Thailand-Malaria Situation in SEAR Countries

Malaria Situation in SEAR Countries

Thailand

Bangladesh

Malaria has been a leading cause of morbidity and mortality in Thailand for many decades. Around 32 million people are at risk of malaria. All the four types of malaria are prevalent in the country. The border areas with Myanmar and Cambodia are worst affected. Non-immune migrant workers occupied with gem mining in forests, logging, agriculture and construction are the most vulnerable and most affected. High mobility of migrant and cross-border population also encourages the spread of multi-drug resistant of P. falciparum malaria from the Thai-Cambodia border to the Thai-Myanmar border, which poses more difficulties. Malaria epidemics occurred periodically in high risk areas, especially along the international borders of Thailand and Myanmar and Thailand and Cambodia. The intensive malaria control programme in Thailand during the past five

Fig. 1: Trends of Malaria Cases in Thailand, 1971-2010

Malaria Situation in Thailand, 2010 : At a Glance
Total population	: 63.80 million
Population in malarious areas	: 45.62 million
Number of Lab confirmed malaria cases	: 32,502
P. falciparum proportion	: 58.3%
Number of probable malaria cases	: 0
Number of deaths due to malaria	: 80 (Reported)
No. of ACT courses distributed	: 26,471
No. of first line treatment courses distributed	: 13,639
No of LLINs Distributed	:
No. of effective LLINs+ITNs (cumulative) availability	: 992,043
Population protected with ITNs	: 1.98 million
Population protected with IRS	: 568 799
Supported by Global Fund in Rounds 2 and 8

decades has resulted in considerable reduction in malaria incidence. Confirmed cases declined from 81692 in 2000 to 32 502 cases in 2010 showing a decrease of 61.2% where as the deaths have gone down from 625 to 80 registering a decrease of 87.2% (Fig. 1). P. falciparum proportions were around 50% of the confirmed cases. All reported cases are examined microscopically or by RDT. The main reason of decline in malaria deaths could be attributed to implementation of selective Indoor Residual spray and ITNs / LLINs as the main vector control measures employed by the country, in which more than 90% of the population at high risk of malaria is covered with either of preventive interventions(Fig. 2) and adaptation of ACT for Pf treatment (Fig.3). It is not out of place to mention that Thailand was the first country of the South Eastern Asia Region to adopt ACT. The total donor’s funding for malaria control has

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Fig2 : Cumulative availability of Effective LLINs /ITNs in Thailand,2005-2010	Fig3 : Trends of DIstribution of ACTs and Reported malaria Deaths in Thailand, 2005-2010

Increased from an average of US$ one million per year during 2004-2006 to US$ 7 million in 2009 and 3.3 million in 2010, mainly financed by the Global Fund (Fig. 4; the full government contribution specially at provincial level was not available despite of the its continued commitments. In 2009, the highest amount was spent on ITN (38.4%) followed by human resources and technical assistance (21.0%) and Monitoring and evaluation (11.2%) where as lowest amount was spent on diagnostics (0.3%), followed by infrastructure and equipments(0.6%) and insecticides and spray materials (0.7%) (Fig. 5) (2010 expenditure information is not available).

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Fig. 4: Availability of Funds by Source in Thailand, 2001-2010	Fig 5 :Details of Expenditure by Type in Thailand, 2009

Programme goals and targets

To reduce malaria morbidity and mortality until the disease is no longer a public health problem in the country.

Targets	Baseline data in 2005	2010
Reduction in malaria morbidity in population at risk of malaria	4.1/1000	<2 /1000
Reduction in hospital base severe malaria case fatality rate	NA.	< 15% by 2011
Control of malaria outbreaks at ward level	NA.	Within six weeks after detection
% of people at high risk of malaria sleeping under bednets	NA.	80% 2011
% of malaria cases confirmed by microscope and RDT	NA.	80% in 2011
% of public health facilities providing appropriate treatment	NA.	80% in 2011

Control strategy:

Early Diagnosis and Prompt Treatment

Effective Vector Prevention and Control

Effective IEC in high risk groups

Community Empowerment

Epidemic Preparedness and epidemic Control

Malaria Collaboration with neighboring countries

Human Resource Development e.g Training Network

Strengthen community participation in malaria control and prevention.

Building of malaria surveillance networking at periphery

Strengthening decentralization of malaria prevention and control to local organizations

Achievement and initiatives

Collaboration between the partners and stakeholders at all levels has been strengthened and the people and community empowered for malaria prevention and control.

The establishment of malaria posts in the remote areas and hard-to-reach villages has increased access to malaria early diagnosis and prompt effective treatment among vulnerable people.

Standard IEC materials have been developed.

The Malaria Early Detection System has been developed for monitoring malaria epidemics at the early stage.

Issues and challenges

Occurrence of multi-drug resistant P. falciparum

Scaling up the malaria control measures and effective interventions at all endemic villages focusing on both Thai and non-Thai population.

Capacity building of local health personnel in malaria prevention and control.

Problem of malaria control in the areas along the southern border provinces urgently

Best practices and success stories

Collaboration and partnership with all stakeholders at district, provincial and national levels including the community.

Establishment of malaria posts in remote and hard-to-reach villages.

Standard IEC materials in appropriate languages.

Malaria Early Warning System helped in responding to disease outbreaks in a timely manner.