Combination approach results in significant drop in malaria rates in Viet Nam - WHO
A multi-pronged approach to battling malaria in Viet Nam has resulted in a ten-fold drop in the proportion of villagers with the parasites in their blood, according to a new study published the journal of the United Nations World Health Organization (WHO).
According to the study, the proportion of people in the village of Phan Tien, a settlement in a wooded, mountainous province in southern Viet Nam, went down from 42 per cent to 4 per cent in a five-year experiment. The drop also helps account for the steep decline of malaria nationally in the last decade, since communities in endemic areas across the country have been using a similar strategy.
The study documents how the combination of a bednet programme, a community-based primary health care system which provides early diagnosis and prompt treatment to patients, and annual malaria surveys "brought malaria under control remarkably quickly," the authors, Le Q. Hung and colleagues, write in the Bulletin.
Though up to 2 million people in the world die each year of malaria, no new method of controlling the disease has been found since the introduction of insecticide-treated bednets in the 1980s. The coverings reduce infection but cannot prevent or control the disease on their own. The recommended strategy has therefore been to make systematic use of all the appropriate means available.
In Phan Tien in 1994, where 30 of the 750 inhabitants had died of malaria earlier in the year, the first step was to set up a health post, the study says. Two medical staff were appointed and equipped with a microscope for diagnosis and a supply of artesunate for treatment. In addition, 10 community members were appointed as "health co-workers" to assure the distribution and use of bednets and their reimpregnation with permethrin every six months, to help carry out annual malaria surveys at the end of the rainy season, and to spread basic knowledge about how to avoid infection or seek treatment for it.
By 1998 the population had grown to 1028 and no cases of malaria were detected in the annual survey. The following year, however, 18 cases were detected, explained in part to a substandard batch of permethrin, imported cases from road workers, and a decline in vigilance due to the feeling that malaria was not a problem any more.
"The whole challenge of malaria control can be seen in this one example," said Dr. Kamini Mendis of WHO's Roll Back Malaria programme. "The means exist and they can be very effective, but only if they are fully used and on a continuous basis."