Category Archives: Cambodia

Targeting mosquito larvae through Integrated Vector Management

Malaria Consortium is piloting a project on integrated vector management to assess the effectiveness of various control strategies to prevent the transmission of dengue. The study is being conducted in Kampong Cham province, Cambodia and is funded by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH commissioned by the Federal Ministry for Economic Cooperation and Development (BMZ) and UK aid from the UK government.

There has been a marked rise in dengue in the country during 2015. According to a recent  National Malaria Center report, health workers recorded 12,218 cases during the first 41 weeks of 2015. This is an increase of 9,284 compared to the same period in 2014.

Kampong Cham is one of the high-risk provinces, recording several dengue outbreaks in recent years. Cases can skyrocket, especially during the rainy season, where the environment provides mosquitos with more breeding sites and human movements play a major role in the spread of the disease.

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A sample adult mosquito was analysed in the laboratory. Species identification was made using a compound microscope.

“We have tripled the number of cases this year,” said Dr Hay Ra, Dengue Supervisor in Kampong Cham province. “So far, we have recorded 1,556 dengue cases including eight deaths. The most at-risk group is the population under age 15. The high density of population and climate change contributes substantially to these dengue epidemics. This area has high density of population of approximately 200 people per square metre. The rainy season also has changed – last year we had the rainy season start from April and last for seven months, while this year it started in July.”

“In this region the average flight distance for mosquitoes is about 100-200 metres,” explained John Hustedt, Malaria Consortium’s Senior Technical Officer who is leading the project. “In highly dense areas, mosquitoes can spread around the disease more widely as mosquitoes can bite more people in one area.”

At the health centre near the Ou Svay Commune, 20 of the 500 litre water jars containing various colourful guppy fish have been set up. Guppy fish have been used to reduce the mosquito larvae and this place is known by the village health volunteers as ‘the guppy fish bank’ where they can come to collect the guppy fish and provide it to the villagers. It has been under the supervision of the Health Centre Chief, Jeng Meng Hong. “We are responsible for two communes and 20 villages and each village has two health volunteers,” he explained. “So we have about 40 health volunteers who will visit our health centre and collect the fish. Each month, we have a monthly meeting to ensure all their assigned households have guppies in all large containers, and replace them if necessary.”

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Malaria Consortium’s staff inspected the number and condition of guppy fish in water jars at the village health volunteer household.

The fish collected from the guppy bank will be allocated to each household and released in their large water containers. It has been found in previous projects to be effective and acceptable by the local villagers.

Muchh Kounthea is one of the villagers who adopted the practice. The 56 year-old farmer has seven jars in her house, five of which contain the guppies. “I am fine with these fish. I just hope we do not have dengue in the village,” she said. Although she has never had dengue before, she knows about it and can recognise the period of dengue outbreaks. “Dengue usually occurs during rainy season around May to October. I know one child who got really sick because of dengue and had to seek the treatment at the private referral hospital.”

Although there is evidence suggesting the use of guppy fish can be beneficial in dengue vector control, no cluster randomised trials to evaluate their effectiveness nor a proper evaluation of their impact on adult mosquito densities have been conducted.

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Guppy fish are bred and nurtured at the guppy bank at the health centre.

To understand and evaluate the impact of a guppy fish and a combination of new vector control tools to sustainably reduce the Aedes mosquitoes, Malaria Consortium’s pilot project also implemented an entomological survey in the villages. In cooperation with the National Dengue Control Programme (NDCP), the entomological team was deployed to collect larvae, pupae, and adult mosquitoes from the targeted villages. All containers around selected houses were inspected and all samples were taken to the laboratory for further analyses. The survey received a lot of attention from the villagers.

At the same time, a survey on the knowledge, attitudes, and practices surrounding water use and vector-borne disease prevention was also conducted. This separate survey aims to guide and evaluate communication and behaviour change interventions to reduce dengue transmission.

Following the survey, training in behaviour change communication and health education was provided for the community health workers. The vector control intervention started in late November will last a year until the same period in 2016.

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Sample larvae and pupae were collected during the entomological survey.

Wanweena Tangsathianraphap is External Communications Officer for Asia

Preventing malaria transmission through the cross border surveillance

At the international border checkpoints between Cambodia and Laos, Stung Treng Province, a green booth with various messages inviting people to participate in the malaria surveillance and investigation activity attracted the attention of several passers-by. It is one of the seven screening booths of Malaria Consortium set up to provide malaria blood test for border crossers using rapid diagnostic tests.

Treatment is provided immediately to anyone found to be positive for malaria and the team also collect blood for further laboratory analysis to check for any mutation in the malaria parasite gene.

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“There are approximately 70 people per day using this border checkpoint to travel between Cambodia and Laos – mostly tourists,” said Hour Suy, Chief of International Checkpoint, Stung Treng Province.

The number crossing the international checkpoint reflects only one element of the actual population crossing between the two countries. With its border among forested mountain areas, Stung Treng is reported to have at least 12 other informal crossing sites. Some of these link to informal roads on the other side, while others have fences or gates. Many people are known to cross via these informal border points.

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See Bia is among one of those crossing via these informal sites. This 35-year-old rice farmer was on her way to cross the border with friends, when she stopped to participate in Malaria Consortium’s surveillance checkpoint. “We normally use this road. Just follow this footpath, and then you can cross to Laos,” she said. Unlike the tourists who need to cross the border at formal checkpoints, many local people like See Bia prefer to use informal borders to access the neighboring country.

The porous border has been another great challenge for malaria control and elimination efforts in addition to general population movement. It can facilitate malaria transmission and spread drug resistance into new areas because some of those crossing may carry the malaria parasite with them. Therefore, screening these populations is vital to understand malaria transmission trends along the border. Early detection of malaria cases will also help stop the spread of the disease.

This surveillance and screening process is part of the second phase of Malaria’s Consortium Cross Border project to compare malaria trends among populations who cross the border at different crossing sites. It will help assess malaria incidence and respective patterns of resistance of malaria transmission, which in the end will benefit the long term plans for malaria control and elimination in this region.

Wanweena Tangsathianraphap is External Communications Officer for Asia

Empowering village malaria workers in Cambodia: Prevention and control of malaria

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Standing under the shade of a cassava barn is Khem Bou, a 17-year-old mother of two from Kampong Cham province. Every day she sleeps with her children on a makeshift bed made of wooden planks, but this hasn’t driven them away from this temporary home.

“Since it became difficult to find work in my hometown, my husband and I relocated our family to find new opportunities in Pailin province. We found a job on this cassava farm and have been working here for a month. We heard that where we live now is a high risk malaria area, but we have no other choice. Although we do not know much about malaria, we know that if we get sick, there is one village malaria worker nearby who we can seek for advice. We also received these mosquito nets from the village malaria worker.”

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Khem Bou and her two children now live on a farm in Pailin province.

Khem Bou and her family are among the country’s poorest. Those living below the poverty line (about 17 percent of the population) are often forced to give up the chance of receiving basic education to work and supplement their families’ income. Many are living under poor hygienic conditions and have limited knowledge of disease and how to protect themselves. Khem Bou’s family is also at high risk of getting malaria and thereby spreading the drug resistant parasite. Like many other mobile and migrant families, their itinerant lifestyles make them difficult to reach with malaria control interventions.

In response to these challenges, Malaria Consortium has been working closely with the Cambodian National Malaria Control Program (CNM) and the Provincial Health Department to carry out malaria control activities with a specific focus on people at risk in Pailin province, where high levels of resistance to antimalarial drugs have been identified by CNM and the World Health Organization.

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Leap Sivmeng, a village malaria worker in Pailin, practices malaria diagnosis procedures during the refresher training with the Malaria Consortium team.

With funding from the UK government, the community health network in 68 villages in Pailin province will be strengthened and village malaria workers (VMW) will be trained to provide early diagnosis and treatment for malaria.

Leap Sivmeng, a VMW in Pailin, participated in the refresher training with Malaria Consortium.

“My father used to suffer from malaria. He almost died because we did not have enough money to see the doctor and treat him. So I volunteered to get the education necessary to help my family. It has been three years already since I started working as a VMW. I have been helping not only my family but also the villagers in the community.”

This training is part of the VMW project framework, which is designed to equip VMWs and enhance their education and technical skills to perform rapid diagnosis tests for malaria and provide treatment according to the national treatment guidelines. They are trained to detect and report any new cases found. Supportive supervision from Malaria Consortium’s field technical staff is provided on a regular basis to keep them motivated and reinforce what they learnt during the training.

So Sam Art, a 57 year old VMW from Pailin province, explained how what he learnt helped him make a better diagnosis.

“There was one new case of malaria I detected in April this year.  Normally, when a patient visits me, I ask about their symptoms and history and check their temperature. If I suspect they have malaria, I will do the blood test. If the patient has malaria, then I will give them the medicine.

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So Sam Art, a village malaria worker in Pailin, checks his medicine kit as part of his training with the Malaria Consortium team.

Leap Sivmeng and So Sam Art are among the frontline VMWs who can help provide primary health services directly to community members and connect with mobile populations in the area. Their work is an important part of malaria control efforts among the most vulnerable and high risk groups.

Cambodia aims to move towards pre-elimination of malaria across the country with special efforts to contain artemisininresistant p .falciparum malaria by the end of 2015, and achieve phased elimination of all forms by 2025.

Wanweena Tangsathianraphap is External Communications Officer for Asia

 

 

Fighting Dengue in Cambodia

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Dengue, for which there is no cure or vaccine, is one of the leading causes of hospitalisation and death among children in Asian and Latin American countries. Its incidence has grown dramatically around the world in the past 40 years.

According to the World Health Organization (WHO), the actual numbers of dengue cases are under-reported and many cases are misclassified, but despite this, evidence indicates a sharp increase in the number of cases in recent years. A number of factors have contributed to the rapid growth of dengue, including urbanisation, globalisation and climate change as well as a lack of effective mosquito control.

Cambodia is one of the countries in Asia that is considered an endemic area, where dengue cases have been identified every year since its first outbreak in 1963. A cumulative total of 3,543 cases were reported to the National Dengue Control Programme (NDCP) in 2014. For this reason, Malaria Consortium has begun implementing dengue projects in the country. Recently, Mr Ian Boulton, a Malaria Consortium Trustee, together with technical officers led by Dr. Jeffrey Hii, Malaria Consortium’s regional Senior Vector Control Specialist, visited the Tong Rong health centre and eight households in Kampong Cham province, Cambodia, to look into local methods of vector control.

Dr. Hii demonstrated an example of entomological monitoring using simple tools to collect live mosquito larvae and pupae. The team observed how sweep nets were used to collect live specimens in the cement water jars. These live specimens were transferred to white plastic pans to facilitate differentiation between mosquitoes and non-mosquito organisms, before transferring to plastic bags for species identification in the laboratory. This method of sampling attracted the attention of young children, women and men who were informed about the purpose of the visit and were told about the link between Aedes mosquitoes in water containers and dengue fever. What was impressive was that some households have reared guppies in the water containers; on average, a guppy can eat over a hundred larvae each day.

Although the use of guppy fish has been recognised as a low cost, sustainable and effective approach to reduce dengue vector populations and the risk of dengue transmission, it has some limitations. Aedes mosquito breeding is not limited to large water jars or cement tanks, but they also breed in other containers, where water can collect, such as flower vases, plant pot bases, discarded cans, coconut shells and tyres.  As a result, mosquito breeding and some dengue risk still persists. In order to reduce Aedes breeding and populations further, Malaria Consortium is currently implementing a project that will evaluate an alternative low-cost, sustainable and effective approach with other larvicides that can be used in combination with guppy fish.

Communication for Behavioural Impact (COMBI) has been included as part of dengue control efforts to create a supportive environment for behaviour change and make community participation a vital part of the project.

To drive and sustain these integrated vector control management strategies, Malaria Consortium Cambodia works together with National Centre for Parasitology, Entomology and Malaria Control to provide dengue surveillance strengthening support and develop the Provincial Health Departments’ capacity to  detect any dengue outbreak and implement the responses.

Wanweena Tangsathianraphap is External Communications Officer for Asia

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Dr. Jeffrey Hii demonstrated how to collect mosquito larvae.

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Ian Boulton, Malaria Consortium Trustee, and Dr. Aranxta Roca, Malaria Consortium Asian Technical Director, used the pipette to transfer the larvae.

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The team visited the guppy farm to investigate different breeds of guppy fish and their capacity to eat mosquito larvae.

Malaria Consortium Cambodia awarded the Certificate of Merit for work with government

Mr. Lim Kim Seng, Malaria Consortium Pailin Field Office Coordinator received the award from HE. Dr. Te Kuy Seang, the Secretary of State of Cambodia.

Malaria Consortium was awarded a Certificate of Merit in recognition of its work implementing the Ministry of Health’s malaria elimination strategy in Cambodia.

On 26th February 2015, the Provincial Health Department of Pailin (PHD) organised an annual conference to review the achievements of 2014 and look ahead at plans for 2015. Malaria Consortium’s Pailin office, as a working partner of the PHD, contributed by co-organising this event. Over one hundred participants attended, including Village Malaria Workers, staff from government offices and the NGO sector and representatives from the Health Center Member Committee. The ceremony was presided by His Excellency Mr. Ing Vuth, Deputy Provincial Governor of Pailin Province.

Malaria Consortium – one of the leading non-profit organisations specialising in the prevention, control and treatment of malaria and neglected tropical diseases – was honoured to receive the Certificate of Merit from HE. Dr. Te Kuy Seang, the Secretary of State of Cambodia. The award was granted in appreciation and recognition of the NGOs and government departments that have contributed to the health sector and Ministry of Health activities in the country. Mr. Lim Kim Seng, Malaria Consortium Pailin Field Office Coordinator was at the event to receive the award on behalf of the organisation.

Malaria Consortium established an office in Cambodia in 2009, with field offices located in Pailin (since 2009) and Rattanakiri (since 2014), in addition to supporting activities in multiple other provinces. Since its inception, Malaria Consortium has assisted at both provincial and national level to strengthen the capacity of government officers and provide technical support for malaria control and elimination. In addition, Malaria Consortium has worked to conduct cutting-edge implementation research in close collaboration with the national malaria control programme and provincial health departments in order to assist Cambodia in tackling antimalarial drug resistance.

Pailin is one of the early provinces where artemisinin resistance was identified, and continues to be a key location for managing resistant malaria.  Malaria Consortium has been implementing projects in Pailin to eliminate artemisinin resistance, including support to the Village Malaria Worker programme, identifying the burden of asymptomatic and resistant malaria in the border-crossing population, research to explore the use of reactive case detection approaches, and piloting of surveillance and mHealth approaches for real-time reporting and response to malaria cases.

To learn more about the current projects we are working on in Cambodia and the wider Asia region, please click here.

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The Certificate of Merit as a recognition of the high performance in partnership on the implementation of malaria elimination strategy from the Ministry of Health of the Kingdom of Cambodia.

Wanweena Tangsathianraphap is External Communications Officer in Asia.

Malaria Consortium’s behaviour change communication project

Monica Posada is Malaria Consortium’s behaviour change communication (BCC) technical specialist for the Asia region. She recently visited Cambodia in order to conduct research into behaviour change communication strategies at cross-border sites in the Greater Mekong Subregion (GMS).

Malaria Consortium has conducted a behaviour change communications (BCC) assessment project in Cambodia to assess how effective these strategies are when it comes to improving health conditions, particularly among vulnerable groups.

Behaviour change communication strategies are used to help prevent the spread of diseases by encouraging positive behaviour within a community. By assessing current BCC methods, the intention is to provide recommendations as to how this approach can be improved in the region, and rolled out on a larger scale.

The assessment included a review of BCC strategies and guidelines in Myanmar, Thailand, Cambodia and Laos, and investigated how these are being implemented and targeted toward vulnerable groups. In particular, the assessment focused on BCC interventions among migrant and mobile populations, who travel and work along key border sites where there is a threat of spreading the artemisinin resistant malaria parasite.

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A local family showing their hammocks and LLIN at their house in Battambang, Cambodia.

A research team conducted a seven day visit to the cross-border areas of Pailin and Battambang in order to conduct focus group discussions and in-depth interviews. More than 104 participants, including migrant populations, community leaders, community health workers, and NGO workers joined the study.

The interviews and discussions provided a chance to better understand the preventive and treatment-seeking behaviours of at-risk populations. For example, villagers were able to provide feedback on the quality and size of long lasting insecticidal nets and the barriers to treatment for malaria at the community healthcare centre.

The most interesting part of this study was to see that the chief of villages and village malaria workers had a considerable degree of trust among the local, migrant and mobile populations. The BCC approach, which relies on strong interpersonal communications and the discussion of best practices in preventing diseases, seems to be a very effective channel for health education.

Helping to eliminate the threat of dengue in Cambodia with Malaria Consortium

Vanney Keo is a Malaria Consortium field assistant, who has been working in Cambodia.

I have been working for Malaria Consortium on a Regional Integrated Vector Management Project in Cambodia, where we have been collaborating closely with the National Dengue Control Programme (NDCP). At a project closing event in the Mongkol Borey district of Cambodia, many community members thanked me for my role in sharing best practices on how to prevent dengue fever. I thought then that I would share my experiences working on this project.

The purpose of the project was to develop community-based methods to improve prevention, recognition and reporting of dengue. The positive deviance (PD) focus of the project involved identifying community members who, despite sharing similar living conditions and resources as the rest of the community, already demonstrated positive behaviours for preventing dengue. These individuals were encouraged to share what they did to preserve their health with the rest of the community by becoming PD volunteers.

At the start of the project I helped to select 16 PD volunteers who were both willing and able to share methods for preventing dengue. This meant four volunteers for each selected village throughout the Banteay Meanchey province. As well as speaking at meetings and seminars, the volunteers visited each household in their allocated village at least twice a month. One benefit of using volunteers from the community to help raise awareness of disease prevention behaviours is that they are recognised in that community and can help to galvanise support for educational events.

It was my responsibility to schedule community meetings so that PD volunteers were able to give seminars on preventing dengue. Their prevention methods include advising individuals to sleep under a mosquito net, even during the daytime; always disposing of containers and cans which can accumulate water; keeping children away from areas with high concentrations of mosquitoes like the forest; wearing long-sleeve clothes, particularly in high-risk areas; using guppy fish in water containers to limit the growth of mosquito larvae; and highlighting the importance of cleanliness.

I kept in regular contact with the volunteers to ensure that their methods were being picked up by the community. By coordinating with the village members on a regular basis, I acted as a bridge between the volunteers and health specialists from NDCP and Malaria Consortium, and helped to monitor the changes in the behaviour of community members.

On one occasion, I helped to organise an event where the villagers were encouraged to create posters explaining the dengue prevention methods they had been taught by the PD volunteers.

One of our seminars was attended by the majority of community members across all four villages (Khtum Reay Keut, Anlong Thngan Keut, Bat Trang Thum Keut, and Bat Trang Touch). Competitions were organised in order to increase community participation, and involved quizzes for the community’s children, which aimed at increasing their understanding of dengue and the threat of mosquitoes.

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Here, a young girl says that she has learnt that dengue fever is transmitted by the bite of a tiger mosquito.

Positive Deviance volunteers also used the opportunity of cross-community events to give speeches, encouraging community members to continue spreading the messages after the closing ceremony. One positive deviance volunteer said, “Now the households of our community are very clean, and I’m really happy that you have all followed our suggestions”.

A positive deviance volunteers thanks community members and urges them to continue implementing preventive methods to protect themselves from dengue.

A positive deviance volunteers thanks community members and urges them to continue implementing preventive methods to protect themselves from dengue.

These events, and the participation of community members, required the approval of respected leaders within the villages. This meant I frequently met with the village chiefs in order to provide updates on the project and to address any concerns. By the end of the project, I believe that we had successfully broken a cycle of dengue as all of the villagers were maintaining good standards of cleanliness in their home, and were always sleeping under a net. I’m confident these methods will continue now that the project has ended.

The positive deviance volunteers at the end of the project.

The positive deviance volunteers at the end of the project.

 

 

 

A new cross-border approach in the move to malaria elimination

The booth with its big banner catches your eye as you approach Phsar Prum, on the Cambodia border with Thailand. There are people there, clustered under the multi-language message about malaria and the colorful logos representing Malaria Consortium and our project partners. Once you pass through the checkpoint, a Malaria Consortium field assistant in a bright green jersey approaches, asking permission to talk with you about malaria, offering you a chance to be tested.

The team is good at what they do. The village chiefs, local health workers and the ‘Village and Mobile Malaria Workers’ are actively engaged and, though it’s only two weeks since the project launched, over 500 people have already been screened at checkpoints in Steung Treng, Rattanakiri and Pailin provinces.

“We explain very clearly what we are doing and why first, before they are asked to join,” says Malaria Consortium field assistant, Sokhoeun Chum. “At first some are scared about the finger prick, but when we explain, most agree to the test and are not worried about what we are going to do.”

All this activity is part of an innovative new study Malaria Consortium is leading focused on the special challenge Cambodia faces in identifying and treating migrants and other travelers, difficult-to-reach populations who may be at risk for malaria and transmission of drug-resistant parasites.

“It is the right thing to do in a right time for mobile and migrant people, and it is very important as a new approach for active case detection to do the screening at the cross borders,” adds Sophal Uth, field office coordinator, Malaria Consortium Pailin Field Office.

The goal? To develop a screening strategy that will help reduce the number of malaria parasites crossing Cambodia’s borders. Doing so could make a big contribution towards elimination of malaria and containment of drug resistance, goals of both Cambodia and the Greater Mekong Sub-Region. By locating check points in three different border provinces, this study presents a unique opportunity to compare and contrast their findings, enriching the strength of the recommendations that will be shared with the Cambodian National Programme for Parasitology, Entomology and Malaria Control (CNM) and others across the region next spring.

These early successes reflect careful planning, coordination and positive working relationships among individuals and organizations across Cambodia: the Ministry of Health and CNM; provincial government and health officials; police and immigration officers, village chiefs, village malaria workers, mobile malaria workers and local health workers; partner NGOs, like FHI360, Institut Pasteur du Cambodge and the London School of Hygiene & Tropical Medicine, as well as the project’s funder, the UK Department for International Development (UKaid).