Mekong Malaria Programme

Areas of Work

Background

The Mekong Malaria Programme, originally launched in Ho Chi Minh City in 1999 as the Mekong Roll Back Malaria Initiative, brought together all national programmes and partners working on malaria. It both reinvigorated existing strategic projects in the Mekong region as well as initiated new ones. The programme, supported mainly with USAID funds, paid particular attention to the following technical areas: (1) monitoring therapeutic efficacy of antimalarial drugs used in the Mekong region to update national drug policies, (2) monitoring quality, access and use of malaria and other drugs available in the field, (3) increasing capacity of national staff to select, plan and monitor malaria control activities, (4) setting up regular exchange forums and technical consultations to identify, share and disseminate best practices in malaria control including cross border activity projects throughout the Great Mekong Subregion (GMS), (5) monitoring Mekong malaria burden trends, (6) setting up and monitoring the malaria research agenda.

As a result, more partners became actively engaged in malaria control and were supporting national authorities to successfully reach their national targets. And since it started operating in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria, has contributed more than USD 275 million in malaria control in Mekong countries.

Official epidemiological records communicated by Mekong Member States to the WHO show that malaria deaths and morbidity cases in 2005 have been reduced by 50% as compared to 1998. These targets were supposed to be reached by 2010

Mekong Malaria Member Countries:

Cambodia

Lao PDR

Myanmar

PR China (Yunnan)

Thailand

Vietnam

Malaria in the Greater Mekong Subregion: Regional and Country Profiles

Informal consultation on resource mobilization for the containment of artemisinin-tolerant malaria parasites on the Cambodia-Thailand border, Phnom Penh, Cambodia, 17-18 June 2008

Together with MMP, WPRO has organized the informal consultation on resource mobilization for the containment of artemisinin-tolerant malaria parasites on the Cambodia-Thailand border in Phnom Penh, Cambodia from 17 to 18 June, 2008. Representatives from Cambodia and Thai malaria programmes and donors (e.g. USAID, BMGF, AUSaid, DFID and Clinton Foundation) participated in the consultation. DPM from WPRO, Dr Nesbit, co-chaired the overall session. Purpose was to present and clarify to potential donors budgeted national / cross-country containment operations resulting from several consultative meetings in Geneva, Bangkok and Phnom Penh and with national programmes thanks to several missions and intensive assistance from WHO and partners. USD 37, 972,981 are requested to cover 18-month operations to take place in both countries (10 provinces in Cambodia and 7 in Thailand) from January 2009 till June 2010, on top of existing funding e.g. from GFR6 in Cambodia and GFR7 in Thailand. It is anticipated that GFR9 will cover longer term operations from July 2010 onwards. Meeting outcomes reiterated the need to start containment operations as emergency operations with solid technical and efficient managerial structure across the 2 countries. In light of the magnitude of short term elimination operations and funding and limited staff capacity at peripheral level, a feasibility study is urgently needed. The writer facilitated the finalization of the cross country containment plan and budget with VBDC Thailand and CNM Cambodia in order to strengthen strategic operations alignment, impact/outcome indicators and overall multi country budget keeping in perspective the essential coordination role of MMP with USAID-funded partners as well. Next action is for WHO to finalize the LOI to be submitted to the BMGF and to collaborate with both countries to develop GFR9 proposals to support long-term containment operations till 2015.

A training session from 23-25 May 2008, Shanghai, China

Following recommendations made in Phuket, Thailand, during an informal consultation to monitor P. falciparum and P. Vivax resistance to 1st line animalarial drugs in the GMS, a training session from 23 to 25 May 2008 was organized by the National Institute of Parasitology in Shanghai (Director, Prof Tang Ling-hua). The training session was facilitated by D. Bustos (dorinabustos@yahoo.com) with 12 participants from PR China and therapeutic efficacy study (TES) focal points from Lao PDR and Viet Nam. Participants became familiar with the updated WHO protocol to monitor resistance and technical clarifications were provided upon request.

Members of the Mekong Malaria Technical Advisory Group on molecular markers, Dr Frederick Ariey from Institute Pasteur, Cambodia, and Dr Hans Peter-Beck from Swiss Tropical Institute, Switzerland visited the National Institute of Parasitology during the same period. The importance of standardized procedures (SOPs) for molecular assays was explained to participants, e.g. for blood collection, transport, laboratory SOPs, quality control procedures and exchange of blood samples.

USAID Mekong Malaria Programme core partners' meeting, 28-29 April 2008, Bangkok, Thailand

WHO MMP has co-organized the USAID core partners' meeting in Bangkok from 28 to 29 April 2008 to review progress made against USAID-funded activities planned in October 2007. As essential meeting outcomes were the 2 presentations made by HE Dr Duong Socheat (Director CNM Cambodia) and Dr Wichai Satimai (Director VBDC Thailand) summarizing budgeted emergency interventions to be performed in 2008 to contain artemisnin tolerant falciparum parasites. Longer-term detailed containment budget will be produced by the 2 countries to be submitted to potential donors e.g. the BMGF and USAID to cover the period from January 2009 to June 2010 and the GFTAM R9 from July 2010 onwards. Participants agreed to increase their technical and financial contributions with focus on field interventions impacting on drug resistance along the Cambodia-Thailand border and in the GMS.

Informal consultation to draft the strategy to eliminate P. falciparum MDR strains, 13-14 February 2008, Bangkok, Thailand

Programme managers, implementers, researchers and donors agree on strategic interventions to be immediately supported by all partners in Cambodian and Thai provinces where tolerant artemisinin malaria parasites have been documented (Bangkok, 13-14 February 2008).

Monitoring Resistance of P. FALCIPARUM and P. VIVAX to Anti-Malarial Drugs in the Greater Mekong Sub-Region, Report of an Informal Consultation, Phuket, Thailand, 3-5 September 2007

Programme Managers and scientists from Mekong countries alongside with partners and donors agreed during

a WHO informal consultation in Phuket, Thailand to use standardized

WHO protocols to conduct in vivo therapeutic efficacy studies in selected sentinel sites in 2008 and 2009

(Phuket, Thailand, 3-5 September 2007)

In a remote village of Tachileik township in Myanmar, discussion takes place with local authorities and village malaria volunteers

who are using rapid tests to diagnose malaria and to provide powerful artemisinin-based combination treatment.

Across Mekong countries (a remote village of Cambodia shown here), bed nets are widely used by people living in malaria endemic areas.

Such conventional nets, when impregnated with insecticide at least once a year,

are becoming powerful tools against infected mosquito bites.

Many kinds of drugs of variable quality are available in local shops in Mekong countries including antimalarials and monotherapies

which contribute to increased parasite resistance to artemisinin derivatives.

Vision

The Mekong Malaria Programme (MMP) overarching contribution, alongside Government and Non-Government Partners, is to improve the health status of the Mekong population with special focus on malaria control and attention to the most vulnerable population in the Mekong region.

Goal

The Mekong Malaria Programme aims to facilitate the implementation and monitoring of a comprehensive Mekong Malaria Control Strategy endorsed by national authorities and stakeholders to address the remaining common challenges in order to make further impact on malaria mortality and morbidity in the subregion.

Objectives

The objectives of the Mekong Malaria Programme which are aligned with the Roll Back Malaria Partnership initiative and technically supported by the WHO southeast and western pacific regions and the Global Malaria Programme are as follows:

to further reduce malaria mortality by at least 50% by 2010 as compared to 2005;

to further reduce the disease burden of malaria (incidence) preferentially in the population where malaria is a major health problem by at least 50% by 2010 as compared to 2005;

to contain the development of multi-drug resistance falciparum parasites.

Strategies

1. Early diagnosis and prompt effective treatment of cases. It includes the large use of recommended artemisinin-based combination treatments (ACTs) for fully curing falciparum malaria infections. This is in a context where P. falciparum, the deadliest form of malarial infection, is becoming more resistant to current ACTs. P. vivax, the most frequent type of infections, are also highly prevalent in the region and attention has to be paid to monitor vivax resistance to chloroquine, the treatment drug. Urgent measures to address factors which may increase falciparum resistance to ACTs also have to be implemented.

2. Prevention by adjusting control measures to transmission settings, malaria vectors and population characteristics, bearing in mind that high coverage is a prerequisite for having an impact on morbidity and mortality.

3. Strengthening the surveillance system to efficiently gather epidemiological data, including those from remote locations, and mapping the population at risk. The surveillance system should be able to detect and control epidemics in a timely manner.

4. Empowering the hard-to-reach population in remote areas to understand the disease through appropriate communications, protect themselves and access any health care services that may be available there.

5. Increasing the coverage of quality peripheral health services, including encouragement of successful public-private mix initiatives, in such a way that population at risk easily access health information, early quality diagnosis and prompt treatment.

6. Improve programme management to ensure it is operational at the district level.

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