Provide basic health services in villages to eliminate malaria, say researchers in Myanmar

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Medical Action Myanmar (MAM) team members deliver medical supplies to a remote community health worker (CHW) station in Myanmar.

Bangkok (Thailand) 25 October 2018 – The incidence of malaria cases continued to drop dramatically in rural and remote Myanmar villages after community workers trained only to detect and treat malaria began providing basic health care as well as malaria services, say University of Oxford affiliated researchers. Adding the health services to malaria control benefitted the villagers access to health and improved malaria services – paving the way for malaria elimination.

Villages where trained community health workers (CHWs) provided malaria diagnosis and treatment experienced a 70% decline in P. falciparum and a 64% drop in P. vivax malaria incidence for each year of operation, the scientists say in a study published in BMC Medicine.

But as malaria fell so did the number of people being screened. When community health workers began offering a broader package of health services – including for tuberculosis (TB), respiratory tract infections, malnutrition and diarrhoea, while continuing to screen for malaria – health improved and so did malaria control.

“To maintain effective malaria control in hard to reach areas village health workers were trained both to screen and treat malaria and to handle other common health care needs,” said study author Oxford Prof Frank Smithuis, Director of the Myanmar Oxford Clinical Research Unit (MOCRU) and the NGO Medical Action Myanmar (MAM) in Yangon, Myanmar.

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Villages with trained CHWs saw a 70% decline in P. falciparum and a 64% drop in P. vivax malaria incidence for each year of operation. (Graph courtesy of Alistair McLean © 2018.

“This significantly reduced malaria transmission and kept patients coming in to be screened for malaria, which is essential if we are to eliminate malaria in Myanmar,” explained Prof Smithuis.

The study did a retrospective analysis of over half a million malaria rapid diagnostic tests conducted between 2011 and 2016 by 1,335 CHWs supported by MAM in cooperation with the Myanmar Department of Health. Its results have important implications for Myanmar and other SE Asian countries racing to eliminate malaria.

“This study demonstrates that to eliminate malaria in hard to reach areas, CHWs networks should be offering malaria screening and treatment and basic health care,” said study contributor Mahidol and Oxford University Prof Sir Nicholas White. “Training health workers to just screen for malaria is not sustainable. These CHWs must offer a package for common health problems. This will sustain the popularity of the CHW services, benefit the accessibility of health services for the community and ensure that malaria is eliminated and then stays eliminated.”

“Many of the people we studied live in communities with no medical care of any kind other than local “quacks” and so remote that it could take 1-2 days of hard travel to reach them,” said Dr Alistair McLean, lead author. “Offering people in hard-to-reach communities a package of basic quality health services is essential to prevent malaria resurgence.”

The project was funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria, the 3 Millennium Development Goal Fund, Planet Wheeler Foundation, Kadoorie Charitable Foundation, DAK Foundation, and The WellcomeTrust (UK).

MOCRU is the Myanmar Unit of the Mahidol Oxford Tropical Medicine Research Unit (MORU), a Wellcome-funded tropical health network based in Bangkok, Thailand.

Reference

Malaria elimination in remote communities requires integration of malaria control activities into general health care: an observational study and interrupted time series analysis in Myanmar. McLean ARD, Hla Phyo Wai, Aung Myat Thu, Zay Soe Khant, Indrasuta C, Ashley EA, Thar Tun Kyaw, Day, NPJ, Dondorp A, White, NJ, Smithuis FM. BMC Medicine 2018; 16(1): 183.

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1172-x