MALARIA CONTROL: A 90% SUCCESS IN VIET NAM
9 August 2002
The proportion of villagers with malaria parasites in their blood went down from 42% to 4% in a five-year experiment in Viet Nam, this month's Bulletin of the World Health Organization reports. The figures are from Phan Tien, a settlement in the wooded mountainous province of Binh Thuan, in southern Viet Nam, and they help to account for the steep decline of malaria nationally in the last decade, since communities in endemic areas across the country are using a similar strategy. The study documents how the combination of a bednet programme, a community-based primary health care system by which to provide 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.
Though up to two 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. These reduce infection but cannot prevent or control the disease on their own. The recommended strategy is therefore 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. 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".
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