Lessons on malaria control in the ethnic minority regions in Northern Myanmar along the China border, 2007-2014

Abstract

Background: For many countries where malaria is endemic, the burden of malaria is high in border regions. In ethnic minority areas along the Myanmar-China border, residents have poor access to medical care for diagnosis and treatment, and there have been many malaria outbreaks in such areas. Since 2007, with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), a malaria control project was introduced to reduce the malaria burden in several ethnic minority regions.

Methods: A malaria control network was established during the period from 2007 to 2014. Multiple malaria interventions, including diagnosis, treatment, distribution of LLINs and health education, were conducted to improve the accessibility and quality of malaria control services for local residents. Annual cross-sectional surveys were conducted to evaluate intervention coverage and indicators of malaria transmission.

Results: In ethnic minority regions where a malaria control network was established, both the annual malaria incidence (19.1 per thousand per year, in 2009; 8.7, in 2014) and malaria prevalence (13.6 % in 2008; 0.43 % in 2014) decreased dramatically during the past 5-6 years. A total of 851 393 febrile patients were detected, 202 598 malaria cases (including confirmed cases and suspected cases) were treated, and 759 574 LLINs were delivered to populations at risk. Of households in 2012, 73.9 % had at least one ITNs/LLINs (vs. 28.3 %, in 2008), and 50.7 % of children less than 5 years and 50.3 % of pregnant women slept under LLINs the night prior to their visit. Additionally, malaria knowledge was improved in 68.4 % of residents.

Conclusion: There has been great success in improving malaria control in these regions from 2007 to 2014. Malaria burdens have decreased, especially in KOK and WA. The continued maintenance of sustainable malaria control networks in these regions may be a long-term process, due to regional conflicts and the lack of funds, technology, and health workers. Furthermore, information and scientific support from the international community should be offered to these ethnic minority regions to uphold recent achievements.

Keywords: Ethnic minority regions; Malaria control; Northern Myanmar.

Fig. 1

The map of Program area in 2012 (The program townships were marked with red hot)

Fig. 2

Malaria stations in these regions (a: a station in WA; b: a station in KSR2)

Fig. 3

Malaria incidences in the five regions from 2009 to 2014 (KSR1 from 2012 to 2014): (a) Proportion of total number of malaria cases by regions; (b) Malaria incidence (cases per thousand per year) for each region. (Blue: KSR1; Red: KSR2; Green: KOK; Purple: WA; Cyan: SR4)

Fig. 4

Reported malaria cases in 2009–2013 by plasmodium species (Blue: P.f; Red: P.v; Green: Other)

Fig. 5

Malaria map in five special regionsin 2014, classified by malaria incidence at township level (Red: >50; Orange: 50–30; Yellow: 30–10; Green: 10–1; Cyan: <1)

Fig. 6

Febrile patient diagnosis, malaria cases (including confirmed cases and suspected cases before 2014), and LLINs distribution in these regions during 2008 to 2014 (Blue: Febrile patients through diagnosis test; Red: Malaria cases treated; Green: LLINs distributed)