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Using a Surveillance Approach and Treating “Incurable Malaria” to Achieve Elimination in the Greater Mekong Subregion

Cambodia, China, the Lao People’s Democratic Republic (PDR), Myanmar, Thailand, and Vietnam have made major strides in eliminating malaria within their borders. Collectively known as the Greater Mekong Subregion (GMS), they are working together towards a shared goal of total malaria elimination by 2030. Reaching this goal depends on careful monitoring and tracking of malaria cases as well as proper treatment that eliminates the parasite that causes malaria. 

In Cambodia and Lao PDR, the National Malaria Control Programs are working toward this elimination goal with support from the U.S. President’s Malaria Initiative (PMI) through the PMI Impact Malaria project. In Cambodia, PMI Impact Malaria supports the National Center for Parasitology, Entomology and Malaria Control and Institut Pastuer du Cambodge in conducting a study testing the performance of a novel point-of-care test for detecting glucose-6-phosphate dehydrogenase (G6PD) deficiency and assessing its severity.   

G6PD deficiency affects around 400 million people globally. Diagnosing G6PD deficiency is important in areas where the Plasmodium vivax (P. vivax) strain of malaria infections are widespread, such as the GMS. The drug of choice for treating P. vivax malaria infections is primaquine. Primaquine can completely rid the P. vivax parasite from a patient’s body, which clinicians call “radical cure”. But it can also cause serious and severe reactions in patients with G6PD deficiency. Without a quick and easy way to diagnose this deficiency, many health care providers are hesitant to prescribe primaquine for malaria as they fear causing potential life-threatening adverse reactions. They know that no treatment is not an option and treatment with drugs other than primaquine that don’t eliminate the malaria parasite leaves patients at risk of recurrent malaria infections and impedes progress towards malaria elimination. This creates a tough obstacle for health providers.

Samphors is a midwife at the Preychumpou Mean Ang Health Center in the Kampong Speu Province of Cambodia. She works hand-in-hand with Village Malaria Workers to encourage community members to seek care at the health center when they are experiencing malaria symptoms. “I wanted to become a health provider because I love to help people in our community, in our country,” said Samphors. As part of the PMI Impact Malaria-supported study, she is one of fifteen people across Cambodia trained on how to use the new G6PD point-of-care test.  


Photo caption: Samphors tests a patient for G6PD deficiency using a point-of-care test and examines the results. Photo credit: PMI Impact Malaria Cambodia  

With the ability to test for G6PD deficiency right at her health center, Samphors can find out immediately if a malaria patient has G6PD deficiency and safely prescribe the most appropriate medicine to treat her patients from what used to be known as “incurable malaria,” or P. Vivax infection. Testing patients for G6PD at the point-of-care saves precious time that would otherwise be lost by sending blood samples to a lab and waiting to hear back before beginning treatment. 

In Laos, the development of an effective nationwide surveillance system called the "1-3-7" approach is key for elimination efforts. PMI Impact Malaria continues to support Laos to train health providers on the 1-3-7 approach, where all confirmed malaria cases are reported within 1 day, cases are investigated within 3 days, and necessary follow-up actions are implemented within 7 days.  

Dr. Khiewsomphone Doungnoukhan has worked as a medical doctor in the Ka Tua health center in Lao Ngam District for three years. He was recently selected to participate in a 1-3-7 training to improve the quality of care he provides to patients. Before the training he was not familiar with the up-to-date malaria elimination guidelines and only knew that he had to report a malaria case within 24 hours. Now, he feels confident with the entire process and has improved his ability to report, investigate, and respond to malaria cases in alignment with national guidelines. Dr. Doungnoukhan also learned how to distinguish the different parasite species that cause malaria and the importance of testing for G6PD before prescribing medication for P.vivax infection. 

Photo caption: Dr. Khiewsomphone Doungnoukhan standing in front of the Ka Tua health center in Lao Ngam District. Photo credit: PMI Impact Malaria Lao PDR 

By investing in training for frontline health workers like Samphors and Dr. Doungnoukhan, PMI Impact Malaria supports partner countries to implement surveillance processes and testing to overcome obstacles like G6PD deficiency to move towards malaria elimination. Achieving a malaria-free region brings the world closer to eradicating humanity’s oldest disease, and a world without malaria. 

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Institute (MEI) at UCSF

Posted by Taylor Prochnow at 00:00
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