Asia – Malaria Consortium Blog

Tackling antibiotic resistance – why it matters and how community dialogue can help

Approx reading time: 3 mins

January 11, 2019January 11, 2019

*The Community Dialogue approach enables community-based volunteers to host regular community meetings to explore how a health issue affects the community*

Antibiotics are lifesavers – they are used to prevent and treat bacterial infections such as pneumonia, tuberculosis and urinary tract infections. However, the misuse of antibiotics in recent years has led to many strains of bacteria becoming resistant to this type of medicines, which means it is now more complex (and sometimes impossible) to treat infections caused by resistant “superbugs”. Unless we urgently change the way we use antibiotics, resistance will continue to spread globally, resulting in higher treatment costs, prolonged hospital stays and, ultimately, more people dying from bacterial infections. The worst case scenario would be a world where antibiotics are no longer effective and people die from common bacterial infections or minor accidents.

A recent report published by the Organisation for Economic Co-operation and Development (OECD) warns that in Europe, North America and Australia alone, 2.4 million people could die between 2015 and 2050 unless urgent action is taken to “stem the superbug tide”. The impact of antibiotic resistance is likely to be even more dramatic in low and middle-income countries, where health systems are weak and access to quality medicines is poorly regulated.

Tackling antibiotic resistance is not going to be an easy task. The development of new drugs and enabling healthcare providers to prescribe antibiotics only when needed will be important cornerstones of efforts to minimise resistant. However, a comprehensive approach will need to address many factors outside the traditional boundaries of the human health sector. For example, one of the ways to minimise the development of resistance is to prevent infections, which requires improvements in access to clean water, sanitation and hygiene. Another major contributor to the spread of resistance is the overuse of antibiotics in livestock and farmed fish, often to stimulate growth and prevent rather than cure infections. Scientists believe that resistant bacteria can spread through the food chain, but also through contaminated water and soils, for example through pollution from inadequate treatment of industrial, residential and farm waste. Because of the many interdependencies, the fight against antibiotic resistance is a prime example of the need to adopt a “One Health” approach – a coordinated, collaborative, multidisciplinary and cross-sectoral approach to improving health and wellbeing.

In November, the Call to Action on Antimicrobial Resistance was held in Accra, Ghana, which brought together policymakers, donors, civil society and researchers from a broad range of countries and backgrounds to discuss the global response to the most critical gaps in tackling the development and spread of drug-resistant infections. The event was co-hosted by the governments of Ghana, Thailand and the UK, with the United Nations Foundation, World Bank and Wellcome Trust and in partnership with the Interagency Coordination Group on Antimicrobial Resistance.

The first day of the event focused on highlighting the work of individuals and organisations taking pioneering action to tackle drug-resistant infections. Malaria Consortium was honoured to be chosen by the Wellcome Trust as one of two “Pioneers” identified through a competitive open call to showcase our work on Community Dialogue to address antibiotic resistance in Bangladesh. The project, a collaboration between the University of Leeds, ARK Foundation and Malaria Consortium, addresses a factor that is often overlooked: what the general public can do to minimise the spread of antibiotic resistance. For example, people should use antibiotics only when prescribed by a health professional, complete the full prescription, and never share antibiotics with friends and family. To bring about positive social and behaviour change among the general public, the project adopts the Community Dialogue Approach, which has been used by Malaria Consortium in different countries and for a range of other health issues. The approach involves enabling community-based volunteers to host regular community meetings to explore how a health issue affects the community, identify solutions to the problem and decide on how the community will address the issue. It builds on the assumption that public discussion and collective decision making will, over time, create a sense of ownership and affect the social norms that shape the behaviour of the wider community, not just those who actively participate in the meetings. In this project, 55 volunteers were trained in the catchment area of five Community Clinics, a total population of 30,000. Since May 2018, over 400 meetings have been held, each involving 40 community members on average. Evaluation of the project is ongoing, but preliminary findings are encouraging, with many participating reporting that they are now more mindful of using antibiotics appropriately.

Delegates at the Call to Action commended the community-level, bottom-up approach to tackling antibiotic resistance. Many were particularly impressed with how the project aimed to embed the approach within the existing health system and community structures to strengthen its sustainability, for example by linking the supervision of volunteers with the network of Community Clinics that provide basic health care in Bangladesh.

In the future, we would like to expand the approach to a larger area and to carry out a robust evaluation of its impact on behaviour. We also see an opportunity to embrace the One Health idea and include the promotion of positive behaviours concerning the use of antibiotics in livestock. Overall, we believe that the approach can be used to help communities to become “resistance fighters” and play a part in tackling the threat of antibiotic resistance.

Learn more

Read our implementation guide for the Community Dialogue Approach

From the field: female community health volunteers in Nepal

Approx reading time: 2 mins

June 8, 2018June 14, 2018

Nepal is one of only five countries that have reduced under-five mortality by 50% since 1990[1], however pneumonia remains one of the primary causes of death for Nepali children (15% of under five deaths in 2015[2]). In rural areas, the government relies on the country’s 50,000 Female Health Community Volunteers (FCHVs) to provide maternal and child health care. Although 42% of these women have never been to school[3] they have been trained to diagnose a number of illnesses, including pneumonia, and provide essential care to young children on a daily basis in the most remote areas where Health Posts are hard to reach.

As part of its Acute Respiratory Infection Diagnosis Aid (ARIDA) project/study, Malaria Consortium (MC) went on a scoping mission to Nepal end of January and visited an FCHV in a valley outside Kathmandu. Guta Kunwor is 38 years old and she has been an FCHV for 12 year. Her aunt was an FCHV before her and she used to accompany her to trainings at the local Health Centre. On average, she sees three children with cough or difficulty breathing every week. When children present with those symptoms she counts their respiratory rate (RR) for 60 seconds according to the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) guidelines and refers them to the nearest Health Post if she diagnoses fast breathing.

So far, Guta has been using the ARI Timer, a device which works like a stopwatch whilst she is counting the child’s breaths by watching their stomach moving with each inhalation and exhalation. The ARIDA study is focused on testing an automated device which is strapped to the child’s belly and automatically counts the child’s breaths. It also reduces the assessment time from five minutes to merely a couple of minutes. When we told Guta about this new device, she spontaneously thought of an analogy which rang very true: she said that using the ARI Timer was a little like touching a child’s forehead and yours at the same time to check for fever, whilst using the ChARM device was more like using a thermometer to get a reliable diagnosis.

This stage of the ARIDA study is looking at the acceptability of this new automated device under a number of specific themes: affective attitude, burden, intervention coherence, perceived effectiveness and self-efficacy. The results should show whether FCHVs and health facility workers (HFWs) using an Acute Respiratory Infection Diagnostic Aid (ARIDA) can adhere to the IMNCI algorithm, and should help us better understand FCHVs’ and HFWs’ perceptions on the benefits of and barriers to using this new device.

Alice Maurel is Senior Programme Officer at Malaria Consortium. Alice visited Nepal in January 2018.

Find out more about the ARIDA study in our project brief here.

The ARIDA study is funded by the La Caixa Foundation and UNICEF in collaboration with the Federal Ministry of Health Ethiopia, Federal Ministry of Health Nepal and Ministry of Health Mozambique.

[1] P Dawson YP, R Houston, S Karki, D Poudel, S Hodgins. From research to national expansion: 20 years’ experience of community-based management of childhood pneumonia in Nepal. Bulletin of the World Health Organization, 2008

[2] Government of Nepal MoH. Annual Report, Department of Health Services, 2015–2016. 2016.

[3] Ibid.

MC in the news: Dengue

Approx reading time: 4 mins

October 4, 2016October 6, 2016

Last week Malaria Consortium Myanmar was in the news with a story about dengue. We worked with Oliver Slow, a journalist to talk about our work and the dengue situation in the country.

The story “The dreaded dengue on the rise” was published in Frontier Myanmar print and online newspaper, an “unbiased voice in transitional Myanmar”

The number of reported cases is rising and more countries are being affected, but dengue fever remains one of the most neglected tropical diseases.

For Ko Yan Naing Soe, 18, it started with a high fever. Thinking it was nothing serious, he didn’t seek medical advice.

“But after four days of a constant high fever, my family took me to the township hospital where I was diagnosed with dengue fever,” Yan Naing Soe, who was 13 at the time, told Frontier.

The township hospital did not have the facilities to perform the necessary blood transfusions, so he was transferred to a children’s hospital in Dagon Township.

“It was quite serious for a while, but after about a week I returned to normal and was released after 10 days. It was lucky they diagnosed it early,” he said.

Although rare, in extreme cases dengue can lead to death.

Last year saw a surge in dengue fever cases worldwide. In Myanmar, 43,845 cases and 140 deaths were reported, of which 135 were children under 14, World Health Organization figures show.

“Dengue cases were reported from all States and Regions, among which Sagaing, Ayeyarwaddy and Mandalay had the highest cases reported,” a WHO spokesperson told Frontier.

In 2016, there has been no reported dengue outbreak. To the end of August 1,505 cases had been reported, including 30 deaths, the spokesperson said.

Dengue is transmitted by female Aedes aegypti mosquitoes (the same species that transmits Zika, yellow fever and chikungunya). Female mosquitoes do not actually feed on human blood for their own nutritional purposes; the protein is needed to produce eggs. So really they’re just being good mothers – something to think about the next time you swat at a mosquito buzzing around your ear.

One of the first recorded cases of dengue was noted by a founding father of the United States, Benjamin Rush, who wrote of “bone-break fever” in As It Appeared in Philadelphia, in the Summer and Autumn of the Year 1780 – a book title that doesn’t exactly roll off the tongue.

The Aedes mosquito was wiped out in Central and South America in the 1950s and 1960s, but it would later return. No such eradication was ever achieved in Asia.

“A severe form of haemorrhagic fever, most likely akin to DHF [dengue haemorrhagic fever, a severe form of the disease], emerged in some Asian countries following World War II,” according to a WHO handout on the disease.

Before 1970, only nine countries had experienced severe dengue epidemics, but that has since grown to more than 100 nations worldwide. Southeast Asia is one of the most severely affected regions, together with the Americas and Western Pacific, according to the WHO.

The UN agency’s figures show that cases in the three regions exceeded 1.2 million in 2008 and over 3.2 million in 2015. “Recently the number of reported cases has continued to increase,” WHO said.

“Countries across Southeast Asia are seeing increased prevalence [in dengue],” said Dr Prudence Hamade, senior technical adviser for Malaria Consortium. “Factors include the migration of people, global warming and increased urbanisation.”

She told Frontier that poor living conditions, including a lack of access to clean water and poor sewage disposal, were fertile feeding grounds for mosquitoes and created “ideal conditions” for the spread of dengue in cities.

A major challenge in diagnosing dengue is the similarity in symptoms with other diseases including malaria and Zika, the latter of which has seen its first cases in Southeast Asia in recent weeks. Symptoms for dengue include high fever, severe headaches, joint and muscle pains, and rashes.

In late 2015 and early this year, the first dengue vaccine, Dengyvaxia, was registered for use in people between nine and 45 years of age in endemic countries.

“Some countries are already deploying it, however it is only partially effective in preventing the disease and only useful in patients nine years and older,” said Dr Hamade. Some of the most vulnerable to death from the disease are young children.

“The most effective way to remove the threat of dengue is to control the mosquitoes that spread the disease. It is therefore important to monitor the presence of these mosquitoes and, if found, to take measures to remove them,” she said.

Measures include being active in looking for mosquitoes, removing breeding sites (mosquitoes can breed in a bottle-cap of water) and protecting from mosquito bites during the day.

A major difficulty in combating dengue is that the Aedes mosquito is active during the day, meaning that mosquito nets are not as effective and outdoor workers are more vulnerable, said Dr Jeffrey Hii, senior vector specialist for Malaria Consortium Asia. His organisation is looking into insecticide-treated clothing for people who work outdoors.

Malaria Consortium is also advocating for more funding for dengue programs worldwide. The organisation argues that while malaria programs receive significant attention and funding, those related to the control of dengue are “seriously underfunded”.

Dengue is classified as one of the 17 recognised neglected tropical diseases, which are typically related to poverty, endemic to the tropics and have poor research funding.

“However, even within NTD circles, it has often been further neglected,” said Dr Hii. It was not one of the 10 NTDs selected by the London Declaration in 2012 as a priority disease to be eradicated.

“There has been a major lack of investment in dengue prevention and control, which has also been mirrored by a lack of policy dialogue within the international community and among governments,” said Dr Hii.

“While remarkable progress has been made against the majority of these 10 NTDs … we have not seen the same high-profile announcements or a commitment to tracking data and progress for dengue. Simply put, it is neglected.”

Dr Sylvia Meek’s contribution to malaria elimination in Asia

Approx reading time: 4 mins

June 29, 2016August 10, 2016

It is with deep sorrow that Malaria Consortium must announce the passing of Dr Sylvia Meek, Malaria Consortium’s Global Technical Director, on 11th May 2016, after an 18-month battle with cancer.

Sylvia’s contribution to the fight against infectious disease, and malaria in particular, through her own, and Malaria Consortium’s work, cannot be overstated. From her ground-breaking work as an entomologist to her high-level policy work, she placed Asia in the epicentre of this fight.

Originating from Hull in Northeast England, Sylvia had a passion for the environment and disease control that led her to study Zoology at Oxford and later Animal Parasitology at the University College of North Wales, Bangor, followed by a PhD in mosquito genetics and control at the London School of Hygiene & Tropical Medicine and Liverpool School of Tropical Medicine. Her research at the London School laid some of the early foundations for current work on what are now termed ‘Wolbachia-infected mosquitoes’.

Sylvia as an entomologist
One of her dear friends, Dr Jeffrey Hii, Senior Vector Control Specialist at Malaria Consortium, remembers sharing a laboratory with Dr Sylvia Meek back in 1979-1980 when she was studying the inheritance of susceptibility to infection with Brugia pahangi and Wuchereria bancrofti in the Aedes scutellaris group of mosquitoes. These were the days before the advent of DNA sequencing techniques, so laboratory crosses were complex. Nevertheless, Sylvia was later able to show from these laboratory crosses that geographical isolation has probably been a very important factor in speciation within the Ae. scutellaris group (Meek, 1988).

During 1985 to 1989, Jeffrey and Sylvia’s paths crossed twice. “Firstly Sylvia joined our entomological team in the Bone-Dumoga forest reserve, in north Sulawesi during the 1985 Project Wallace expedition organised by the Royal Entomological Society of London and Indonesian Institute of Sciences (LIPI),” he recalls. “She assisted in larval collections which led to the re-description of An. (Cellia) sulawesi Waktoedi, a hitherto incompletely described species.”

“We then met again in Chiang Mai where Sylvia informed me of her new job as World Health Organization (WHO) malaria adviser for the antimalarial programme in the Solomon Islands. We both participated at a WHO Special Programme for Research and Training in Tropical Diseases consultation on forest malaria in 1989 in Chiang Mai, Thailand. Sylvia’s presentation on forest malaria formed the basis of her landmark paper on ‘Vector control in some countries of Southeast Asia: comparing the vectors and the strategies’ (Meek 1995[1]).”

Throughout her career, Sylvia kept research close to her heart, contributing her expertise to shaping the various studies conducted in the Asia region.[2]

“During the past two years in Malaria Consortium, I have had the pleasure to work with Sylvia in research about ways to improve access to interventions that have been shown to work but have not reached many of the people who could benefit from them,” Jeffrey says.

Dr Sylvia Meek presenting at JITMM in Bangkok, 2013 (© Malaria Consortium)

From research to helping refugees
Sylvia’s work with WHO took her around the world, during which time she gained the nickname ‘Mosquito Sylvia’. She also worked with the World Food Programme and the United Nations Development Programme, setting up and running disease control programmes for 200,000 refugees.

Dr Prudence Hamade, Malaria Consortium Senior Technical Advisor, another close friend and colleague describes this experience: “Sylvia worked in the refugee camps along the Thai-Cambodia border and although an entomologist she was soon diagnosing and treating malaria among the many patients there as well as doing her work and research into the entomology and providing protection for the refugees. During her stay there she had dengue at least a couple of times and has described to me how she lay on the floor of a hut with a high fever and had to get up and travel on the next day.”

Regional expertise and policy advice
Prudence continues, “She was instrumental in conducting the Cambodia malaria indicator surveys, the first of their kind in the Greater Mekong Subregion in 2004. In 2007 she supported both Thailand and Cambodia to develop their Global Fund bids and conducted Malaria Programme Reviews in Thailand and Myanmar to advise governments on how to improve their malaria programmes.

At WHO Technical Expert Group meetings, Sylvia provided well-thought logical arguments and brought the Asia view to the WHO Malaria Policy Advisory Committee (MPAC) which helped to drive some of the key policy changes related to malaria control and elimination in Asia. Through MPAC and drug resistance WHO regional meetings, Sylvia contributed to the recommendations of the treatment policies for Cambodia, a country particularly affected by multi- drug resistance. She was also an active member of the Emergency Response to Artemisinin Resistance (ERAR) in the Greater Mekong Subregion working groups.

“Sylvia’s impact on Malaria Consortium and our partners was, and continues to be, immense,” says Jeffrey. “She was an inspiration and everything we could ever admire in our profession and our personal lives. Sylvia’s values will be carried on by those she mentored, collaborated with and taught, and her inspiration has instilled a generation of malaria programme staff and entomologists in Solomon Islands, Greater Mekong Subregion, sub-Saharan Africa and elsewhere. She will be remembered for her subtle sense of humour, her enormously infectious curiosity and enthusiasm, her friendship and kind and generous nature.”

Dr Sylvia Meek surrounded by her colleagues at the Malaria Consortium Asia retreat 2015 in Thailand (© Malaria Consortium)

[1] Meek, S.R. (1995). ‘Vector control in some countries of Southeast Asia: comparing the vectors and the strategies’. Ann Trop Med Parasitol; 89: 135-147.

[2] Non exhaustive list of some of Dr Sylvia Meek’s recent publications:
Hustedt J, Canavati SE, Rang C, Ashton RA, Khim N, Berne L, Kim S, Sovannaroth S, Ly P, Ménard D, Cox J, Meek S, Roca-Feltrer A (2016). ‘Reactive case-detection of malaria in Pailin Province, Western Cambodia: lessons from a year-long evaluation in a pre-elimination setting’. Malaria Journal.

Edwards HE, Canavati SE, Rang C, Ly P, Sovannaroth S, Canier L, Khim N, Menard D, Ashton RA, Meek SR, and Roca-Feltrer A (2015). ‘Novel cross-border approaches to optimise identification of asymptomatic and artemisinin-resistant Plasmodium infection in mobile populations crossing Cambodian borders’. PLoS One.

Cox J, Dy Soley L, Bunkea T, Sovannaroth S, Soy Ty K, Ngak S, Bjorge S, Ringwald P, Mellor S, Sintasath D, Meek S (2014). ‘Evaluation of community-based systems for the surveillance of day three-positive Plasmodium falciparum cases in Western Cambodia’. Malaria Journal.

World Malaria Day in Bangladesh

Approx reading time: 2 mins

May 18, 2016May 23, 2016

In late April 2016, I spent World Malaria Day in Bangladesh after being invited by the Director of Communicable Disease Control, Dr Shamsuzzaman of the Ministry of Health and Family Welfare. Malaria Consortium has been providing technical assistance and funding support to the Bangladeshi organisation iccdr,b to conduct a study in the Chittagong Hill Tracts areas regarding perceptions of health services. In addition, we have recently been in discussions as to where Malaria Consortium could best support the efforts of the government to control malaria, dengue and other neglected tropical diseases, especially focused in the border areas where malaria elimination needs to be accelerated to avoid artemisinin resistance crossing the border from neighbouring Myanmar.

It was a great privilege to be invited by Dr Shamsuzzaman, and we were happy to partially fund the event by providing $3,000 – funds that went towards travel for key government officials, renting of the venue, refreshments and the printing of key malaria materials.

It was a hot day in Chittagong, the second largest city in Bangladesh, with lots of people out and about on the streets for the World Malaria Day celebrations. Bands were playing and I participated in the parade and subsequent rally where indoor residual spraying was demonstrated. The slogan of the event was ‘end malaria now’, which was chanted from the crowd and by officials.

After the parade, a large crowd gathered for an outdoor meeting. There were several speeches about how there has been a great reduction in malaria in Bangladesh over the past several decades, with cases now confined mostly to border areas – particularly in the Chittagong Hill Tracts. Given this progress, the focus of the Ministry of Health and Family Welfare has become centred on eliminating malaria in the country.

During the panel session of the rally, Malaria Consortium and BRAC – a Bangladeshi international development organisation – were the only two non-governmental organisations to speak. The Minister of Health made an appearance by Skype, and the Directors of Health and Family Planning were also present.

On behalf of Malaria Consortium, I presented the results of a research project in Bandarban that investigated the knowledge, attitudes and practices of community members, facility-based health workers and community health workers in relation to malaria and neglected tropical disease control. We are hoping to be able to work with the family planning division in Bangladesh to train peripheral level health workers to use rapid diagnostic tests for malaria and give out treatments to patients attending community clinics for primary health and antenatal care. We are also looking into possibilities that will allow us to expand into malaria, dengue and community-based care of childhood diseases.

I would also like to thank the icddr,b organisation in Bangladesh for supporting our visit on this important day.

Prudence Hamade is Malaria Consortium’s Senior Technical Advisor

Dressing for malaria: testing insecticide treated clothing

Approx reading time: 2 mins

February 9, 2016February 9, 2016

According to the recent World Malaria Report 2015, around 234 million people are at high risk of malaria in Southeast Asia. The region accounted for 10 percent of global malaria cases and seven percent of deaths in 2015.

There are two types of malaria that cause the most concern in the region – and both can be deadly. Seventy-four percent of P. vivax malaria cases occur in Southeast Asia. P. falciparum resistance to artemisinin, the most effective treatment, is also of grave concern in the region and has now been detected in five countries in the Greater Mekong Subregion (GMS): Cambodia, Lao People’s Democratic Republic, Myanmar, Thailand and Vietnam.

Malaria can be transmitted by biting mosquitoes during indoor and outdoor activities. However, current malaria vector control policy relies almost entirely on methods that address indoor feeding and resting mosquitoes through indoor residual spraying and insecticide treated mosquito nets. National malaria control programmes are finding that outdoor mosquitoes continue to pose a challenge to their efforts. Certain groups, such as night-time forest workers or migrant populations, are exposed to outdoor transmission on a daily basis. Nightime activities such as working on rubber plantations or travelling to forested areas can increase the risk immensely. These groups are also less likely to know about malaria and often have less access to preventive measures.

Permethrin is a common synthetic chemical that is widely used as an insecticide for mosquito nets. However, it can also be applied to clothing and other materials and garments. The chemical is approved for use on mosquito nets and garments by the World Health Organization (WHO). Little is known about responses of mosquitoes to permethrin-treated clothing, and whether this intervention has a significant impact on disease transmission.

With funding from UK aid from the UK government, Malaria Consortium has been working together with the Department of Medical Entomology, Faculty of Tropical Medicine Mahidol University and arctec at the London School of Hygiene & Tropical Medicine, to conduct a collaborative study on the laboratory evaluation of permethrin-treated clothing for reducing contact between humans and mosquitoes.

An acceptability and preference study has already been carried out in rubber plantations in Myanmar[1]. Currently, the insecticide treated fabrics are being evaluated in laboratory experiments using WHO cone test bioassays and arm-in-cage repellency tests to determine the level of protection provided by different types of insecticide-treated clothing. Ultimately, the tests will indicate how effective the treated clothing will be in the short- to medium-term when worn by the rubber tappers. The results from the laboratory and acceptability studies will be used to inform decisions on the fabrics that are to be taken forward to a randomised controlled trial to reduce malaria incidence in populations working outdoors, or for dengue prevention.

The photos below show initial laboratory trials from the study. The test will be replicated with all randomly selected clothing, with results compared by an independent laboratory for validation. It is expected that the outcome of this study will help us develop an effective method for the control of outdoor malaria transmission in Thailand and Myanmar. The results are expected early next year.

pThe armincage repellency test demonstrates mosquito landing and feeding activity on an untreated arm compared to an arm covered with a type of treated clothp

[1] Crawshaw A, Maung TM, Kyaw MP, Tin MW, Sint N, Win AYN, Celhay O, Nicholas S, Roca-Feltrer, Shafique, Hii J. Acceptability and effectiveness of insecticide-treated clothing for prevention of outdoor malaria transmission among rubber tappers in Myanmar. Abstract oral presentation at the Joint International Tropical Medicine meeting 2015, 2-4 Dec 2015, Bangkok, Thailand.

Wanweena Tangsathianraphap is the External Communications Officer in Asia

Targeting mosquito larvae through Integrated Vector Management

Approx reading time: 4 mins

January 7, 2016January 8, 2016

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.

“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.”

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.

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.

Wanweena Tangsathianraphap is External Communications Officer for Asia

Preventing malaria transmission through the cross border surveillance

Approx reading time: 2 mins

November 17, 2015November 19, 2015

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.

“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.

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

Approx reading time: 3 mins

August 17, 2015August 17, 2015

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.”

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.

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.

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

Approx reading time: 3 mins

June 15, 2015June 18, 2015

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

Dr. Jeffrey Hii demonstrated how to collect mosquito larvae.

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

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