PILOTING MALARIA POST MODEL IN MALARIA PREVENTION AND CONTROL

(MPC) FOR MOBILE AND MIGRANT POPULATION (MMP)

Nguyễn Quý Anh National Institute of Malariology

Parasitology and Entomology (NIMPE)

1. Introduction • Vietnam is one of the countries which has successful malaria

prevention and control (MPC) program, malaria has been significantly decreased

• Malaria patients are mainly concentrated in provinces with a large number of mobile population, people sleeping on “ray”, seasonal and cross-border migrants

• The community healthcare network, especially the village health workers are insufficient and weak in malaria active areas, it’s hard to reach the migrants

• Interventions (access, active case detection, treatment, disease management, BCC) are needed among MMP for reduction of malaria and prevention of parasite and anti-drug parasite transmission

1. Introduction

• In 2014, WHO introduced the idea of piloting the malaria post model to enhance access to and provision of healthcare services for MMP

• This model was applied in 4 provinces: – Quảng Nam: conducted by the NIMPE – Bình Phước: conducted by the IMPE in HCM city – Đăk Nông and Gia Lai: conducted by the IMPE in

Quy Nhơn • Period: 1 year (depending on each IMPE)

2. Objectives

1. Build the “case detection, management and treatment” post model.

2. Strengthen the MPC measures for MMP. 3. Reduce malaria incidence among MMP.

3. Implementation

Post selection criteria - Villages with many malaria cases (Region 4, 5) - Villages with a large number of people working in

forest and sleeping on “ray” - Villages with seasonal migration - Villages with forest gates or areas where people

pass by on the way to forest.

3. Implementation

Staff selection criteria: - Age: 20-60 - Graduates from medical schools without job yet - Retired health workers - Agree to participate - Must be present daily at malaria post

4. Tasks of malaria post staff • MMP management • MPC propaganda • Case detection, diagnosis, treatment and

management • Involvement in the MPC activities in locality • Monthly, weekly reporting

4.1. MMP management

- Listing the village households - Monitoring the number of workers coming to the

village for long-term, short-term work - Monitoring the number of outbound migrants Working in forest Working on “ray” Sleeping on “ray” Working in other areas

Recording and weekly reporting

4.2. MPC propaganda - Involve in all village meetings for MPC

propaganda - Visit households for propaganda - Meet household owner and members for

propaganda - Meet people when working on “ray”: find out

whether they sleep there or not? whether they bring mosquito net or have one on “ray”?

- Distribute propaganda leaflets and posters - Encourage people to use mosquito net when

sleeping on “ray” or in the forest

4.3. Case detection, diagnosis, treatment and management

• Detect fever cases in the village • Take blood sample for testing (keep dry & send to

Commune health center (CHC) for identification of malaria parasite)

• Perform quick test • Provide treatment if results are positive Report to CHC, DHC when detecting patient Provide daily medicine (give medicine to patients at their

home or invite them to come for taking medicine) Investigate the case and fill in report form Check and monitor patient’s family members

• Record to monitor and weekly report to CHC

4.4. Reporting

• Report immediately to CHC, DHC whenever a case is detected

• Send microscopic blood sample to CHC • Weekly report to CHC • Involve in monthly CHC inter-departmental meeting • Fill in the report template and send to CHC/DHC

5. Equipment & materials

• Healthcare bag: each post is equipped with a healthcare bag, stethoscope, thermometer, clamp, cotton pack, etc.

• Microscopy slide, needle, alcohol (National) • Quick test (QTC-RAI project) • Communication materials (RAI project) • Long Lasting Insecticidal Nets - LLINs (awaiting

WHO mosquito nets)

OUTCOMES Site selection: Trà Cang, Trà Leng and Trà Dơn

• Trà Cang: Village No. 1, 5 and 7

• Trà Dơn: Village 2 • Trà Leng: Village 1, 2 and

3 Most people in the commune have malaria parasites Most of cases are people working in forest and sleeping on “ray” (80-90%)

Commune name Parasite in 2013

% parasite in village/commune

Trà Cang 311 Village 1 55 17,68 Village 5 113 36,33 Village 7 83 26,69 Trà Dơn 149 Village 2 104 69,80 Trà Leng 139 Village 1 39 28,06 Village 2 42 30.22 Village 3 44 31.65

OUTCOMES Staff selection - Nam Tra My DHC makes recruitment decision and signs labor contracts - List of staff in malaria posts is as follows:

No Full name Location Age Gender Education

1 Hồ Tấn Mạnh Village 5, Trà Cang 22 Male Pharmacist

2 Nguyễn T Thúy Ly Village 7, Trà Cang 22 Female Pharmacist

3 Trần Văn Hình Village 1, Trà Cang 24 Male Health worker

4 Nguyễn Hoàng Yến Village 1, Trà Leng 23 Female Pharmacist

5 Trần T Thủy Quyên Village 2, Trà Leng 21 Female Nurse 6 Hồ Văn Tiến Village 3, Trà Leng 22 Male Nurse

7 Đỗ Đình Duẩn Village 2, Trà Dơn 24 Male Nurse

OUTCOMES Healthcare bag provision

OUTCOMES Training: - Treatment and diagnosis

guideline - Microscopy slide blood

sample taking method - Quick test method - Report template - Tasks of malaria post staff - Implementation at all

levels.

OUTCOMES Post activity implementation - Household survey - MPC propaganda - Taking household blood sample slide - Quick test for people with fever - Mosquito net distribution - Monthly report

OUTCOMES Household monitoring

Commune Location

No. of househol

ds

No. of family

members

Number of persons working in forest and sleeping on “ray”

Feb Mar Apr May

Trà Leng Village 1 122 485 449 478 478 385

Trà Leng Village 2 67 315 174 176 176 174

Trà Leng Village 3 205 912 828 929 1001 637

Trà Cang Village 3 186 796 812 834 837 983

Trà Cang Village 5 131 640 546 526 561 525

Trà Cang Village 7 108 491 409 314 586 431

OUTCOME Number of households communicated

Commune Location Feb Mar Apr May

Trà Leng Village 1 5 11 7 8 Trà Leng Village 2 4 5 6 5 Trà Leng Village 3 9 9 11 11 Trà Cang Village 3 2 2 2 2 Trà Cang Village 5 3 4 4 6 Trà Cang Village 7 2 3 3 2

Total 25 34 33 34

OUTCOMES Active case detection

Commune Location Feb Mar Apr May Total

Slide Test Slide Test Slide Test Slide Test Slide Test Trà

Leng Village 1 55 2 32 2 48 2 0 0 135 6

Trà Leng Village 2

6 1 49 2 24 1 32 3 111 7 Trà

Leng Village 3 75 0 57 0 35 2 56 0 223 2

Trà Cang Village 3

0 28 0 28 0 38 0 15 0 109 Trà

Cang Village 5 16 0 19 0 23 0 33 0 91 0

Trà Cang Village 7

42 0 37 0 23 0 43 0 145 0 Total 194 31 194 32 153 43 164 18 705 124

OUTCOMES Malaria status in communes after 4 months of monitoring

Commune Slide Test Case Parasite

Trà Leng 938 340 0 0

Trà Cang 869 409 3 3 P.v

(Hospital)

OUTCOMES Contribution of malaria posts in 4 month case detection

0

100

200

300

400

500

600

700

800

900

1000

Trà Leng Điểm SR Trà Cang Điểm SR

LamTest

OUTCOMES Monitoring at post - Central level: 1 time - Provincial level: 2 times - District level: 5 times - Commune level: monthly

No Malaria post Number of tests Positive (+) %

1 B Du. Ia Mla 41 5 12.20

2 Boi Jik. Ia Mla 39 0 0.00

3 B. Ma Nhe B Đất Bằng 37 12 32.43

4 B. Ma Nhe A. Đất Bằng 36 7 19.44

5 B. 12 households, Ia R Sai 77 2 2.60

6 B. E Nan Ia R Sai 71 3 4.23

7 B H Lang. Chư R Căm 36 0 0.00

8 B Du. Chư R Căm 54 5 9.26

Total 391 34 8.70

Malaria case detection in Krong Pa Gia Lai post

(8 malaria posts conducted by Quy Nhom IPME)

Month Test + Sleeping on “ray” + Working in

forest

Informal

migrants

+

12/2014 38 2 5.26 22 2 8 0 8 0

1/2015 83 0 0 49 0 23 0 11 0

2/2015 102 1 0.98 46 1 34 0 22 0

3/2015 109 2 1.83 43 2 54 0 12 0

4/2015 86 2 2.33 52 1 21 1 13 0

5/2015 110 2 1.82 91 2 7 0 12 0

528 9 1.70 303 8 147 1 78 0

Malaria case detection in Tuy Đức, Đăk Nông post

(8 malaria posts conducted by Quy Nhom IPME)

Active malaria case detection in Binh Phuoc

(9 malaria posts conducted by HCMC IPME)

Content

Đăk Ơ commune (3 posts)

Bù Gia Mập

commune (2 posts)

Đăk Nhau commune (4 posts)

Total (9 posts)

Number of quick test/slide 30/30 69/75 197/226 296/331

Number of positive case - P.falciparum - P.vivax - PH

9 3 5 1

14 7 5 2

21 9

12 0

44 19 22

3

6. Dicussion • Quang Nam is a province with a low number of MMP,

most migrants are seasonal, mobile, working in forest and sleeping on “ray”

• Malaria in the first 5 months of 2015 decreased considerably compared to the previous period.

• No communication materials • No WHO supported mosquito nets for malaria posts Severely affect evaluation of malaria post

performance

Advantages

• Provincial MPC center understands issues and gives timely instructions to DHC

• DHC enthusiastically implements: selecting staff, signing contracts, making payment.

• Quick test and microscopic slide are provided from QTC & National level

• Anti-malaria medicines (arterakin, cloroquin, primaquin) are also provided to posts from the national level

Disadvantages • All staff are new graduates and have no experience

of working with the community • Short duration training, not enough time to convey

information. • Weak communication skills • Post staff is NOT local people • Language barrier

Disadvantages • Working place is not suitable • Not being present 24/7 at post • Wide operation area (village-wide) • Local people have not been aware of post staff’s role • Small budget (not including social insurance, ect.) • Change of staff at post (turnover rate)

Conclussion 1. Malaria posts initially support CHC in active case

management 2. Proactively monitoring the number of people

working in forest and sleeping on “ray” every month

3. Not being able to manage malaria cases (communes do not manage malaria cases and do not require the post staff to monitor)

4. MPC communication is mainly direct communication

5. Support CHC to deliver and insecticide mosquito nets

Thank you!