Abstract
BackgroundIllegal gold miners in French Guiana, a French overseas territory (‘département’) located in Amazonia, often carry malaria parasites (up to 46.8%). While the Guiana Shield Region aims at malaria elimination, the high prevalence of Plasmodium in this hard-to-reach population in conjunction with frequent incorrect use of artemisinin-based anti-malarials could favour the emergence of resistant parasites. Due to geographical and regulatory issues in French Guiana, usual malaria control strategies cannot be implemented in this particular context. Therefore, new strategies targeting this specific population in the forest are required.MethodsNumerous discussions among health institutions and scientific partners from French Guiana, Brazil and Suriname have led to an innovative project based on the distribution of kits for self-diagnosis and self-treatment of Plasmodium infections. The kit-distribution will be implemented at “resting sites”, which are areas across the border of French Guiana regularly frequented by gold miners. The main objective is to increase the appropriate use and complete malaria treatment after a positive malaria diagnosis with a rapid test, which will be evaluated with before-and-after cross-sectional studies. Monitoring indicators will be collected from health mediators at the time of kit distribution and during subsequent visits, and from illegal gold miners themselves, through a smartphone application. The project funding is multisource, including Ministries of Health of the three countries, WHO/PAHO, and the European Union.ResultsThis project will start in April 2018 as a 18 month pilot study led by the Clinical Investigation Centre of Cayenne. Results should be available at the end of 2019.DiscussionThis innovative approach may have several limitations which should be taken into account, as potential side effects, kit misuse or resale, declarative main criteria, or no Plasmodium vivax curative treatment. Close monitoring is thus needed.ConclusionsThis project may be the best available solution to a specific and important public health challenge in the Guiana Shield. If the use of self-diagnosis and self-treatment approach is effective, this strategy could be sustained by health institutions in the region.
Highlights
Illegal gold miners in French Guiana, a French overseas territory (‘département’) located in Amazo‐ nia, often carry malaria parasites
This is the case for the malaria situation in French Guiana, a French territory located in the Amazonian forest between Suriname and Brazil
A long process of political discussions Several strategies have been discussed over the past few years at different levels: (1) local, with the Regional Health Agency (RHA), regional state representatives, researchers, French military health service and health care structures; (2) national, with the Ministry of Health, the Ministry of Foreign Affairs, Home Affairs, Ministry of Overseas Territories, Ministry of defense; (3) international, with representatives of Brazil and Suriname, World/Pan-American Health Organization (WHO, PAHO), and the Global Fund
Summary
Illegal gold miners in French Guiana, a French overseas territory (‘département’) located in Amazo‐ nia, often carry malaria parasites (up to 46.8%). Context of malaria in illegal gold mines in French Guiana Exceptional situations call for exceptional responses. This is the case for the malaria situation in French Guiana, a French territory located in the Amazonian forest between Suriname and Brazil. A study showed that 52% of gold miners self-medicated during their last malaria crisis, using under-the-counter drugs and with poor adherence (40%) [5]. The quantity of primaquine is not mentioned on the packaging, which does not respect pharmaceutical standards [6] This drug is not registered with a stringent medicine regulatory authority or the WHO prequalified programme, it is illegal in French Guiana and neighbouring countries
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