Yangon, Myanmar - “Scaling up insecticide-treated clothing and targeting migrant and mobile populations in Myanmar is crucial. Treated clothing partly fills a gap in personal protection of vulnerable populations who are exposed to bites during the night when malaria mosquitoes are most active. The method could help contribute to the success of the expanded malaria control and elimination programme in Myanmar.”
Dr Jeffrey Hii, Malaria Consortium’s regional Senior Vector Control Specialist, was addressing an audience of health and other government sectors, public and private sector representatives, donors and non-governmental organisations at a workshop in Yangon today on the role that could be played by insecticide-treated clothing in contributing to malaria elimination in Myanmar. Dr Hii’s assertion follows the findings of a recent study by Malaria Consortium.
According to the World Health Organization, Myanmar had 152,195 reported malaria cases in 2015. The actual number is likely to be much higher. However, recent scale-up in prevention and control by the National Malaria Control Programme (NMCP) has helped achieve a significant decline, and malaria in Myanmar is now largely concentrated among high-risk and hard-to-reach groups. These include forest-dwellers, people residing in forest-fringe villages, armed forces, and migrants working in logging or mining in forested areas, palm oil and rubber plantations or construction sites. They are exposed to mosquitoes through high-risk night-time work in the forest or on construction sites, and have limited access to health services.
The insecticide-treated clothing (ITC) project was set up to determine the acceptability of ITC for malaria prevention among the key risk group of rubber tappers. Malaria Consortium is the first organisation to reach out to this key risk group in rural malaria-endemic areas to understand their perceptions of ITC. Previously the use of ITC has mostly been limited to military and recreational markets and has not reached the community level.
The project fills a gap in personal protection. Mosquitoes that transmit malaria act in various ways. Some rest and feed indoors, while others are more active outdoors. Current malaria control methods mostly focus on mosquitoes that feed indoors through indoor residual spraying of houses and the use of mosquito nets. People who are outdoors during the night are therefore not covered by typical measures and lack personal protection. “Addressing this residual transmission of malaria is increasingly important as Myanmar responds to drug resistance and moves towards malaria elimination,” explained Dr Hii.
The study showed that the level of ITC acceptability was high: most participants wore the distributed clothing regularly and scored the clothing highly on a number of characteristics, including reduced mosquito bites, appearance, ease-of-use, durability, ability to clean, texture and colour.
Wearing ITC can also reduce the number of working days lost, increase economic productivity, protect against other vector-borne diseases and reduce the socio-economic burden on households.
"In the Greater Mekong Subregion there is a high number of malaria cases concentrated in border areas. Drug resistant malaria is also emerging regionally,” stated Joint Secretary General Daw Khine Khine Nwe from the Republic of the Union of Myanmar Federation of Chambers of Commerce & Industry. “We want people to come work in Myanmar. When investments and trade flow in, the economy will grow and more jobs will be created. Looking after workers’ health will become pertinent.”
The project was funded by UK aid from the UK government and the President’s Malaria Initiative (Centers for Disease Control, USAID). Through the Department of Medical Research and the NMCP, the Myanmar Ministry of Health were collaborators on the project.
Hosted by Malaria Consortium in partnership with Insect Shield and the Myanmar Health and Development Consortium, the workshop formulated recommendations on how to drive the agenda to eliminate malaria forward. As proved in this study, operational research on ITC needs to be high on the agenda and it is now included in Myanmar’s draft National Strategic Plan for 2016-2020. Further research is needed to carry out specific community assessments to understand their perceptions and preferences and raising community awareness prior to distribution. Moreover, optimal treatment methods and technological applications for each setting and occupation should be explored. Once policymakers become aware of these and other recommendations, they can make appropriate decisions to rid the country of malaria for good.