From the field: female community health volunteers in Nepal

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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.

Guta

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.

A child wearing the ChARM device

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.

Empowering communities through village health clubs in Uganda

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Uganda’s highest disease burden is from child health conditions. In 2015, Malaria Consortium introduced the Integrated Community Case Management – Maternal and Child Survival (iCCM-MaCS) project, funded by Comic Relief, to reduce Uganda’s maternal and child health burden and to empower communities to take control of health issues within their communities.

As the project draws to a close this February, we take a look back at the success of the introduction of iCCM training for village health team members (VHTs) who, in turn, established village health clubs (VHCs) in the 14 districts where the project has been implemented.

The initial purpose of VHCs was to spread health messages and provide community-based primary healthcare, but in practice, they developed into groups that focus on resolving many community issues. When the project began, the VHCs looked to childhood illnesses, such as malaria, pneumonia and diarrhoea, as well as boosted uptake of antenatal care services. They have now evolved into an effectiveool that uses health as a gateway to broader empowerment, helping communities to realise their potential to contribute collectively to addressing and solving various day-to-day issues that arise.

Fred Rwaboona, Community Chairperson, from Kitenguleillage has seen the benefits of VHCs in his own community. He says:

“The village health club brings the community together as they have weekly meetings. This helps them do work as a team so that tasks that would have been done by one person in a week, can be done as a team and solved in a day.”

Village health teams have given village communities a platform to take charge of issues in their own communities. There are many examples of how village health team members have mobilised the community to work on different issues. Karugaba Agnes, nurse and VHT Coordinator in Nyankwanzi Subcounty, explains about how she has seen village health clubs help communities:

“Depending on the problems each village has, we teach them to handle the most urgent and biggest problem first as a community.

“I had Kyarugangma village, and when they had the meeting and went through their problems, they decided their main problem was water. Their water source was very far, so they organised themselves and reconstructed a water source and a road, which helped the community. They built a new water source nearby to reduce the distance that children and mothers had to travel to fetch water.

“Another problem was that we had an old lady who had many vulnerable children, orphans. She didn’t have a latrine, so the kids were always sick, sick, sick. So the community helped her to construct a very nice pit latrine.”

Ali Karim Bagyanyi, a VHT in Kitengule Village, explains his village health club’s plans to pool donations from community members, allowing them to develop a community emergency fund.

“We have a small amount of savings – a thousand shillings each per week – which we give to a community member who has a problem, to solve that problem. We are planning to have a fund for emergency money that we all contribute to, so if someone needs to be referred to a health facility, but they cannot afford transport, they can use that fund to pay for transport.

“In years back, we have not had the medicines we have needed, so we have seen it as a problem, so in the future if that happens and we have a case, we will use that VHC fund to pay for medicine.“

The introduction of village health clubs in the region by the project has eased the work of VHTs, giving them a platform to communicate essential community health messages, like net use, without needing to go to individual households. Village-owned clubs have provided a base for communities to continue enjoy the iCCM MaCS project gains and sustain them by themselves, even as the project has drawn to a close.

Watch our new film on the iCCM MaCS project below to learn more:

Mozambique: The behaviour changing power of radio

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Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Ismael Janato is a presenter and technician at Ngauma community radio, Niassa Province, and Jonas Ali Mussa, director of the community radio on the Island of Mozambique. The Ngauma district, located in the midwest of Niassa Province, near the border with Malawi, has an estimated population of 86,000. The Island of Mozambique is part of Nampula Province with a population of about 53,000 inhabitants.

Despite the enormous distance separating Ismael and Jonas – over 700km – both have the same mission: to discuss the prevention of malaria on their community radio programmes.

Radio is recognised as the ‘African media’ for its broad accessibility and its ability to transcend cost barriers, geographical barriers and low levels of literacy, supporting listeners as they negotiate the challenges of everyday life. The Malaria Prevention and Control Project in Mozambique, implemented by Malaria Consortium in the provinces of Nampula and Niassa, has established partnerships with community radio networks to develop and transmit quality messages and programmes in local languages, promoting essential malaria prevention and treatment behaviours.

Ismael Janato from the Ngauma community radio talks about his experience with the activities:

“For the past three years, I have been managing the project activities. We received audio announcements on malaria, its transmission, signs and symptoms, the use of mosquito nets and the importance of seeking treatment. As a presenter, my job was to translate the spots into the local language, to broadcast the messages every 15 minutes, and to animate public debates live in the communities.”

Often malaria symptoms are not recognised, yet rapid and appropriate diagnosis and treatment of malaria are extremely important for reducing morbidity and mortality. Ensuring population access to essential information can substantially increase the effectiveness of existing interventions for malaria prevention.

Ismael explains that he gained knowledge about malaria through his participation in the training provided by Malaria Consortium, and thus developed the ability to discuss these issues properly. Besides broadcasting the spots, Ngauma’s community radio produces interactive programmes with the public through phone-in discussions on malaria issues and interviews with health technicians. Ismael continues, “With the work we do we have noticed changes in people’s behaviour regarding the use of mosquito nets, better hygiene at home, and there are more people who, when ill, go to the health centre and do not go to traditional practitioners anymore.”

Jonas Ali from the community radio of Mozambique Island also reports an improvement in the correct use of mosquito nets and reduction of malaria cases in the communities.

“With the work we have done, we have been able to see that there is a reduction in the use of mosquito nets for fishing and that fishing communities use the nets more responsibly. People are using the mosquito net correctly, malaria cases are also decreasing thanks to better knowledge of the consequences of malaria.”

Indeed, monitoring data and testimonies indicate an increase in knowledge about malaria and some behavioural changes in the project areas. These developments are likely to be the result of a number of complex factors and combined interventions of the Ministry of Health and its partners. The results of the Malaria Prevention and Control Project indicate that the significant expansion of intensive awareness raising, education and mobilisation activities combined with the mass distribution of long-lasting insecticidal nets may have contributed to this positive development.

Goncalves Bacar, Training Officer at Malaria Consortium Niassa, underlines that “the use of a combination of reliable sources of information – community structures, schools and radios – to disseminate harmonised messages at community level was certainly key.”

This story is part of a broader project documentation exercise; to read more and other lessons learnt, click here.

Leadership makes the difference in defeating malaria

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Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Nacala-Porto, on the northern coast of Mozambique, is the deepest natural harbour on the east coast of Africa. It serves as a terminal for the rail link to landlocked Malawi. Many goods transit through this district on their way to Malawi and other parts of southern Africa. The town is also known for its beaches and diving; this may be the district’s best known feature. What is less well known is the strong leadership within the District Health Service where there is an exceptional team dedicated to defeating malaria and saving lives.

The Nacala-Porto District Health Services were among the pioneers in the implementation of the Malaria Prevention and Control Project in 2011.  Malaria Consortium’s role, as one of the implementing partners for the project, was to support 17 districts of Nampula Province until 2017.

The main objective of the project was to contribute to the reduction of malaria through a combination of interventions aimed at improving malaria knowledge among the population and promoting the adoption of good practices in relation to malaria prevention and treatment at community level.

Successful implementation of this project required strong coordination between the district government and Malaria Consortium, health facilities and communities, as well as with schools and community radios. The excellent leadership of the Nacala-Porto District Health Services represented best practice in managing the partnership, including integrating the Project Field Officer into the district team, in line with the collaboration and coordination approach sought by the project implementers.

Janete Chau is the District Health Director at Nacala Porto. She is as charming and friendly as she is professionally demanding and rigorous, and she has embraced the project and managed to develop an effective partnership approach. It is for these qualities that she was awarded the title of ‘best district director of the province’ by the Nampula Provincial Health Directorate in October 2017.

“The Malaria Consortium Field Officer was actually working under our responsibility. He had to share his work plans and get involved in all the activities, and we had regular review meetings to look at the malaria situation here in the district. …My main role was to monitor and control project activities, see what was being done at district level, know where the activities were being done and what impact the project was having. ”

Janete Chau, District Health Director in Nacala Porto, Mozambique

The District Health Services’ team and Malaria Consortium worked together to map out community structure such as community health committees and local organisations, select and train them, and implement communication interventions towards behaviour change at community level. According to Ms Chau, malaria prevention activities carried out by community volunteers have contributed to increasing knowledge about malaria, care seeking and reducing malaria deaths in the area.

“People have gained knowledge about malaria, they now know how to describe it. They realise that malaria comes from the mosquito and that they breed in stagnant water. They now know they should go to the health centre if they present any malaria signs and symptoms and this has helped us to reduce malaria deaths.”

These efforts to promote good malaria prevention and treatment practices at the population level have also been accompanied by improved diagnosis and treatment of malaria patients at the health facilities level, as Ms Chau explains. “As an institution, through this project we became more aware that malaria is a serious problem and that we must keep it under control. It must be discussed. Our clinicians are more aware that they should not simply attribute malaria based on symptoms, but that we need to test for confirmation of malaria.”

These efforts are already starting to pay off but need to be maintained to achieve long-term impact. Nacala Porto’s team remains committed and motivated: “Every health professional is psychologically prepared to continue doing everything the project was doing so that one day malaria will be out of Mozambique.”

This story is part of a broader project documentation exercise; to read more and other lessons learned, click here.

Saving lives and transforming communities in rural Nigeria

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Originally published on Medium

Lessons from the field

In the village of Njediko in Nigeria, Kadigiti Mohammad gently calms her young son, who has a high fever. Her son is being seen by the village community health worker, who confirms it is malaria. He is given medicine before mother and child are sent back home.

I met Kadigiti on a recent visit to Njediko where Malaria Consortium is supporting the Rapid Access Expansion (RAcE) programme in Nigeria. She was worried for her child, but assured that he would recover because he was able to get medication quickly.

It was during this visit when I saw what receiving immediate access to care meant for mothers like Kadigiti and how this transformed the communities they live in.

Reaching the most remote populations

The RAcE programme was launched in Nigeria in 2013, pioneering the implementation of integrated community case management (iCCM) in the country. iCCM is now being scaled-up to increase healthcare access through trained community health workers who can treat pneumonia, diarrhoea, malaria and malnutrition among children at community level.

In Niger State, Malaria Consortium is implementing iCCM in underserved communities in six local government areas. The two communities that I visited, Njediko and Etsu Gudu, were among some of the hardest-to-reach.

The walk downhill to the village of Etsu Gudu (left) / A river blocks the road to a remote community in the local government area of Rafi (right)

 

The journey into these communities involved a two hour drive from the capital of Niger State. The roads were mostly rough and occasionally blocked by small rivers. Another hour travelling along narrow dirt roads led into the communities. Come nightfall, the roads were pitch black.

I thought of Kadigiti having to carry her sick child in these conditions. It was clear that urgent action was needed to reach out to populations who cannot easily access a health centre.

Bringing healthcare closer to the home

Typically, in many remote communities in rural Nigeria, access to healthcare is made difficult as there are no nearby health centres.

Mothers would carry their sick child, often on foot, to the closest health centre which can be miles away and can sometimes take days. During the rainy months, the roads and footpaths can become impassable. Sometimes, upon reaching the health centre, medicines may not be readily available.

One mother who lost a child from malaria said, “if we had immediate access to care and medicine then, my child could have had a chance to survive”.

Such was the challenge mothers faced in Njediko and Etsu Gudu until iCCM was introduced. Today, mothers like Kadigiti no longer need to travel far. Instead, they can immediately take their sick child to a community health worker.

This means that unnecessary deaths are prevented, as children can be treated for pneumonia, diarrhoea and malaria right in their village.

Empowering communities

Community health workers are trained, supervised and equipped to provide free and timely treatment of malaria, pneumonia and diarrhoea. And because they are selected by their own community and live in the community they serve, they have become a valuable resource in remote and rural villages that otherwise have no means of accessing healthcare.

The community health workers I met were hardworking, proud of what they do, and deeply committed to the health of their people.

In Ndejiku and Etsu Gudu, village leaders and parents talked about how their community health workers helped improve the health of their children and how they no longer face the burden of the cost of healthcare and making the long journey to a hospital.

Across the community, this appreciation is shown in extraordinary ways.

“When I am treating children all day, the people bring me firewood and help me with the farming,” says Miriam, community health worker in Etsu Gudu.

“The community raised money collectively to build me a house, so I can continue doing my work,” says Muhammed, the community health worker in Njediko.

Miriam Mohammed, community health worker in Etsu Gudu prepares to test a young child for pneunonia using a respiratory rate timer (left) / Community health worker Mohammed Jiya stands in front of the house his community built for him in Njediko (right)

An effective and sustainable solution

In Niger state, results from the RAcE programme show that iCCM is an effective and sustainable approach to decreasing childhood mortality.* At community-level, one way for iCCM to become sustainable is community support for community health workers.

In Njediko and Etsu Gudu, I saw evidence of all these. I saw progress in reduced child deaths, as a result of access to life-saving health services in rural and remote areas.

But I also saw people owning their own health, community leaders advocating for the health of their people, and communities coming together to sustain the health services they now have.

The community of Njediko, where child deaths have significantly reduced since the introduction of iCCM

Portia Reyes is Publications Manager at Malaria Consortium. She recently visited communities in Niger state as part of a project to document the impact of iCCM. Malaria Consortium is working with the Ministry of Health and partners in Niger state to implement iCCM through the RAcE programme.

View our latest film, Saving lives and transforming communities, to learn more about our work on iCCM in Nigeria

The Rapid Access Expansion (RAcE) programme is funded by the Government of Canada through the World Health Organization to support the scale-up of iCCM in five malaria-endemic countries in sub-Saharan Africa.

More from Malaria Consortium

Malaria Consortium in Nigeria: reflections from a new Trustee

Malaria’s Consortium’s approach to community delivery

Malaria Consortium’s RaCE project: Implementing iCCM in Nigeria

Chimbonila: A district committed to fighting malaria

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The district of Chimbonila in Niassa province has a high malaria burden, which can be difficult to manage for a number of reasons.

The district itself is very large. It is located about 30 km from the city of Lichinga and covers an area of ​​8,075 km² with a population of about 87,000 inhabitants. Despite its proximity to the capital city, however, Chimbonila has the typical challenges of the other districts of Niassa: poor roads and high poverty rates, as well as a remote, mostly rural population which relies on an economy based on agriculture (population density of 15.8 inhabitants per km²).

Since 2014, the National Malaria Control Programme of the Ministry of Health and its partners (World Vision and Malaria Consortium) with funding from the Global Fund, has been implementing the Malaria Prevention and Control Project within local communities.

The project in Chimbonila District involves 22 community structures, 428 volunteers, 23 schools, 72 teachers, 14 health facilities and one community radio in a continuous effort coordinated by Health, Women and Social District Services to ensure the prevention and treatment of malaria.

Since 2014, Gabriela Nazaré has been the Malaria Consortium Field Officer assigned to this district. Her role is to coordinate the activities of all project stakeholders, ranging from health facilities to community volunteers.

Every day Gabriela visits the villages by motorcycle, ensuring that all project’s participants have the necessary tools for mobilisation work and that they have a correct understanding about how to prevent malaria and that they know what to do in the occurrence of malaria symptoms.

After three years as Field Officer, Gabriela feels integrated in the community: “I was born and raised in Lichinga. I moved to Chimbonila to work and today I feel at home. Despite the complexity of the job, knowing that I am contributing to the improvement of people’s living conditions is rewarding.”

Rain or shine, her activities don’t stop. Owing to the large number of beneficiaries, her schedule is very busy. “I try to spend as much time as possible in each community. My routine in each village is to visit schools, health facilities and work with community structures.

“Over the years we have been establishing work mechanisms and today it is amazing how communities are engaged in the project in such a way that they now bring in their own initiatives and suggestions for new approaches.”

 

Text and photos: Xavier Machiana

World Malaria Day 2017: Mozambique’s Niassa province launches mass net distribution

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World Malaria Day ceremony, Metangula Village

To mark World Malaria Day on April 25, Niassa province Mozambique held an official launch ceremony for a campaign to distribute long lasting insecticidal nets across the provinces 15 districts. The ceremony was held at the distribution headquarters in Metangula and was attended by district leaders, provincial leaders, civil society organisations and community members.

Activities included the laying of flowers at Heroes’ Square and a march with different civil society players, delivering speeches to spread the message of malaria prevention.

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District administrator Sara Mustafa

The formal distribution of the mosquito nets was initiated by the district administrator, Sara Mustafa, who stressed the importance of using them correctly to a large audience of community members.

Her statements were echoed by Dr. Inês Juleca from the National Malaria Programme of the Ministry of Health, who said, “The distribution campaign needs to be complemented by ongoing mobilisation and awareness raising activities at the local level so it is effective and reduces malaria among the communities the campaign was created to reach.”

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Monica Saíde, mother of five, collecting her mosquito net

Malaria is a major public health issue in Niassa Province, with over 700,000 registered malaria cases in 2016 giving an incidence rate of 407 cases per 1,000 people. The campaign, run by the Ministry of Health and Malaria Consortium, is part of an effort to reduce this burden through wide spread national and local level programmes.

 

The campaign is part of a national initiative led by the Ministry of Health with the support of the Malaria Prevention and Control Project, a project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as the main partner,  Food for the Hungry, Community Development Foundation and Malaria Consortium.

Text and photos: Xavier Machiana

Technology to save children’s lives

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Mobile health coverage is expanding in Mozambique. Following a successful pilot in a few districts of Inhambane province, the Ministry of Health, in partnership with Malaria Consortium and UNICEF, will scale up an innovative mobile health (mHealth) app-based system to all districts of Inhambane and to the northern province of Cabo Delgado, as part of our new upSCALE project.

In recent years, mobile Health, or mHealth, has emerged as an important innovation with tremendous potential to strengthen health systems in low- and middle-income settings. It achieves this by providing better access to knowledge and information by improving service delivery and reducing response time to crises. Mobile phone coverage is growing rapidly across the world, both in terms of network coverage and the number of users.

upSCALE aims to expand an mHealth system using an interactive mobile android application.  The app provides step-by-step guidance to community health workers, or agentes polivalentes elementares (APEs), in running procedures for diagnosing and treating common diseases that are addressed at community level by trained workers. In September 2016, 258 community health workers were trained on this mHealth system.

Salvador was the oldest among the trainees, demonstrating that age is not a limitation for successfully using modern mobile technology.

“My namAPE SALVADOR PICTe is Salvador Waciquetane. I am 56 years old and I have been doing community health work for many years in Inhambane’s Vilankulo district, community of Chelene. I started to volunteer as a health activist in 2006 and, at the time, I was giving health talks in my community about good health practices. In 2010, I was the one chosen by my community to participate in the training to become an APE, as part of the Ministry of Health revitalisation programme. From the training until today, the people of my community are counting on me to provide basic health care.

Each year, I participate in various refresher trainings; in September, I received a call from my supervisor, Valério, requesting me to come to the district headquarters to participate in a CommCare training, which involves using a mobile phone in my work as an APE. After the phone call, I was curious and I began to imagine that the cell phone would be the same as the ones I saw during the general population census, when I had to map the population of my community. But when the training started, I was very impressed. I saw that the phone is equipped to help me do much more than I had imagined: family planning activities, follow-ups of pregnant women, diagnosing and treating diseases such as malaria, diarrhoea and pneumonia, as well as tracking people with tuberculosis and HIV to refer them to the health centre. I am very happy because this phone is going to help me a lot in my work, as it is easy and it guides the APE well.

“When I return I will meet with my community leader to ask him to arrange a meeting so I can present my new device to the community members. I think they will react very well and this will increase the trust they have. Any novelty is a challenge at first, but as time goes by I will find my way and I will grow to understand it.”

 

By Éder Ismael Zerefos

MC in the news: Dengue

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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.”

Preventing malaria transmission through the cross border surveillance

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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