong, Cu Knia and Dak Wil of Cu Jut district by active detection measure.

-       To analyse some of epidimiologic charateristics of mobilised people.

Malaria patients were mainly mobilised people who come from other areas as well as the people of Cu Jut district going into malaria-endemic areas of other regions.

II. Location and time

1. Location

- Communes of Dak Drong, Cu Knia and Dak Wil, Cu Jut district.

2. Time: August, 2015

III. Results of the surveillance

3.1. Some of characteristics related to malaria situation in Cu Jut district

Cu Jut district is the high malaria-endemic area of Dak Nong, lying in the north of the province with the highway 14 running through, far from Gia Nghia town 110 km and far from Buon Ma Thuoc city of Dak Lak province 20 km. With the geographical position, severe malaria patients will be transferred upper level and they are often transferred the provincial general hospital of Dak Lak. The area of the district is 718.9 km², the population are 97.400 people, including 8 communes/town. There are many ethnic groups such as Kinh, M'nong, H'mong, Tay, Nung, Dao, etc.

The people mainly work o­n agriculture and farming such as rice, wheat, corn. Some of people often go to the forest and exploit the forest and native products. Therefore, it is difficult to control and manage these objects.

Farming habits

-      The people often till the fields and go to forest to exploit forest products. The field-huts are far from the village about over 20km, mainly going o­n foot or riding specialized motorcycle.

-      The rate of people sleeping in the field-huts makes up about 30-35% of the population. The field-huts are scattered and narrow.

3.2. Situation of malaria patients in Cu Jut from 2012 to first 8 months of 2015

Table 1: Some of malaria indexes of Cu Jut

Remarks:

-      Malaria parasites distribute in all groups of age, including under 5 years old, from 5- 15 years old and above 15 years old. However, the group of above 15 years old has the highest rate of infecting malaria. Besides, there are several malaria cases of pregnant women.

-      On structure of malaria parasites, P.vivax is mainly.

-       Although the number of malaria patients is high, there have had no severe and complicated malaria case, malaria death in recent 4 years.

Table 2: Distribution of malaria parasites monthly from 2012-2015

Remarks:

-      Malaria occurs all year round from January to December

-      From September to January next year, there are high rates of infecting malaria parasites.

-      From August to October, three end months of rainy season, malaria patients increase higher than the same period of last year; however, at the current time, malaria patients tend to decreased significantly.

Figure 1: The graph compared malaria parasites in the period of 2012-2014 with 2015

Remarks: Malaria parasites in 2015 are detected higher than the average of the period of 3 year (2012-2014); however, in May, malaria parasites tend to decreased.

Table 3: Distribution of malaria parasites at communes annually in the period of 2012 - 2015 No. Communes 2012 2013 2014 First 8 months of 2015 1 Dak Wil 37 30 29 12 2 Eapo 45 25 60 13 3 Nam Dong 38 17 15 6 4 Dak Rong 82 105 72 20 5 Cu Knia 58 27 41 13 6 Truc Son 5 3 4 5 7 Tam Thang 24 20 40 23 8 Eatling 26 8 52 18 9 Other 32 15 24 9   Total 347 250 337 119

Remarks:

- Malaria parasites distribute at 8/8 communes, town.

- Some of communes have high rate of malaria parasites such as Dak Drong, Cu Knia, Dak Wil, Ea Po. The people of these communes often go to forest to till the fields such as station 18 of Dak Drong, sub-area 839, 840 of Dak Wil.

3.3. The survey result of malaria patients at three communes of Dak Drong, Cu Knia, Dak Wil

3.3.1. Some of general characteristics of 3 communes of Dak Drong, Cu Knia, Dak Wil

The population of Dak Drong commune is about 18.019 people, with 3,063 households in 20 villages/hamlet. The ethnic groups living in the commune are very diversified, the Nung make up the highest rate (25%), the Tay (15%), the H'Mong (10%), the Dao (10%), the other ethnic groups (Kinh, M'Nong, Ede) having other rates (from 1-5%). The communal health station have 8 medical staff, including 2 doctors, 1 physician, 2 nurses, 2 midwives and 1 pharmacist. The health station has microscopic point to serve blood test and malaria diagnosis at locality.

The population of Cu Knia commune is about 7,370 people, with 1,837 households in 12 villages/hamlets. The ethnic groups living in the commune are very diversified, the H'Mong make up the highest rate (35%), the Tay (25%), the Kinh (10%), the Nung (10%), the Thai (7%), the other ethnic groups (M'nong, Ede) having low rates. The communel health station have 8 medical staff, including 1 doctor, 3 physicians, 1 nurse, 1 midwife, 1 pharmacist and 1 staff as demegrapher. The health station has microscopic point to serve blood test andmalaria diagnosis at locality.

The population of Dak Wil commune is about 9.368 people, with 2,003 households in 17 villages/hamlets. The ethnic groups living in the commune are very diversified, the Kinh make up the highest rate (45%), the Tay (15%), the Dao (12%), the other ethnic groups (M'nong, Ede, H'Mong, Nung having low rates. The communal health station have 7 medical staff, including 1 doctor, 2 physicians, 2 nurses, 1 midwife and 1 pharmacist. The health station has microscopic point to serve blood test andmalaria diagnosis at locality.

3.3.2. The results of the active investigation o­n malaria patients

Table 4: Results of the invesitation o­n Malaria Patients

Remarks: Through examining, taking blood and diagnosing with rapid diagnostic tests for the mobilised population and forest goers, field-hut sleepers in three communes of Dak Drong, Cu Knia, Dak Wil, we have not detected any malaria case. This result is suitable to the current malaria situation of the local area recently.

Table 5: Some characteristics of the investigated objects

Remarks: The proportions of both male and female going into forest to work are not so different. The average age is 34.22 years old and children and elderly also join their family in working in the mentioned areas.

3.3.3. Analysis of an epidemiological characteristic of the investigated household

Table 6: Analysis some characteristics of the interviewed people

Remarks: Through the active detection of malaria patients for 601 people in three above communes, we interviewed those objects and found that: 476 households were approached by us, the numbers of people in those households are 2,266 people. The proportion of people in the households who work in the forest/field-hut make up 50.84% in 3 communes.

Table 7: Analysis of some characteristics of the forest goers, field-hut sleepers in the households

Remarks: The mobilised population in the investigated households of the 3 communes included: 363 people in Dak Drong commune, 584 people in Cu Knia commune and 241 people in Dak Wil commune. As for the gender: male accounts for a higher proportion in comparison with female, 56.03% and 43.97% in all three communes, respectively. As for the ethnic groups: the H'Mong make up the highest proportion - 70.49%, distributing in 2 communes of Dak Drong and Cu Knia. Dak Drong commune has two ethnic groups that accounted for high proprtions: Kinh and E De.

Table 8: Analysis o­n some epidemiological factors of the forest goers/field-hut sleepers in the households Factors Total % Dak Drong Cu Knia Dak Wil Numbers % Numbers % Numbers % Occupation Tilling the field 1151 99,91 362 99,73 548 100 241 100 Going into forest 1 0,09 1 0,27 0 0 0 0 Duration of sleeping in field-hut/forest                 Below 7 days 435 37,76 46 12,67 334 60,95 55 22,82 7 days and more 452 39,24 214 58,95 203 37,04 35 14,52 Above 1 month 265 23,00 103 28,38 11 2,01 151 62,66 The months with increased activities of sleeping in field-hut/forest: from May - November yearly Working locations   Dak La commune (Dak Min district) 927 80,47 298 82,09 515 93,98 114 47,30 Field in the commune 233 19,36 65 17,81 33 6,02 125 51,87 Cambodia 2 0,17 0   0   2 0,83

Remarks:

Through the investigation and collection of the information sources relating to the mobilised population of the 3 communes have shown that:

-      The propotion of the mobilised population working the field account for a high rate (99.91%), o­nly 0.09% people go into forest for logging. Through the active investigation, we encountered some difficulties in approaching the forest goers: the forest goers are always o­n the move to find wood sources so that it is impossible to know their locations; until we approach these objects, very few of whom are willing to cooperate with us due to some personal problems (they suspect the presence of the foresters in the team, they fear that their exploiting wood will be detected, they fear that their exploiting position will be detected...). According to our subjective assessment, the activities of the forest goers of the three communes are very common, they may account for 3 - 7% of the all mobilised population, however it is diffucult to approach these objects.

-      As for the resident duration of the mobilised population: The duration they sleep in the forest/field is diverse, however the people in the communes say that no matter they stay in long or short term, they must come home every Sunday to take part in religious activities (the ethnic groups come from the north: H'Mong, Tay, Nung, Thai), get the food and come back to the working place. The people also know they usually go into forest/field-hut from May to November yearly.

The place where people move freely:

-      Dak Drong commune: the people of the hamlet 19 and hamlet 20 are the most intensive mobilised populations. The location where they work is the forest area belong partly to Dak Drong commune, and mostly to Dak La commune (Dak Min district). It is extremely difficult to go to these areas, most of them go o­n foot, some people travel by motobikes (the vehicles were modified to be able to travel o­n hilly terrain). In rainy season they o­nly could walk to work. It takes about 4 - 20 hours to travel from home to work o­n foot. According to their way of naming, these areas are called Tre stream, Stop 18, Stop 20, etc.

-      Cu Knia commune: The people in the hamlet 7, hamlet 9 and hamlet 10 are the most intensive mobilised populations. The location where they work is the same with the people of Dak Drong commune. The characteristics of the mobile population of this commune is the same with the people of Dak Drong commune.

-      Dak Wil commune: The people in the hamlet 9, hamlet 10 and Doi May hamlet are the most intensive mobile populations. The locals of Doi May hamlet move freely into sub-area 478. The people of hamlet 9 and hamlet 10 move freely into the forest area of sub-area 839 and 840. These sub-areas belong to Dak Wil commune. As for the transportation, they can travel by motobikes in these sub-areas (the vehicles were modified to be able to travel o­n hilly terrain), however it is very difficult to travel in the rainy season. It takes about 20-30 km to move from home to the working place (mountainous terrain). Beside the locals going into the sub-areas, there are also other mobilised population from the other communes in the district such as Tam Thang commune, Ea Po commune.

IV. Conclusions

-      The malaria situation of Cu Jut district occured complicatedly from the end of 2012 - 2014, however no death was recorded. At this time, in the first 8 months of 2015 the malaria cases tend to reduce. Malaria cases distribute in all communes of the district, the malaria cases increase considarebly from September to the January next year. The malaria cases are mostly caused by their habits of sleeping in forest/field-hut. The structure of malaria parasite in this area tend to appear P.vivax;

-      No malaria case was detected in the period of the investigation;

-      The people in some hamlets of two communes Dak Drong and Cu Knia move freely to the forest area between 2 districts Cu Jut and Dak Min to work in the forest/field-hut;

-      The people in Dak Wil commune and in some other communes of this district move freely to the forest of Dak Wil commune to work in the forest/field-hut.

V. Reccomendations

1. Prepare medicine, materials and protective chemicals adequately before entering the malaria transmitting season of 2015. Detect and diagnose early malaria cases to reduce the harmful effects of malaria to the people.

2. Enhance health education and communicaton for the people, particularly the group of forest goers/field-hut sleepers.

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