On July 13th 2012, in Quy Nhon city, Binh Dinh province, the IMPE-Quy Nhon held the Workshop on Reviewing Malaria and Helthminthiasis situation in the first 6 months of 2012. The workshop had the attendance of the leaderships of the Preventive Medicine (the Ministry of Health), the Institiutes of Malariology, Parasitology and Entomology, the provincial malaria control centres/Provincial centres for preventive medicine, the Army Medical units, rubber companies in Central Vietnam and several of severely-hit malaria-endemic areas.
2012 is the first year of implementing the National Strategy for Malaria Control and Elimination; but the Central and coastal area confronted with the difficulties and challenges because of its specific characteristics compared with other areas of the whole country. Especially, difficulties in management of mobilised people into malaria-endemic areas (free immigrants, forest goers and sleepers, cross-border objectives,etc.); besides, the awareness of the people on prophylactic hygiene was low and preventive measures had not been really effective, so risk of malaria outbreaks can occur anytime.
Confronted with the increase of malaria, in the first 6 months of 2012, the IMPE-Quy Nhon and provincial health services of Central Vietnam strengthened malaria control measures according to the given targets.
Results of implementing anti-malarial targets in 2012
Malaria situation in the first 5 months of 2012 against the same period of 2011
Table 1: Malaria indexes in the first 5 months of 2012
Targets in 2012 | Malaria Indexes | Indexes of 2012 compared with 2011 |
1st 5 months of 2012 | 1st 5 months of 2011 | %(+/-) |
Decreased morbidity | <1,000/00General Population (GP) | Malaria patients Malaria morbidity/1000 GP | 5,261 0.33 | 5,189 0.32 | + 1.39 + 3.13 |
Malaria parasites (MPs) Rate of MPs/slide Rate of MPs/1000 GP | 4,074 0.85 0.25 | 3,120 0.77 0.20 | + 30.58 + 10.39 + 25.00 |
Severe and complicated malaria cases | 23 | 32 | - 28.13 |
Decreased mortality | <0,0360/0000GP | Malaria deaths | 1 | 3 | - 2 cases |
Epidemic Containment | Malaria outbreaks | 0 | 0 | |
Compared with the same period of 2011, in the first 5 months of 2012, malaria morbidity cases increased by 1.39%, (5,261/5,189), severe malaria cases decreased by 28.13% (23/32), malaria parasite increase 30.58% (4,074/3,120), no malaria outbreak occuring.
Malaria morbidity
Malaria morbidity cases of the whole region in first 5 months of 2012, as compared with the same period of 2011, increased by 1.39%, with the Central Coastal area 12.48% lower, the West Highlands 18.97% higher.
- 7/15 provinces had increased morbidity rates, including Phu Yen (+63.89%), Gia Lai (+35.52%), Binh Dinh (+25.55%), Dak Lak (+17.92%), Thua Thien - Hue (+16.13%), Da Nang (+14.29%), Khanh Hoa (+1.71%).
- 1/15 provinces had unchangeable rate of malaria morbidity (Dak Nong).
- 7/15 provinces had decreased morbidity rates, including Quang Nam (-38.24%), Binh Thuan (-35.13%), Quang Tri (-21.76%), Ninh Thuan (-20%), Quang Ngai (-14.75%), Quang Binh (-14.42%), Kon Tum (-1.57%).
Malaria parasites
The malaria parasite rates in the whole region, as compared with the same period of 2011, increased by 10.39%, with the Central Coastal area 12.05% lower, the West Highlands 42.86% higher.
- 8/15 provinces with increased rates of malaria parasites included Kon Tum (+92,31%), Phu Yen (+68,97%), Dak Lak (+47,06%), Khanh Hoa (38,83%), Gia Lai (30,92%), Quang Binh (+15,85%), Da Nang city (+15,38), Dak Nong (11,96%).
- 7/15 provinces with decreased rates of malaria parasites included Binh Thuan (-49,43%), Quang Ngai (-43,33%), Ninh Thuan (-38%), Thua Thien-Hue (-25%), Quang Tri (-20,41%), Binh Dinh (-7,58%), Quang Nam (-1,33%).
Severe and complicated malaria and malaria death
In first 5 months of 2012, the whole region had 23 severe malaria cases, decreasing by 28.13% (23/32) compared with the same period of 2011. Most of the severe malaria cases occurred in provinces of Khanh Hoa (8 cases), Dak Lak (6 cases).
However, there was one malaria death at Khanh Son district, Khanh Hoa province. The patient was a 6-year-old child from Rac Lay ethinic minority, who was diagnosed with cerebral severe malaria and detected positve for malaria parasites in the exammination of his blood smear.
Table 2: Malaria morbidity and mortality of provinces in first 5 months of 2012 against the same period of 2012
No. | Province | Malaria Morbidity | Malaria Death |
5th/2012 | 5th/2011 | % (+/-) | 5th/2012 | 5th/2011 | % (+/-) |
1 | Quang Binh | 368 | 430 | -14.42 | 0 | 0 | |
2 | Quang Tri | 151 | 193 | -21.76 | 0 | 0 | |
3 | TT-Hue | 72 | 62 | 16.13 | 0 | 0 | |
4 | Da Nang city | 16 | 14 | 14.29 | 0 | 1 | -100.00 |
5 | Quang Nam | 323 | 523 | -38.24 | 0 | 0 | |
6 | Quang Ngai | 52 | 61 | -14.75 | 0 | 0 | |
7 | Binh Dinh | 172 | 137 | 25.55 | 0 | 0 | |
8 | Phu Yen | 236 | 144 | 63.89 | 0 | 0 | |
9 | Khanh Hoa | 596 | 586 | 1.71 | 1 | 0 | (+) |
10 | Ninh Thuan | 348 | 435 | -20.00 | 0 | 0 | |
11 | Bình Thuan | 205 | 316 | -35.13 | 0 | 0 | |
12 | Gia Lai | 1320 | 974 | 35.52 | 0 | 1 | -100.00 |
13 | Kon Tum | 438 | 445 | -1.57 | 0 | 1 | -100.00 |
14 | Dak lak | 625 | 530 | 17.92 | 0 | 0 | |
15 | Dak Nong | 339 | 339 | 0.00 | 0 | 0 | |
| Central coastal area | 2539 | 2901 | -12.48 | 1 | 1 | 0.00 |
| West Highland | 2722 | 2288 | 18.97 | 0 | 2 | -100.00 |
| Whole region | 5261 | 5189 | 1.39 | 1 | 3 | -66.67 |
Malaria Prevention and Control Activities in the first 5 months of 2012
Organizing and directing
In early 2012, IMPE-QN had sent a lot of documents to the Departments of Health, provincial Malaria Prevention and Control Centre/Preventive Medicine Centre and Hospitals to warn about the malaria risk, directing these offices to strengthen malaria prevention and control measures in localities; simultaneously sending missions to steer the implementation directly in the provinces where malaria increased in 2011 such as Gia Lai, Dak Lak, Phu Yen, Binh Thuan.
The regional provinces had sent documents to inform the districts ofstrengthening the malaria prevention and control measures, supplementing the intervening methods in the high-risk regions of increasing malaria such as mobile groups, border area, hinterland and malaria stricken regions. The health network of all levels had attached special importance to improve the quality of the technical measures in the malaria prevention and control campaign and actively constrain the varying malaria regions (the regions have free immigrants, forest goers and sleepers, and cross-border objectives); the grassroots health network (district, commune, hamlet, village, microscopy spot) participated actively in the malaria control activities, however it is still difficult to detect and treat promptly and manage the malaria case at grassroots levels, especially in the Laotian-Vietnamese borderland in Quang Tri province or the Vietnamese-Cambodian borderland due to lack of border cooperation in malaria control.
Malaria epidemic monitoring and preventing
The IMPE-QN had collaborated with the regional provinces, organizing the missions to monitor malaria epidemic in the stricken and high-risk regions of malaria in order to evaluate the malaria situation, propose solutions and limit the risk of malaria explosion; with the support of the Global Fund for Malaria Control, the IMPE-QN had concentrated on surveying the malaria situation of stricken regions, borderlands and propose the solutions to contain morbidity and prevent epidemic from breaking out.
Because the localities delivered the malaria reports to the IMPE-QN in the prescribed time, the IMPE-QN had reported timely to the MoH and gave feedbacks to the localities; concurrently reinforced the direction to improve the quality of the malaria control and prevention measures and supplement the measures such as insecticide-residual spraying, impregnated bed-nets and treating patients in the high-risk regions. The epidemic supervision in stricken region and monthly shift changing from lower level toupper level commune, district, province was maintained usually, therefore the information was analyzed, timely controlled malaria increasing and the risk of outbreak. Many regional provinces had directed the levels to build early epidemic forecasting system, initially improve the roles in epidemic supervision.
Vector control
The IMPE-QN had provided chemicals for spraying and impregnating in the first 5 months of the years, guaranteed that the provinces deploy the residual spraying plan correctly in order to protect the community in the second half of the year. However, up to now, the statistics of the vector prevention activities is not compiled completely due to the fact that many provinces are still deploying.
Conducting the malaria transmitting vector prevention and chemical spraying and impregnating campaign, direct the provinces to improve the quality of the residual spraying measure, bed-nets impregnation and process the packing, chemicals after spraying and impregnating; evaluate the susceptibility of the transmitting mosquito (Anopheles) to the insecticides are being used and the residual extermination effect of the insecticides on the walls and on the impregnated bed-nets.
Survey the impact of the environment factors in the Se San river hydroelectric system to the Anopheles mosquito's regional flora in the locality to form the foundation forproposing the research subject to the Ministry level.
Diagnose, treat and manage malaria drug
The IMPE-QN had supplied enough malaria drugs according to the plan of 2012, meet the demand to treat the malaria patients of the regional health foundations, especially the malaria drugs were granted to the hamlet health stations, which help the prompt treatment as well as the self-treatment supply for the workers far away from the health station in the malaria endemic area as appointed.
The IMPE-QN had sent delegation to monitor the quality of malaria diagnosis and treatment in the hospitals of Gia Lai, Dak Nong, Quang Nam, Quang Tri, Binh Dinh; monitor the therapeutic effect of Artemisinin-based Combination Therapy (ACT) in the provinces Thua Thien - Hue, Quang Tri, Quang Nam, Quang Ngai, Binh Dinh, Ninh Thuan, Gia Lai and Dak Nong.
Work in collaboration with the Army Medical Department - Ministry of National Defence to train the Southern Military Hospital (Central and South Vietnam) to diagnose and treat malaria.
Plans of malaria control in the first 6 months of 2012
Malaria situation tended to decrease in the whole region, but still increased partially, especially in severy-hit areas. Main target of health services is to control the prevalence of the disease in the community, no malaria death and no outbreaks occuring. In the last 6 months of 2012, malaria control measures need to be strengthened more effectively.
Line steering and malaria epidemiplogical surveillance
Strengthen the direction and activitites of malaria epidemiology surveillance at severely-hit areas, prevent the increase of malaria and risk of malaria outbreaks; control rate of malaria deaths for mobilised people.
Concentrate on malaria control activites at highly malaria-endemic areas with high rate of malaria morbidity and mortality and in areas appearing malaria parasite resistance to antimalarial drugs.
Enhance the quality of the reporting and statistical activities to ensure exactly and timely. Apply the information technology to the malaria epidemiological surveillance and statistical activities. Carry out the surveillance activities and expand the software applications of Malaria Management Software (MMS) at some localities.
Surveillance and vector control
Enhance the quality of vector control, ensure the coverage of insecticide according to the given plans; especially areas of mobilised people to prevent the spread of malaria.
Strengthen the epidemiological surveillance of the density and distribution of mosquitoes transmitting malaria, monitor the susceptibility of some Anopheles species to the insecticides.
Manage the use of insecticides and tackle the packing of insecticides after using.
Surveillance and malaria treatment
Strengthen the surveillance of malaria diagnosis and treatment at grassroot-levels; especially diagnosis early and treatment timely for mobilised people.
Strengthen the monitoring and surveillance of malaria diagnosis and treatment at district andprovincial hospitals, and health services.
Develop and maintain the activities of communal microscopic points to detect early and treat timely with suitable therapies for every parasites.
Monitor and evaluate the siuation of malaria parasite resistance to drug at microscopic points and at laboratory.
Inspect and evaluate frequently rate of malaria parasite drug resistance at the fields and the laboratory.
Health Communication, Education and Socialization of Malaria Control
Strengthen the activities of health communication, education and socialization at localities. Coordinate with health services and relevant organs to launch health communication and education campaign on malaria control.
Coordinate with provincial malaria control centres to organize the "Competition on malaria control knowledge for ethnic minorities" at districts of Buon Don (Dak Lak) and Ba To (Quang Ngai).
Organise the training courses on malaria control knowledge for medical staff at grass-root levels, provide the documents for the communication activities for the people at high-risk area.
Enhance the quality of training and re-training on malaria control
Enroll 35 th courses on second-level laboratory examinations (2012-2014) according to the norm of the Ministry of Education and Training and the Ministry of Health, held the final examination for 33 th course vocational students (2010-2012).
Organise the training courses on malaria diagnostic and treatment according to the plan of the Global Fund on Malaria Control and re-train to enhance the knowledge and skills on epidemiologic surveillance.
Scientific research and information technology and international cooperarion
Deploy 3 ministerial-level projects on scientific research, check and take over 2 ministerial-level projectsto deploy institutional-level projects. Coordinate to carry out international cooperation projectsin controlling malaria and parasitic diseases with Medical Committee Netherlands-Vietnam (MCNV), Australian Army Malaria Institute (AAMI), Naval Medical Research Unit 2 (NAMRU 2), World Health Organization (WHO), Guangzhou University of Traditional Medicine (China).
Research preventive measures on malaria parasite resistance to Artemisinin, carry out malaria control for mobilised people, forest goers, sleeping in the field huts and crossing borders..Coordinate with the Global Fund on Malaria Control to deploy reporting information systems together with current reporting information system (MMS).
Continue to develop the Institute website to update the information on malaria, vector-borne diseases; moreover, hold the scientific workshop quarterly to update information on special fields of malariology, parasitology and entomology for the staff of the Institute.
Management of anti-malarial drugs, insecticides and fund for malaria control
Strengthen the surveillance of using antimarial drugs, insecticides and materials on malaria control at all levels.
Guide the provinces to make plan for malaria control activities of the Central Vietnam for 2013.