Aggressive approaches in Cambodia and Lao PDR

  • Depending on foci classification, Cambodia employs synergistic combinations of interventions, including VMW/MMW deployment near the forest, LLIN mass campaigns, targeted drug administration (TDA), intermittent preventive treatment (IPT) and weekly door-to-door fever screening.

Aggressive interventions to vanquish P falciparum are being employed in Cambodia and Lao PDR. 

  • In Lao, aggressive strategies used in hotspot areas include TDA, IPT, door-to-door fever screening every two weeks, top-up LLIN distribution and targeted distribution of LLIHNs.
  • TDA is given to men aged 15-49 in Cambodia, who have the highest risk of malaria, and to men and women aged 7-49 in Lao.
  • Foci management also includes training of health workers, community engagement and social mobilization.

Multi-generational community engagement in thailand

  • Thailand’s national malaria program plans to target 360 schools in the highest burden villages to implement a ‘junior VHV approach’.
  • Teachers nominate students of ages 8-12 years with the potential to become junior VHVs (Village Health Volunteers).
  • Junior VHVs learn about the role of community health workers with integrated malaria elimination interventions, and are responsible for communicating malaria
    awareness to their peers, families and communities.
  • Teachers participate by encouraging and supervising students’ activities.

Testing new opportunities for p. vivax radical cure in cambodia

  • Operational research funded under RAI3E is testing and evaluating different new radical cure regimens, comparing the standard 14-day course of primaquine (PQ) (15mg) to a shortened 7-day course of PQ (30mg) and a single dose (300mg) of tafenoquine (TQ).
  • To be eligible for the trial, patients must not have G6PD deficiency and must not be pregnant or breastfeeding.
  • Patients are followed up on days 3 and 7, and monthly thereafter for a period of six months.
  • Outcome measures include the efficacy of RCT, including the rate and risk factors of recurrence, as well as the incidence of any adverse events such as haemolysis.
  • Pharmacokinetic and pharmacogenetic metrics are also included to better understand the factors underlying treatment efficacy.

Health and community systems strengthening

  • Engaging with communities is essential in the last mile of the fight for malaria elimination.
  • Health education interventions sensitise communities to the importance of using preventive tools and seeking testing.
  • RAI3E also champions community-led approaches by investing in the capacity building of local community-based organizations (CBOs).
  • With the continuing decline in malaria cases in the GMS, village and mobile malaria workers could deskill at malaria case management, and communities may be less likely to engage if the health workers do not also treat other health problems.

With the fight against malaria led by health workers from the very communities they serve, communities have increased trust in the programme and the motivation to act together to eliminate malaria. 

  • The region is therefore moving towards the integration of the community malaria worker role into broader community health platforms that provide a package of essential preventive, diagnostic and treatment services to their communities. Malaria surveillance systems are also being integrated with general health surveillance systems.
  • Health systems are the backbone of the fight against malaria. RAI3E invests in health systems by supporting the training of health workers, strengthening the linkages between public, private and not-for-profit health sectors, building fit-for-purpose health information systems that link to the community front-end through the enhanced use of technology (such as smartphones), and collaborating with partners to make supply chains more efficient and reliable.

Human rights and gender

  • RAI3E integrates human rights considerations in its programming through interventions specifically aimed at increasing access to malaria services for the most vulnerable populations, including migrants, refugees, ethnic minorities and rural and remote populations.

Gender is a major determinant of health and a gender lens is crucial in the design of malaria programs.

  • Although adult men represent the majority of malaria cases in the GMS, mostly due to labour in forest areas, both risk of disease exposure and barriers to accessing healthcare have gendered dimensions that affect the health and well-being of all individuals.
  • Responsive programming in RAI3E depends on gender equity and social inclusion at all decision making levels.
  • RAI3E partners have identified gender-related barriers as a key issue, and are taking positive steps to improve gender equity in leadership and at all levels of decision making. 
  • Gender affects the risk of exposure to malaria transmission

    • Men are more likely to work in forest or forest fringe areas, especially at peak biting times, and are more likely to sleep inside the forest.
    • Forest-goers, which are mostly adult men, generally have low bednet utilisation rates.
    • Women are at risk while preparing food, seeking water or carrying out agricultural work in the early evening hours.
    • Pregnant women have an elevated risk of developing severe falciparum malaria.
  • Gender influences access to healthcare

    • Women generally have less of their health needs met then men, despite a higher demand for healthcare.
    • Women generally have less control over the use and allocation of household resources.
    • For women with Pv infection, qualitative G6PD tests do not adequately assess hemolysis risk with radical cure treatment, leading to lower treatment rates among women.
    • Pregnant women face cultural limitations on mobility, particularly to public places like health facilities.
    • Men are more likely to migrate for work, with difficulties finding or being reached by health services in unfamiliar settings.