Academic journal article Bulletin of the World Health Organization

Control of Malaria: A Successful Experience from Vietnam. (Research)

Academic journal article Bulletin of the World Health Organization

Control of Malaria: A Successful Experience from Vietnam. (Research)

Article excerpt

Voir page 665 le resume en francais. En la pagina 665 figura un resumen en espanol.

Introduction

Malaria remains a threat to almost 50% of the world's population. With 200 million estimated new cases and 1-2 million deaths per year, the disease remains a major cause of morbidity and mortality (1, 2). No new methods of controlling malaria have appeared since the introduction of insecticide-treated bednets (ITBNs) in the 1980s, and they are not expected in the near future. A control strategy comprising proper application of existing means is advocated: early diagnosis and treatment (EDT) of symptomatic malaria to prevent progression to severe and potentially fatal stages; preventive measures including use of ITBNs and selective residual spraying; and prediction, containment and, if possible, prevention of epidemics; and strengthening of local capacities (2, 3). Although use of ITBNs has been shown to reduce malarial morbidity and mortality, this measure needs to be supported by an adequate health care system providing EDT, possibly at the household level (2, 4). WHO advocates the combined approach of ITBNs and EDT in its Roll Back Malaria initiative, but there has been little study of the combined efficacy of these two approaches (5).

In Viet Nam, malaria became a serious problem during the late 1980s and early 1990s. In 1991, a total of 1 642 000 cases of uncomplicated malaria, 32 000 cases of severe malaria, and 4650 deaths from the disease were reported, and resistance to chloroquine and sulfadoxine-pyrimethamine was widespread (6). The mountainous, forested regions of the country, which have limited basic health care facilities, and are populated by ethnic minorities, were especially affected. In 1992, a malaria control strategy based on the above-mentioned principles was adopted. It was decided that diagnosis and treatment of malaria should be free, and two important elements were added to the basic approach: development and application of artemisinin drugs; and health education at the community level. The price of drugs such as mefloquine on the international market was an important incentive for the development and use of artemisinin drugs.

A programme of malaria control was started in Binh Thuan Province, in the south of Viet Nam, in accordance with national guidelines. All health posts were provided with a microscope and health staff were trained in diagnosis and treatment of malaria. Support was obtained from several parties, including nongovernmental organizations, and through scientific collaboration projects. The present paper reports the results of an assessment of the effectiveness of this combined approach in an ethnic minority commune, Phan Tien, carried out using a longitudinal follow-up of the population and annual surveys carried out from 1994 to 1999.

Methods

Population and study site

Phan Tien village, an ethnic minority community, is situated in Bac Binh district in the mountainous part of Binh Thuan Province. The population is composed of several ethnic minority groups. Phan Tien has been in existence for approximately 20 years' as one of the areas for resettlement of members of displaced hill tribes, and there is still some influx of families. People live in families of 5-6 persons in one hut; the huts have clay walls and a thatched roof. In 1993, a primary school was started; it also serves families of a nearby commune. Prior to 1999, Phan Tien was isolated: during the wet season it could not be reached by car and in the dry season only after a drive, of several hours in an all-terrain vehicle. However, a permanent, gravel road, built in 1999, substantially increased the movement of people to and from the village. There is no electricity, and until 1994 the water supply was from a small river. In 1994, the first wells were drilled with the help of UNICEF. The people lived from subsistence farming, mainly rice and forest labour. Food supplies were supplemented under the national malnutrition programme. …

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