Cambodia's countermalaria strategy shows good results (News Feature)

By Robert Carmichael Jul 6, 2010, 13:32 GMT

Phnom Penh - The Cambodian government and the World Health Organization (WHO) on Tuesday announced promising results in their battle against a resistant strain of malaria around the western town of Pailin.

Blood tests on nearly 2,800 villagers from seven villages in the area - one of the most malarious in the country - have shown 35 people were infected with malaria.

The bulk of those who tested positive were carrying the vivax parasite, which causes a recurrent malaria and is generally not fatal. More importantly, just two tested positive for falciparum, the most deadly malarial parasite.

The news is a significant boost in efforts to contain the spread of a potentially devastating strain of falciparum malaria that emerged three years ago.

That strain showed resistance to artemisinin, a compound that the WHO said is not only 'the most effective treatment against malaria' but is also largely responsible for the successes in fighting malaria over the past decade.

While vivax has shown no resistance to artemisinin, the falciparum strain from western Cambodia has.

The WHO's team leader on malaria in Cambodia, Dr Steven Bjorge, said scientists were worried this resistant falciparum strain could escape from western Cambodia and add to the million deaths a year malaria causes, mostly in Africa.

To counter its spread, the Cambodian and Thai governments joined forces with the WHO to mount a campaign that involved distributing more than half a million mosquito nets, clamping down on substandard and fake drugs, and educating villagers on how to avoid malaria.

The results announced Tuesday seem to vindicate that multimillion-dollar, two-year effort.

Dr Nguon Sokomar, who heads the testing team at Cambodia's National Centre for Malaria Control, said another essential component of the strategy was training two people in every village to provide a basic malaria test and give free medicines to those who test positive.

He pointed out that the stakes are high.

'Historically, Pailin is the area where we find the resistant strain, so it is a concern for us - not only Cambodia, but a global concern - to stop the spread of that resistant strain,' he said.

'We have to find as much as possible all falciparum parasites within the area and treat them, cure them completely, so they would not have the chance to continue spreading the disease,' he said.

Dr Nguon Sokomar said his teams would now move on to another 13 villages and continue testing for malaria but the results to date led him to believe that few would test positive for falciparum.

Bjorge said Tuesday's results chimed with two other data sets that also indicated a sharp decline in the number of malaria infections around Pailin.

The first source is records from health clinics and hospitals, which showed fewer malaria cases and no deaths from the disease in the Pailin district.

The second source is the village malaria workers who collect and test blood samples. They, too, have noted few cases of malaria and most were vivax malaria.

'And thirdly, we have these mass blood surveys taking place right now in the most malarious areas, according to records from 2009, and those villages also are showing very, very low incidence rates and mostly vivax malaria,' Bjorge said.

Although the battle is far from won, it is this combination of good results that has health workers optimistic that they have the upper hand.

Their campaign is to be strengthened when a 102-million-dollar containment programme is rolled out across the country this year using cash from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Bjorge said he was 'cautiously optimistic' that it could mark the turning point in Cambodia's battle against malaria, but he also pointed out that this approach is not much different to that of 30 years ago.

'It's just a matter of is the country at the right stage to move forward with control and even elimination of malaria,' he said. 'That's the critical factor.'

Among the requirements are a certain level of infrastructure and staffing.

'Other countries have gotten to this stage at an earlier date, like Thailand and Malaysia, for example,' he said. 'Now, it's Cambodia's turn.'