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Researchers from the Mahidol Oxford Tropical Medicine Research Unit at NDM, in a recent study, analysed the uptake of community health workers' services and the effectiveness of this programme in controlling and eliminating malaria.

To counter the threat posed by worsening artemisinin and partner drug resistance in Plasmodium falciparum malaria, the Greater Mekong Subregion countries have agreed to aim for the elimination of falciparum malaria by 2025. This goal has been elusive as malaria is now prevalent predominantly in remote and difficult to access communities, mainly in Myanmar, which has the majority of all the reported malaria cases in the region. Access to health care services for these communities is very difficult.

There was a rapid, sustained reduction in the incidence of both falciparum and vivax malaria. Falciparum malaria was eliminated within 6 years, and vivax malaria reduced markedly, say researchers in a study published in PLoS Medicine.

Medical Action Myanmar introduced 172 community health workers (CHWs), serving a population of 236,340 people, to deliver early diagnosis and treatment for malaria in hard-to-reach communities in Mon State, East Myanmar. Within 2 years of starting the programme malaria incidence had decreased substantially, and other causes of febrile illness were now dominating consultations. An integrated basic healthcare package was then added to address this changing pattern of needs.

Professor Frank Smithuis, Professor of Tropical Medicine and Head of the Myanmar-Oxford Clinical Research Unit (MOCRU), based at Yangon said: ‘Eliminating falciparum malaria has been our objective all along, so achieving that goal is an enormous achievement. That it has been done in six years is exceptional. This project showed that malaria elimination is achievable by simply providing community-based diagnosis and treatment. Adding basic health services with the malaria services was key in getting local populations with a fever to visit the CHW, where they could be tested for malaria, and treated if necessary or receive treatment for other diseases if the malaria test was negative.’

Other currently recommended malaria elimination approaches, including weekly fever screening and frequent entomological surveys are expensive, labour-intensive, and they are generally not feasible in these remote areas. This study suggests that they are not needed.

Professor Arjen Dondorp, Deputy Director of MORU and the Regional Artemisinin-resistance Initiative coordinator and Head of Malaria said: ‘This is a great example of an effective malaria elimination programme, one that should be an example for the entire GMS – and beyond. It’s cost-effective, realistic, and aligned with GMS conditions. With an uncertain financial future for regional malaria control activities, it is important to identify the core malaria control elements that must be sustained to complete elimination.’

Professor Sir Nicholas White, Professor of Tropical Medicine at NDM’s Centre for Tropical Medicine and Global Health and co-author of the study said: ‘No one thought that falciparum malaria elimination could be achieved in Eastern Myanmar, but this and other recent studies showed that it could be done, and they emphasise the critical value of supporting community health workers to diagnose and treat malaria. In low transmission settings such as Mon state this was enough to eliminate falciparum malaria in six years’.

This malaria research was funded by the Wellcome Trust (UK), and supported by Access to Health Fund, The Global Fund to fight AIDS, Tuberculosis and Malaria and Medical Action Myanmar (MAM).