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Myanmar has made significant progress in reducing malaria morbidity and mortality. Plasmodium vivax (P.v) malaria is prevalent in 291 out of 330 townships in Myanmar. The annual parasite index (API) of malaria cases has decreased significantly in Myanmar, with a reduction from 10.00 to 1.46 cases per 1,000 population between 2009 and 2018, marking an 85.40% decline. Malaria detection and management services are available at public health facilities and village levels, administered by volunteers. There is a notable variance in malaria incidence between the western and eastern regions of Myanmar. Transitioning from malaria control to elimination poses challenges. This study aims to assess the gaps in National Malaria Control Programme (NMCP) services at community, township, and national levels. It will provide action plans and policy recommendations based on the analysis of malaria incidence and prevalence in hotspot areas of Rakhine State.
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The epidemiological analysis relies on factors such as disease transmission, susceptibility, health services, and population behavior. The malaria surveillance database provides insights into the population’s mobility, mortality trends, and the number of tested and positive malaria cases from 2015 to 2020, as shown in the Table 1 below.
Year Population ABER API Tested Positive 2015 210,072 8.36 13.34 17,569 2,804 2016 215,294 6.27 8.85 13,519 1,906 2017 220,431 11.28 8.26 24,869 1,821 2018 222,412 8.58 6.06 19,089 1,359 2019 228,191 7.40 3.46 16,900 790 2020 230,605 5.42 2.25 12,366 514 Abbreviation: ABER=annual blood examination rate; API=annual parasite index. Table 1. Malaria prevalence in Minbya Township (2015–2020), Rakhine State.
The population of Minbya Township fluctuates between 210,072 and 230,605 individuals, with a mean of 221,167.5 due to population growth. Since 2017, the NMCP has enacted a strategy to enhance testing capacity and expand the involvement of VHVs. The API exceeded 1 per 1,000 people in seven townships in Rakhine state, falling short of the national strategic plan goal to reduce API to less than 1 per 1,000 by 2020. This collaboration has enabled the scaling up of capacity building in data management and reporting systems through the use of the malaria surveillance database at the township level. 3,857 local malaria volunteers have been trained since 2013 to support malaria elimination efforts. The NMCP collaborates with local partners to provide malaria prevention and control activities. Since 2017, 201 local malaria volunteers have been recruited and trained in malaria diagnosis and treatment guidelines as part of the malaria elimination plan. Among the VHVs, URC consistently provides 74 volunteers, comprising 112 males and 82 females. Two-thirds of the VHVs have obtained secondary education.
Table 2 displays the distribution of malaria species in Minbya Township from 2015 to 2020. Notably, there were no reported outbreaks of P.v during this period. Data from the malaria epidemiology monitoring dashboard of Minbya Township indicates that Plasmodium vivax species accounted for 55 percent, Plasmodium falciparum species for 42 percent, and the remaining cases involved mixed species.
Year % of Plasmodium falciparum % of Plasmodium vivax % of Mixed 2015 26 69 5 2016 21 75 4 2017 55 42 3 2018 43 55 2 2019 62 34 4 2020 43 52 5 Table 2. Percentage of malaria species in Minbya Township from 2015 to 2020.
Figure 1 illustrates the comparison of malaria testing capacity in Minbya Township between 2019 and 2020. The capacity was assessed by basic health staff at healthcare centers like RHCs and sub-centers, excluding data from local malaria volunteers. In 2019, 2,119 patients were tested by basic health staff. From January to August, testing capacity was consistent, but it decreased from September to December. In 2020, 1,785 patients were tested, with reduced testing capacity from January to May, followed by an increase from May to December due to a seasonal disease prevention approach. This study indicates that the health care management by basic health staff has maintained an effective and timely reporting system. To prevent underreporting of malaria cases in 2020, the Basic Health Staff (BHS) conducted malaria testing alongside fever surveillance for coronavirus disease 2019 (COVID-19) (4). At the village level, detection capacity primarily relies on local community volunteers who provide integrated malaria services in their own and neighboring villages. They promptly test villagers with suspected COVID-19 symptoms like fever following the NMCP guidelines (5).
Figure 2 displays the number of malaria cases tested and confirmed in Minbya Township from 2019 to 2020 across six rural health centers (RHCs). Min Ywar RHC and Pan Maung RHC exhibit the highest prevalence of malaria due to factors such as geographical location and the increased vulnerability of certain populations, like forest workers and farmers, to malaria.
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