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In the
past few years, the significant reduction of malaria prevalence in most
countries of the Greater Mekong Sub-region has increased the difficulty to
recruit patients to monitor therapeutic efficacy of anti-malarial drugs as
per criteria of routine WHO protocol. The workshop contributed to identify
the various challenges to be addressed by PIs by using the existing TES
protocol pertaining to sentinel site selection, maintenance, patient
recruitment, data management and supervision especially in very low
prevalence countries such as Lao PDR.
Participants were able to draft a revised district-based TES protocol
to be piloted in Lao PDR (and further in other GMS countries experiencing
similar situation). The estimated budget to implement the revised protocol
has yet to be itemized in order to be submitted to WHO
by May 2010 and to be performed from October 2010. It was noted that Thailand has been using village-based
recruitment in 2 provinces bordering with Cambodia where falciparum cases are almost disappearing.
Procedures
to internally and externally cross check results from blood smears were
reviewed, and country best practices to improve microscopy QC procedures were
highlighted. It was agreed to make a
better use of the country and regional “WHO accredited list of microscopists” managed by ACTMal
in collaboration with WHO in such a way that level 2 microscopists
are actually based in the TES sentinel sites to validate slides and level 1 microscopists are used at higher level to cross check all
slides from the field. A suggestion was made to pursue efforts made in 2009
to cross check results externally as well by level 1 microscopists
from the region facilitated by WHO in all GMS countries.
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