Sat, 24 Apr 2010
By : Robert Carmichael
Phnom Penh - Next week, teams of health workers will head to 10 of Cambodia's most malaria-infected villages near the western town of Pailin, in a region notorious for its mystifying ability to produce resistant strains of the disease.
The purpose of their visit is unique in the country's programme to combat malaria.Health workers will take blood samples from every villager, lab test for the falciparum malaria parasite, and then provide treatment within days to anyone with the parasite whether or not they are showing malaria symptoms.
This pre-emptive action is one of many the government and donors have taken in a year-old programme to combat a potential catastrophe: The spread of a falciparum strain that has shown resistance to the world's most important malaria treatment - ACT, which combines artemisinin with other drugs to attack the parasite.
Dr Steven Bjorge, a malaria specialist at the World Health Organization's office in Phnom Penh, said scientific tests have proven that a deadly strain resistant to chloroquine, for example, developed in western Cambodia before migrating to Africa.
"And so the fear is that again the drug-resistant parasite, for example from western Cambodia, will move to Africa, and Africa is a malaria problem many magnitudes worse than anything in South-East Asia," Bjorge said.
The objective of next week's effort, which follows World Malaria Day on April 25, is to reduce the number of malaria carriers. Should that prove successful, it will be rolled out across the country as part of a wider containment programme, he said.
"And that's going to then reduce the number of parasites that are generally in the population, and then probably reduce transmission," Bjorge said.
Dr Duong Socheat heads the government's National Centre for Malaria Control. When news broke two years ago of the increasing resistance to ACT, health professionals and the government met to map out an urgent course of action.
"The experts were very concerned - how to contain, how to stop the spread of artemisinin-resistance to other areas?" he said.
"So before it spread, we had to take some action."The resultant containment plan divides Cambodia into three zones.Zone 1, comprising around 5 per cent of Cambodia, is centred in the west around Pailin and is the main initial focus. Zone 2, a buffer zone, expands beyond the first zone and accounts for about half of the country. Zone 3 comprises the rest of Cambodia.
The ongoing plan combines prevention, education and treatment.Duong Socheat said one aspect has been to provide training to private health practitioners, drug manufacturers and importers to ensure they understand the importance of not using one drug to treat the disease - so-called monotherapy.
Another is a government crackdown on counterfeit drugs being sold in markets and pharmacies."This is a real achievement that people are following our guidelines," he said.
"Before you could see plenty of counterfeit drugs in the market, but now there are very few."Other steps include providing bed nets to prevent people being bitten by mosquitoes. WHO figures show Zone 1 now has an average of 1.79 people per bed net.
Another vital step was training at least one volunteer in every Zone 1 village how to use a free kit to provide testing for any villager with fever.
In a country where people are often charged for theoretically free health services, a free testing service is key.Duong Socheat said indications show the situation has stabilized in Zone 1, which last year reported zero deaths from malaria.
The number of infections was stable too. All 270 deaths from the disease in Cambodia last year took place in Zones 2 and 3.WHO's Bjorge said he is "very, very cautiously optimistic" the containment programme is working."
We feel that in Zone 1 we are having some success. It's still early in the game and so we are trying to gather the data and evaluate it, but we think that we are having some impact," he said.
Assuming the data shows success, the next step is to expand the containment programme over the next five years to cover Zones 2 and 3, using money provided under the Global Fund, which targets HIV/Aids, tuberculosis and malaria.
Duong Socheat said the government wants zero malaria deaths in Cambodia by 2020. The containment programme is bound to help.
He said the most difficult task will be to ensure migrant workers who crisscross Cambodia looking for work do not bring back the resistant form to their home provinces.
The more the government can help to improve the economy, the easier that task will be."It's very important.
When the economy improves, gross domestic product increases and it's easier for poor people to protect themselves," he said.