This year's World Malaria Day theme, "Zero Malaria Starts With Me" re-uses the fight to eliminate malaria which, although preventable and treatable, still kills over half a million people every year. While incredible advances have been made over the past 15 years (with over 7 million malaria deaths averted and about 40% reduction in malaria globally), the fight against the disease now fights against a tip – progress has slowed in some parts of the world and reversed some.
A major challenge to eliminating malaria is the emergence of drug-resistant malaria in the Greater Mekong Subregion (GMS), including countries such as Thailand, Cambodia, Myanmar, Laos and Vietnam. Thailand's public health minister said Professor Piyasakol Sakolatayadorn of the CNS (Citizen News Service): "Drug resistant malaria is a threat to Thailand and the Greater Mekong Subregion (GMS). This area is the epicenter of drug-resistant malaria. Resistant malaria can become a global health risk if we cannot handle it. and eliminating drug-resistant malaria in Thailand and GMS. "Historically, the GMS region has long been an epicenter of antimalarial drug resistance. In fact, 40-45 years ago, chloroquine resistance spread throughout the world from this region. So there is fear of the risk of recurrence of malaria due to anti-artemisinin resistance.
"If drug resistance from the Greater Mekong Subregion (GMS) spreads outside this region, it will have a devastating impact on countries with high levels of malaria," warned Alistair Shaw, senior program director, Raks Thai Foundation.
But science is at best incomplete if the spread of drug resistance is a risk. "It is mostly the asymptomatic patients who carry gametocytes and transfer Plasmodium Falciparum. In Thailand, fewer than 5% have gametocytes that can be transferred to the next mosquito cycle. There is no strong evidence until a person who has drug-resistant malaria can transfer it to the mosquito and mosquito repellent." carrying that phenotype, sending it to another person, says Professor Jetsumon Sattabongkot Prachumsri, director of the Mahidol Vivax Research Unit (MVRU), Tropical Medicine, Mahidol University in Thailand.
Agree to Dr. Tim France, a listed global health expert , which also leads Inis Communication: "At present, it can be said that there is more that we do not understand about malarial drug resistance and we know that we are on a very active learning period. But at the end of the day if drug resistance spreads or occurs de novo, the conclusions and essential actions are the same. "
Governments Promised to Quit Malaria
Thai Health Minister Piyasakol Sakols Tatyadorn confirmed the country's target date for completing local transfer nationally:" Thailand is engaged in regional effort and eliminating malaria before 2024. "
It is noteworthy to mention that By 201
Thailand's national malaria elimination strategy was approved in 2016 with the 2024 elimination targets. Since then, malaria cases have continued to decline: from 2012 to 2017 The number of malaria cases in Thailand decreased by 67%, with a decrease of 39% between 2016 and 2017. During 2017-2018, malaria cases in Thailand fell further by 51% (from 14 684 to 7, 153).
Challenges confronting the fight against the elimination of malaria
Prof Sakolsatayadorn stressed the fight against drugs Partly resistant malaria with limited pipeline of new drugs as one of the challenges.
World Health Organization Researcher (WHO) Dr. Soumya Swaminathan agreed: "Although there are tools available to deal with malaria, but modeling studies show that in order to achieve elimination, we will need new and better tools through better diagnostics, better treatment strategies and even an effective vaccine. "
"Thailand not only extends to the elimination of malaria before 2024 but also progresses towards sub-regional elimination targets in Thailand," said Shreehari Acharya, project manager, regional malaria CSO platform. Last year on World Malaria Day 2018, Thailand declared 35 provinces (out of a total of 76) malaria-free. But malaria concentrates on Thai borders, which makes the fight to end the disease even more complex. "As we slowly move toward the elimination of malaria in Thailand, cases continue to move closer to the borders and more difficult-to-access mobile migrant populations," said Alistair Shaw of the Raks Thai Foundation.
To strengthen Thailand's response to eliminating malaria within the border and from the Greater Mekong Subregion, the Global Fund for AIDS, Tuberculosis and Malaria (Global Fund) was pumped into the largest majority of regional grants of US $ 243 million (2018- 2020) to speed up the elimination of drug-resistant malaria.
"Our role has been to create malaria-resistant communities that can identify when they suspect malaria cases and can respond to it through all the different mechanisms that have been established and the links that have been made to health care services. We have also made strong relationships with the local authorities to carry out mobile testing and prevention training in vulnerable populations, including mobile migrant populations from Cambodia, Vietnam, Laos and Myanmar, as well as mobile Thai ethnic minority groups traveling through forests or across borders for various activities. for the public services to communities that are very far from municipal health services and do not feel comfortable or cannot access a conventional health service, says Alistair Shaw of Raks Thai Foundation, which is one of the recipients of this global fund contribution.
Testing and treatment of mold aria is free for all people in Thailand including those who are not Thai citizens. Migrant workers who come to Thailand are normally covered by Thailand's disease control programs and they have access to malaria clinics. But Shreehari Acharya, Project Manager, Regional Malaria CSO Platform sees the difficulty of gaining access because ", although the services are free, all mobile migrant populations cannot necessarily access them."
Acharya added "In some malaria high-risk border areas there is no internet access, no mobile network and / or no public transport, which makes access to health services more difficult. Another obstacle to healthcare is the mobile immigrant groups having a language barrier and / or lacking legal acts, they are still not comfortable walking alone to a health facility, they need someone who they can trust and who speak their language to accompany them, and government health facilities are sometimes understaffed, so government employees cannot be available to follow with civil society to go to the forests or farms and provide health care to high-risk populations. "
But as Thailand is moving towards abolition of malaria, Professor Jetsumon Sattabongkot Prachumsri said:" As malaria cases decrease, people's awareness also decreases, especially in areas that were malaria end For example, Kanchanaburi province used to be malaria endemic with malaria in each district, but now it has very few (less than 30-40) cases and it does not happen in each district. Young people born in a district who now have no more malaria cases do not know about malaria. But the elderly can still carry the malaria parasite asymptomatically inside them and be a reservoir for malaria transmission. We cannot release our guards, otherwise it could happen again. "
" We need to see greater cooperation to improve monitoring, especially along the border. As countries implement malaria programs with an elimination method, monitoring becomes more important to prevent re-emergence. We also need clearer roles if civil society can play in malaria monitoring, "added Shreehari Acharya.
Messages on #WorldMalariaDay 2019
Professor Jetsumon Sattabongkot Prachumsri said:" Malaria elimination is possible if we raise awareness of all people. Everyone needs to understand that malaria is transmitted by the vector and that some people may have no external symptoms but can still have the parasite in their bodies and can transmit malaria. Everyone, especially those living in malaria endemic areas, must be aware and protect themselves from mosquito bites. "
Shreehari Acharya said:" We must do all malaria and other essential services that are as close as possible to society. I also believe that the community at the village level is best for efficiently providing these services, as civil society volunteers or anyone trained in society should be able to test and treat malaria unless medical treatment is indicated (such as malaria in pregnancy or other serious cases requires medical care). The government needs to recognize the role of civilian society in trying to eliminate malaria. Looking across the region, civil society plays a central role in partnership with the government in malaria control. We will ensure that civil society / community organizations are well-equipped, educated, and incentive. "
Shobha Shukla and Bobby Ramakant, CNS (Citizen News Service)