Infectious Diseases of Poverty has published an
article investigating the risk of malaria on the China-Myanmar border and how
this has changed over the years. Jian-wei Xu explains more about the work in
this blog.
As a
malaria control staff member in Yunnan Province of China, I have been working
on the China-Myanmar border for 27 years. I’ve heard many stories about
malaria, experienced many malaria situations, and joined many intervention
activities.
Understanding the high death rates
In
November 2003, more than 100 deaths occurred in Kokang, Shan Special Region in
Myanmar. At the time, local people and the authorities didn’t know the cause of
these deaths. Chinese investigators suspected Acute Respiratory Syndrome (SARS)
or plague to be the main cause of these deaths.
Eventually,
experts from Yunnan Institute of Parasitic Diseases (YIPD) confirmed it was
malaria. For 13 days, between November 7 and November 19, 1392 new cases of
malaria and 125 deaths were detected across 30 villages in Kokang, Myanmar.
Intensive
efforts with international and domestic financial support to control malaria
have dramatically reduced malaria burden on China-Myanmar border over the past
decade.
Especially
with support from the 6th and 10th rounds of GFATM malaria control projects,
and cooperation with Myanmar and Health Poverty Action (HPA), malaria control
interventions was able to conduct in five special regions of Myanmar from 2007
to 2013.
Malaria prevalence
As a
result of the interventions of GFATM projects, parasite prevalence rate had
decreased from 13.6% in March 2008 to 1.5% in November 2013 in the five special
regions of Myanmar. Annual parasite incidence had reduced from 19.6 per 10, 000
person-years in 2006 to 0.9 per 10, 000 person-years in 2013 across 19 Chinese
counties.
In the
Shan Special Region II (locally called Wa State) of Myanmar, our annual
indicator survey for evaluation did not detect any malaria parasites in
November 2013.
On June
19, 2014, HPA reported a P. falciparum malaria outbreak in a private Rubber
Plantation, located close to the border. At the time when the outbreak was
reported, there were 122 inhabitants, in 24 households of which 14 families
were of the Lahu ethnic minority who emigrated from Lancang County, China in
2004.
There
were ten families of the Wa ethnic minority who emigrated from other villages
of the Shan Special region of Myanmar in 2005. We realized that our GFATM
projects did not cover the special community when we arrived at the outbreak
site.
What does our research suggest?
Our
investigation results show that imported P. falciparum from Salween River
Valley caused the outbreak and that children were at higher risk of malaria
infection during the outbreak.
Seeking
inappropriate treatment from a private healer who just administered a single
artemether injection for treatment of malaria and lack of protection of bed
nets were the causes of the outbreak.
The
majority of the China-Myanmar border is just a political border where
immigration control is only available at those important border crossing
points. Illegal immigrants, internally displaced people, refugees and ethnic
minorities exist along the mountainous and forested border. However they have
limited access to the public health service.
Inappropriate
diagnoses and treatments with sub-therapeutic-dosage and/or mono-therapies
still exist in the private sector along the international border.
We cannot
deny that inappropriate treatments in the private sector have helped to save
lives, however, they contribute to maintain malaria transmission and are thus
harmful to patient prognosis, public health and also a cause of drug
resistance.
In this
situation, our malaria control and elimination programs should give special
attention to these neglected populations. In order to increase coverage and
service of public health facilities, and to strengthen cooperation with private
sectors for proper malaria case management, malaria control along China-Myanmar
border needs further multilateral collaboration.
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