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World Malaria Day, 25 April 2014
Invest in the future. Defeat malaria
Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 42% globally and 49% in Africa. Increased political commitment and expanded funding have helped to reduce malaria incidence by 25% globally, and 31% in Africa.
WHO/S. Hollyman
But we are not there yet. Malaria still kills an estimated 627 000 people every year, mainly children under 5 years of age in sub-Saharan Africa. In 2013, 97 countries had on-going malaria transmission.
Every year, more than 200 million cases occur; most of these cases are never tested or registered. Emerging drug and insecticide resistance threaten to reverse recent gains.
If the world is to maintain and accelerate progress against malaria, in line with Millennium Development Goal (MDG) 6, and to ensure attainment of MDGs 4 and 5, more funds are urgently required.
The theme for 2014 and 2015 is: Invest in the future. Defeat malaria
Goal: energize commitment to fight malaria
World Malaria Day was instituted by WHO Member States during the World Health Assembly of 2007. It is an occasion to highlight the need for continued investment and sustained political commitment for malaria prevention and control. It is also an opportunity:
- for countries in affected regions to learn from each other's experiences and support each other's efforts;
- for new donors to join a global partnership against malaria;
- for research and academic institutions to flag scientific advances to both experts and the general public; and
- for international partners, companies and foundations to showcase their efforts and reflect on how to further scale up interventions.
Cambodia’s frontline heroes in the fight against drug-resistant malaria
Village Malaria Workers or VMWs are trained by Cambodia’s National Malaria Control Programme and its partners, with technical support from WHO, to deliver malaria prevention and treatment services to remote villages. In Battambang province, VMWs like Chhiv Khea are also trained to ensure patients receive a malaria test and complete the full course of treatment with artemisinin-based combination therapy (ACT) when found positive, thus contributing to the rational use of ACTs and the elimination of malaria parasites that are resistant to artemisinin and/or its partner drugs.
WHO
Village malaria worker Chhiv Khea
It is 10 o’clock in the morning in Battambang Province’s O Nonong village along Cambodia’s northwestern border with Thailand. 23-year-old Chhiv Khea is busy working on her cassava farm with her newly-wed husband and other farmers.
Then, her mobile phone rings. A sick pregnant woman has come to Khea’s village house in the Ta Sanh commune to seek her help. The woman suspects she has malaria and wants to get a blood test and treatment if she has the disease. Pregnant women are particularly vulnerable to malaria infection and malaria during pregnancy has devastating effects not only on mothers, but also on newborns and infants.
As a voluntary village malaria worker, or VMW, Khea politely asks the young mother to wait and tells her she will arrive in about 10 minutes. Khea hops on her motorcycle and drives home from her farm about three kilometers away.
As she arrives home, Khea hurriedly begins her usual interview and diagnosis to determine whether the woman has malaria.
“What is your name?” she starts asking the woman.
“Khuth Poeun.”
“How old are you?”
“24.”
“Why do you want to have a blood test?” Khea quickly gets to her point.
“I have a headache, fever and chills in my body,” the woman responds.
“For how many days?”
“Two days.”
“How many months have you been pregnant?” Khea cautiously asks.
“Eight months.”
“Now, let’s have your blood tested for malaria,” Khea explains as she begins to draw Poeun’s blood for screening. “Please wait for 20 minutes.”
For generations, people in O Nonong village were firmly entrenched in their traditional beliefs. When people fell sick with an illness like malaria, they would pray to the spirits of the land and water and seek treatment with herbal medicines. Now, however, things are different. With malaria, people in O Nonong village – and others like it – can get blood tests and free quality treatment from a VMW like Khea.
Khea says she became a VMW three years ago after her mother, who was her predecessor in this position, requested the Ta Sanh Commune Health Center to let her continue the voluntary work in O Nonong village.
Khea explains how she became involved in the programme. “My mother was getting old and she couldn’t see clearly. She asked me to go to the monthly VMW meetings and prepare reports for her.” After getting a nod from the chief of the health center, Khea says her mother began to prepare her for the work and then she underwent training organized by Cambodia’s National Malaria Control Centre (CNM) and its partners, with technical assistance from WHO.
“I used to watch my mother doing blood tests using the RDT (Rapid Diagnostic Test) kits and treating patients with malaria,” Khea recalls. “That prepared me for the work ahead,” she adds.
It is important to have VMWs. In the past, many people were sick with malaria. Now, there are fewer and fewer malaria cases due to the work of VMWs.Chhay Sovanda,
chief of O Nonong village
Then, she says, she attended workshops in September 2010 organized by the USAID-funded University Research Co. (URC) in partnership with WHO and CNM, on how to diagnose malaria using RDTs, and to administer ACTs following the Directly Observed Treatment protocol (DOT) for those who tested positive for falciparum malaria. DOT is important because failure to complete the full ACT treatment course can also contribute to the development of resistance to artemisinin and/or partner drugs.
Khea says each month during the rainy season she gets around 20 people who come to have their blood tested for malaria and she usually finds two or three cases, particularly among migrant workers and people from remote villages. However, she says work is more difficult during the rainy season when she has to travel in difficult conditions to the houses of malaria patients to personally supervise the intake of their medicines.
“Every day, for three days, I watch the patient take their daily dose in front of me and I make sure they don’t run away after getting a bit better. But during the rainy season it’s quite a task getting to their houses because of the slippery mud on the tracks and also the landmines,” she points out. Despite intensive de-mining efforts, there are still numerous explosive remnants of previous wars remaining in the ground in Battambang province and flooding often dislodges them, posing a serious threat to villagers.
“At the beginning, it was difficult for me,” Khea says. “I was afraid that it would be very embarrassing if I made a mistake.” However, she says people started to trust her as she became skilled in her malaria work after attending more refresher trainings organized by URC. “I feel proud that people like me now,” she says with a smile.
CNM and its partners, with technical support from WHO, have trained over 1800 village malaria workers in key provinces where malaria is rife. Battambang province has 125 VMWs trained by URC, with support from WHO and CNM, on the DOT protocol. A similar partnership with WHO and CNM was entered into with the NGO Family Health International (FHI 360) and Malaria Consortium to upgrade the skills of 114 VMWs in Pailin province.
Chhay Sovanda, chief of O Nonong village, agrees that the VMW programme is essential in the fight against malaria.
“It is important to have VMWs,” says the female village chief. “In the past, many people were sick with malaria. Now, there are fewer and fewer malaria cases due to the work of VMWs.”
The village chief also speaks highly of Khea. “She does very good work. She is very punctual and will come immediately if she hears that somebody is suspected of having malaria.”
Now, it has been 20 minutes since Poeun had her blood test.
“You do not have malaria,” Khea tells Poeun.
“I am happy to hear that I have no malaria,” the pregnant mother replies delightedly.
Related links
- Malaria in pregnant women
- Emergency response to artemisinin resistance in the Greater Mekong subregion
- Antimalarial drug resistance
Antimalarial drug resistance
To date, parasite resistance has been documented in three of the five malaria species known to affect humans: P. falciparum, P. vivax and P. malariae. Drug resistance results in a delayed or incomplete clearance of parasites from the patient’s blood. The problem of antimalarial drug resistance is compounded by cross resistance, in which resistance to one drug confers resistance to other drugs that belong to the same chemical family or which have similar modes of action. During the past decades, several highly efficacious antimalarials had to be removed from markets after the development of parasite resistance to them.
Artemisinin-based combination therapies
Today, WHO recommends artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated malaria caused by P. falciparum. ACTs have been integral to the remarkable recent successes in global malaria control, and there is broad consensus that protecting the efficacy of these medicine combinations is an urgent priority. However, P. falciparum resistance is now emerging to artemisinin, and has been detected in four countries of the Greater Mekong Subregion: in Cambodia, Myanmar, Thailand and Viet Nam. Containment activities are ongoing in all four countries as part of a multi-stakeholder effort.
Global plan for artemisinin resistance containment
The emergence of P. falciparum resistance to artemisinin is an urgent public health concern, threatening the sustainability of the global effort to reduce the malaria burden in all endemic regions. In January 2011, WHO released the Global plan for artemisinin resistance containment (GPARC), which puts forward four main goals and recommendations:
- to stop the spread of resistant parasites
- to increase monitoring and surveillance to evaluate the artemisinin resistance threat
- to improve access to diagnostics and rational treatment with ACTs; and
- to invest in artemisinin resistance-related research.
The GPARC calls on endemic countries and stakeholders to scale up containment activities in affected countries, and to implement comprehensive plans in other endemic regions to prevent the emergence of resistance.
Prevention and containment
Prevention and containment activities need to build on, expand and accelerate ongoing national efforts to control and eliminate malaria. Artemisinin resistance seems to be occurring primarily near national borders, and in areas with a high number of migrants; therefore strong cross-border and regional programmes are central to continued success in the fight against malaria. WHO is currently implementing an emergency response plan to scale-up containment efforts in the Greater Mekong Subregion, and has opened a regional hub in Phnom Penh, Cambodia to spearhead the multi-partner effort.
