The incidence of malaria has continued to drop dramatically in remote rural villages in Myanmar after community workers trained only to detect and treat malaria began providing basic health care as well as malaria services, researchers affiliated with Oxford University have said.

Adding health services to malaria control has helped the villagers access better care and improved malaria services – paving the way for malaria elimination.

Villages where trained community health workers provided malaria diagnosis and treatment enjoyed big falls in two strains – a 70% decline in Plasmodium falciparum and a 64% drop in Plasmodium vivax –malaria incidence for each year of operation, the scientists say in a study published in BMC Medicine.

But as malaria fell so did the number of people being screened. When community health workers began offering a broader package of health services – including for tuberculosis (TB), respiratory tract infections, malnutrition and diarrhoea, while continuing to screen for malaria – health improved and so did malaria control.

“To maintain effective malaria control in hard-to-reach areas village health workers were trained both to screen and treat malaria and to handle other common health care needs,” said study author Oxford Prof Frank Smithuis, director of the Myanmar Oxford Clinical Research Unit (MOCRU) and the NGO Medical Action Myanmar (MAM) in Yangon.

“This significantly reduced malaria transmission and kept patients coming in to be screened for malaria, which is essential if we are to eliminate malaria in Myanmar,” Prof Smithuis explained.

The study did a retrospective analysis of over half a million malaria rapid diagnostic tests conducted between 2011 and 2016 by 1,335 community health workers supported by MAM in cooperation with the Myanmar Department of Health.

These results have important implications for Myanmar and other Southeast Asian countries racing to eliminate malaria.

‘Basic health services boost fight against malaria’

“This study demonstrates that to eliminate malaria in hard to reach areas, community health workers’ networks should be offering malaria screening and treatment and basic health care,” said study contributor Mahidol and Oxford University Prof Sir Nicholas White.

“Training health workers to just screen for malaria is not sustainable. These community health workers must offer a package for common health problems. This will sustain the popularity of the community health workers’ services, benefit the accessibility of health services for the community and ensure that malaria is eliminated and then stays eliminated.”

Dr Alistair McLean, lead author of the study, said: “Many of the people we studied lived in communities with no medical care of any kind other than informal local healthcare providers [quacks] and so remote that it could take several days of hard travel to reach them.

“Offering people in hard-to-reach communities a package of basic quality health services is essential to prevent malaria resurgence.”

The project was funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria, the 3 Millennium Development Goal Fund, Planet Wheeler Foundation, Kadoorie Charitable Foundation, DAK Foundation, and The Wellcome Trust (UK).

mam_image_04
Health workers take blood from a woman in Myanmar. Photo: MAM

Medical Action Myanmar supports a network of 750 community health workers to provide basic health care in the most remote villages in north and eastern Myanmar – Kachin, Karen, Kayah, Mon states and Tanintharyi division.

“Due to the remoteness of the villages and the small size of the villages, this project is very labor intensive. A lot of effort has to be made to reach relatively small groups of people. However, these villagers need it most. They never got any form of healthcare services so far and this is the first time that they have a trained healthcare worker with reliable tests and treatment in their villages,” the MAM website explains.

MOCRU is the Myanmar unit of the Mahidol Oxford Tropical Medicine Research Unit (MORU), a tropical health network funded by Wellcome and based in Bangkok.