Abstract
BackgroundIn Savannakhet province, Laos and Quang Tri province, Vietnam, malaria is still an important health problem and most cases are found in the mountainous, forested border areas where ethnic minority groups live. The objectives of this study were to obtain a better joint understanding of the malaria situation along the border and, on the basis of that, improve malaria control methods through better cooperation between the two countries.MethodsFourteen villages in Savannakhet and 22 villages in Quang Tri were randomly selected within 5 km from the border where a blood survey for microscopic diagnosis (n = 1256 and n = 1803, respectively), household interviews (n = 400, both sides) and vector surveys were conducted between August and October 2010. Satellite images were used to examine the forest density around the study villages.ResultsMalaria prevalence was significantly higher in Laos (5.2%) than in Vietnam (1.8%) and many other differences were found over the short distance across the border. Bed net coverage was high (> 90%) in both Laos and Vietnam but, while in Laos more than 60% of the nets were long-lasting insecticide-treated, Vietnam used indoor residual spraying in this area and the nets were untreated. Anopheles mosquitoes were more abundant in Laos than in Vietnam, especially many Anopheles dirus were captured in indoor light traps while none were collected in Vietnam. The forest cover was higher around the Lao than the Vietnamese villages. After this study routine exchange of malaria surveillance data was institutionalized and for the first time indoor residual spraying was applied in some Lao villages.ConclusionsThe abundance of indoor-collected An. dirus on the Laos side raises doubts about the effectiveness of a sole reliance on long-lasting insecticide-treated nets in this area. Next to strengthening the early detection, correct diagnosis and prompt, adequate treatment of malaria infections, it is recommended to test focal indoor residual spraying and the promotion of insect repellent use in the early evening as additional vector interventions. Conducting joint malaria surveys by staff of two countries proved to be effective in stimulating better collaboration and improve cross-border malaria control.
Highlights
In Savannakhet province, Laos and Quang Tri province, Vietnam, malaria is still an important health problem and most cases are found in the mountainous, forested border areas where ethnic minority groups live
With respect to malaria prevention measures, this study showed that the possession of bed nets by households was high on both sides, but that the coverage of insecticide-treated nets was much higher in Laos than in Vietnam
The presence of An. dirus, which is known to be a highly efficient malaria vector, is likely to cause the higher prevalence of malaria in Laos compared with Vietnam
Summary
In Savannakhet province, Laos and Quang Tri province, Vietnam, malaria is still an important health problem and most cases are found in the mountainous, forested border areas where ethnic minority groups live. Malaria control strategies and policies as well as the quality and management of the health care systems and conventions in data collection may differ across national borders, making cross-border collaboration difficult. One such area, with a clear trend towards greater infection and malaria morbidity near the international border, is on the border between Savannakhet province of Laos and Quang Tri province of Vietnam. Laos relies mostly on rapid diagnostic tests (RDT) while Vietnam uses microscopy as a rule In both Vietnam and Laos the policy is that malaria patients do not need to pay for anti-malarial medicines when seeking care from the public health sector.
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