Expanding malaria diagnosis and treatment in Lao PDR: lessons learned from a public–private mix initiative

Simmalavong, Nouannipha; Phommixay, Sengkham; Kongmanivong, Phoudaliphone; Sichanthongthip, Odai; Hongvangthong, B.; Gopinath, Deyer; Sintasath, David

doi:10.1186/s12936-017-2104-5

Cited by 21 publications

(30 citation statements)

References 7 publications

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“…The present study has some limitations. First, because the survey period did not coincide with the high transmission season (often between June and August) [21], the present study could underestimate the prevalence of malaria infection. Second, the participation rate was 75.4%, suggesting that there is a possibility of selection bias.…”

Section: Discussionmentioning

confidence: 99%

Malaria among foreign migrant workers in Savannakhet Province, Lao People’s Democratic Republic

et al. 2019

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BackgroundAlthough mobile and migrant populations are considered an important group in malaria elimination settings, there is currently a lack of understanding about foreign migrant workers in the Lao People’s Democratic Republic (Lao PDR). The present study aimed to document the migration characteristics, positive rate of malaria infection, and preventive and treatment-seeking behavior for malaria among foreign migrant workers in the malaria-endemic districts of Savannakhet province, Lao PDR.MethodsA community-based survey was undertaken in four districts of Savannakhet province between February and June, 2015. Questionnaire-based interviews and blood examinations, including rapid diagnostic tests and PCR assays, were conducted with 391 migrant workers who were registered at local police departments.ResultsMost of the study participants were men (75.7%) and Vietnamese (92.6%). The median age (interquartile range) was 31 (25 to 41) years old. Most common occupation was factory worker (47.6%), followed by trader/shopkeeper (21.5%) and plantation worker/farmer (16.4%). The median length of stay (interquartile range) in the districts was 405 (183 to 1207) days. The majority of the participants (85.9%) had not worked in a province other than the study province, nor had the majority (92.6%) worked in a foreign country other than the Lao PDR. Although most of the participants (62.7%) reportedly used a bed net daily, these nets were mostly conventional untreated ones. No one tested positive for malaria. However, 10.0% of the participants reported a malaria-like illness episode that had occurred in the Lao PDR. The most common measure taken for the episode was to visit a hospital/health center in the Lao PDR, followed by conducting self-medication alone. Forty-one participants reported an experience of working in the forest while living in the Lao PDR.ConclusionsForeign migrant workers who are registered at local police departments are unlikely to play a major role in maintaining local transmissions and spreading drug-resistant malaria in the study province. However, some of them were involved in forest-related activities, suggesting that these workers are potentially at risk of malaria. The Lao National Malaria Control Program should educate foreign migrant workers about the risk of malaria when living in Lao PDR.

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Section: Discussionmentioning

confidence: 99%

Malaria among foreign migrant workers in Savannakhet Province, Lao People’s Democratic Republic

et al. 2019

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“…education, agriculture, environment). The experience in Laos suggests extending diagnosis and treatment coverage to all febrile patients in endemic areas while leveraging support from the private sector [ 13 ]. Although this study did not assess asymptomatic patients or submicroscopic malaria, they are acknowledged as a challenge and a critical reservoir that is sustaining malaria transmission, as pointed out by Stresman et al [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Challenges for the diagnosis and treatment of malaria in low transmission settings in San Lorenzo, Esmeraldas, Ecuador

Mosquera-Romero

Zuluaga-Idárraga

Tobón-Castaño

2018

Malar J

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BackgroundEcuador is on the verge of eliminating malaria according to the World Health Organization criteria. Nevertheless, active transmission foci still persist in the country, and these represent an important challenge for achieving the objectives set out. Diagnosis and treatment are a mainstay in the control and elimination of this disease. This study aimed to explore the barriers hindering the implementation of malaria diagnosis and treatment strategies in a focus of active transmission in the San Lorenzo canton, Ecuador.MethodsUsing a convergent mixed methods design during 2017, the researchers assessed the physical and human resources of the services network at the primary level of care along with the quality assurance activities, patient access to healthcare services and perceptions regarding the care provided to patients with malaria.ResultsThe programme’s administrative transition from the National Service of Vector-borne Diseases to the Ministry of Public Health is perceived from the interviewed participants to have weakened the diagnosis network established in recent years. A mean of 6.4 ± 0.88 months was found for anti-malarial medication shortage at the primary level of care. Likewise, there was high healthcare staff turnover (permanence, Me = 7 months; IQR = 5–16) and a deficit of general knowledge on the disease among the entirety of healthcare staff, as only 29% of physicians were aware of the correct first-line treatment for malaria by Plasmodium falciparum and Plasmodium vivax. It was evidenced that 95.7% of patients were hospitalized to receive anti-malarial treatment. Both patients and healthcare staff considered the area to be difficult to reach due to its geography and the presence of groups outside the law. They also identified the lack of personnel and microscopy posts in this border area as the main barrier.ConclusionThe network of diagnostic services for malaria is weak in San Lorenzo, and socio-economic, political and historical factors hinder the implementation of the universal malaria elimination strategy based on diagnosis and treatment.

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“…Artemether–lumefantrine, one of the artemisinin-based combinations, has been used in Laos as the first-line treatment regimen for P. falciparum since 2005 and for P. vivax since 2011 [17]. Through the support of the Global Fund, the ACT is prescribed to malaria patients free of charge at public healthcare facilities, and some private clinics and pharmacies after a confirmation of Plasmodium infection by microscopy or RDTs, which is termed “Private–Public Mix programme” [18]. Therefore, currently, the ACT is not available without proper diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneous distribution of k13 mutations in Plasmodium falciparum in Laos

Iwagami

Nakatsu

Khattignavong

et al. 2018

Malar J

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BackgroundThe emergence and transnational spread of artemisinin resistance in Plasmodium falciparum in the Greater Mekong Sub-region (GMS) is a serious threat to malaria elimination in the region and could present a threat to malaria control in Africa. Recently, the Lao Government adopted the goal of malaria elimination by 2030, for which monitoring of artemisinin-resistant malaria within the country is indispensable. This study’s objectives were to assess the distribution of k13 mutations in Laos.MethodsPlasmodium falciparum isolates (n = 1151) were collected from five southern provinces in Laos between 2015 and 2016, and three isolates from the northernmost province bordering China in 2017. Polymorphisms of the k13 gene and two flanking regions were analysed to estimate relationship among the isolates.ResultsIn the five southern provinces, overall 55.5% of the isolates possessed artemisinin-resistant mutations of the k13 gene (C580Y, P574L, R539T, Y493H). The C580Y was the predominant mutation (87.2%). The frequencies of the k13 mutations were heterogeneous in the five southern provinces, but with a clear tendency showing the highest frequency in the south (72.5%) and to a lower degree when moving northward (28.0%). The three isolates from the Lao–Chinese border also possessed the C580Y mutation. Analysis of the flanking loci demonstrated that these three isolates were genetically very close to resistant strains originating from western Cambodia.ConclusionsArtemisinin resistance was observed to be rapidly increasing and spreading northwards through Laos and has now reached the Chinese border. The Lao and Chinese governments, as well as the international community, should make dedicated efforts to contain the spread of k13 mutations within Laos and in the GMS.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2625-6) contains supplementary material, which is available to authorized users.

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Expanding malaria diagnosis and treatment in Lao PDR: lessons learned from a public–private mix initiative

Cited by 21 publications

References 7 publications

Malaria among foreign migrant workers in Savannakhet Province, Lao People’s Democratic Republic

Malaria among foreign migrant workers in Savannakhet Province, Lao People’s Democratic Republic

Challenges for the diagnosis and treatment of malaria in low transmission settings in San Lorenzo, Esmeraldas, Ecuador

Heterogeneous distribution of k13 mutations in Plasmodium falciparum in Laos

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