Malaria elimination in Lao PDR: the challenges associated with population mobility

Abstract

Although the Lao People’s Democratic Republic (Lao PDR) is comparatively small landlocked country with patterns of both in- and out-migration, its human migration situation has been poorly studied. This is despite all of the country’s 18 provinces sharing both official and unofficial border checkpoints with neighboring countries. Economic reforms in the last decade have seen a gradual increase in the promotion of foreign investment, and main towns and transportation networks have been expanding thus offering new opportunities for livelihoods and economic activities.In the last decade, there has also been a significant reduction of reported malaria cases in Lao PDR and while this is an important prerequisite for eliminating malaria in the country, malaria outbreaks reported in the last four years suggest that population mobility, particularly in the south, is an important factor challenging current control efforts.Bolder investment in social sector spending should be geared towards improving health service provision and utilization, ensuring equitable access to primary health care (including malaria) through efforts to achieve universal health coverage targets. This should be extended to populations that are mobile and migrants. The local government plays a critical role in supporting policy and enforcement issues related to private sector project development in the provinces. Cross-border initiatives with neighboring countries, especially in terms of data sharing, surveillance, and response, is essential. Mechanisms to engage the private sector, especially the informal private sector, needs to be explored within the context of existing regulations and laws. Existing and new interventions for outdoor transmission of malaria, especially in forest settings, for high-risk groups including short- and long-term forest workers and their families, mobile and migrant populations, as well as the military must be combined into integrated packages with innovative delivery mechanisms through social marketing approaches. This should happen at multiple points in the mobility pathway and involve the private sector rather than being fully reliant on the national malaria vertical programThis article based on the review of existing literature from abstracts and full texts, includes published, peer-reviewed English language literature sourced through PubMed and grey literature sources through Google and Google Scholar. The review included also case reports, sector reports, conference proceedings, research reports, epidemiology studies, qualitative studies, and census reports in both Lao and English languages. The authors used the search terms: malaria and mobile populations, malaria control program and elimination, health system performance, malaria outbreak, Lao PDR; and included articles published until June 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0283-5) contains supplementary material, which is available to authorized users.

New insights into malaria vector bionomics in Lao PDR: a nationwide entomology survey

“…In total, sixty-three percent of the vector were collected outdoors which is in adequacy with the results of Malaria transmission in the Mekong region is currently concentrated in forested and rural areas and along national borders from where the disease is likely to spread to other areas due to the movement of population groups (WHO 2019, Kounnavong et al, 2017;Inthavong et al, 2017). A part of the transmission is taking place outdoors in the villages as previously mentioned, but the remaining transmission occurs outside of the villages, especially in the forest.…”

“…Despite a continued decline of malaria cases (by 74%) and deaths (by 94%) in the last decade in the Greater Mekong Subregion (GMS), malaria remains a major public health problem impacting on the health and lives of a large proportion of people particularly in remote areas and concentrated along international borders (Hii et al, 2018;Cui et al, 2018. In Laos, malaria transmission is heterogeneous, with more intense transmission in forested areas particularly in the southern part of the country (Kounnavong et al 2017) where more than 207,000 cases were reported in 2018. The country has implemented a nation-wide malaria control program since 1992, and the current strategies emphasize the promotion of long-lasting insecticide treated bed nets (LLINs), early diagnosis by microscopic examination and rapid diagnostic tests, and prompt treatment with artemisinin-based combination therapy (ACT).…”

Barriers to health care services in migrants and potential strategies to improve accessibility: A qualitative analysis

“…The broader social environment in which a migrant lives, works and interacts is a significant determinant of health and health inequities in the Western Pacific Region. In the Lao People's Democratic Republic, for example, malaria is most prevalent in the southern parts of the country, where many communities are engaged in forest-related work (83). Unregulated deforestation, land clearing for development projects and changes in climate conditions have all been linked to an increased risk of exposure (83).…”

“…In the Lao People's Democratic Republic, for example, malaria is most prevalent in the southern parts of the country, where many communities are engaged in forest-related work (83). Unregulated deforestation, land clearing for development projects and changes in climate conditions have all been linked to an increased risk of exposure (83). A report of an outbreak in 2011 suggested internal and cross-border migrants accounted for 70% of confirmed malaria cases in the Lao People's Democratic Republic (83).…”

“…Unregulated deforestation, land clearing for development projects and changes in climate conditions have all been linked to an increased risk of exposure (83). A report of an outbreak in 2011 suggested internal and cross-border migrants accounted for 70% of confirmed malaria cases in the Lao People's Democratic Republic (83). In Viet Nam and Cambodia, living and working in forest areas has been recognized as an important risk factor for exposure to malaria (8,12,84,85,86).…”