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    Lessons Learned from Cambodia Useful for Region

    Schoolgirls Malaria Knowledge Helps Family Avoid Getting Sick

    Cambodia Task Force Meeting in progress. Pix by WHO

    Seub Saren who educates her family in Pailin about malaria. Pix by WHO/Sonny Krishnan

    CONTAINMENT is published by WHO Cambodias Malaria Containment Project. For enquiries please contact Dr. Najibullah Habib, Malaria Containment Project Manager, World Health Organization

    Cambodia, 177-179 St. Pasteur (51), PO Box 1217, Phnom Penh OR e-mail: habibna@wpro.who.int

    January-March 2011

    There are lessons to be learned by other countries in the Greater Mekong Sub-region as they push for containment and eventual elimination of artemisinin-resistant malaria.

    Malaria is spread by female nail mosquitoes during nighttime.

    of drug-resistant malaria on the Thai-Cambodian border

    Quarterly Newsletter of the Strategy for the Containment of Artemisinin-Tolerant Malaria Parasites in South-East Asia Project

    This was the message put for-ward by the Secretary of State for the Ministry of Health, His Ex-cellency Chou Yin Sim, when he opened the third Cambodian Task Force meeting on December 3, 2010 at the Phnom Penh Hotel.

    The National Task Force of Cambodia provides national su-pervision to the Containment Project funded by the Bill & Melin-da Gates Foundation, he told the meeting attended by WHO, the National Malaria Control Centre (CNM), and their working partners.

    Elimination of resistant malaria parasites will remain out of reach unless we pay adequate attention to the delivery of health services, including good surveillance of re-mote areas and migrant popula-tions. This cannot be done with-out the strengthening of health systems, stressed H.E. Yin Sim.

    H.E. Yin Sim pointed out the strategies that have been effec-tive in the Containment Project.

    The strategies that have been found to be effective in the Contain-ment Project have been the provi-sion of free diagnosis and treatment by village malaria workers and the promotion of the use of LLINs (long-lasting insecticide treated nets) by

    populations at risk of malaria, es-pecially those who stay overnight in the forest, he told the meeting.Another important strategy was the ban on monotherapies that H.E. Yin Sim said had proven to be effective in addressing the spread of multi-drug resistant falciparum malaria.

    The Ministry of Health is com-mitted to eliminating monothera-pies and perpetrators will be sub-jected to administrative measures

    and legal ac-tion, he said.

    In Cambodia, a ban on mon-otherapies to-gether with the Public-Private Mix initiative have achieved almost zero p r e v a l e n c e of artemisinin m o n o t h e r a -pies as well

    as a significant reduction in fake and substandard drugs on the market, said H.E. Yin Sim. I do hope this positive exam-ple and the lessons learned can be replicated in other countries in the region, he emphasized.The US$22.5-million ContainmentProject funded by the Bill & MelindaGates Foundation involves both Cambodia and Thailand. There are respective National Task

    Forces in both Cambodia and Thailand overseeing the project.

    The international level oversight is through a panel of international malaria experts in the International Task Force. So far the Internation-al Task Force has held twom e e t -ings the first in Phnom Penh in 2009 and the other inHanoi in February 2010.

    The ultimate goal of the project is to contain the artemisinin-resist-ant malaria by removing selection pressure and reducing and ulti-mately eliminating falciparum ma-laria through a series of strategies, said Dr. Najibullah Habib, WHOs

    Malaria Containment Project Manager.Stressed Dr. Habib: If this resist-ance to artesunate spreads from this area to other regions or other countries, it constitutes not only a regional but a global public health issue. Therefore its an issue that

    goes beyond just Pailin or Western Cambodia or Zone One or Zone Two it goes regionally and globally.

    Dr. Habib explained to the TaskForce Meeting the zoning of theContainment Project. Zone 1 in-volves not just Western Cambodia but also some areas in Thailand as well. And thats where we have our elimination strategy to eliminate

    artemisin-resistant malaria. Zone 2 is a buffer zone to make sure the disease does not spread beyond the focal area. For Zone 3, we have now good news that Global Fund Round 9 activities are geared to-wards control in those areas includ-

    ing the whole of Cambodia.

    In order to reduce selection pressure, it is imperative to use ar-temisinin-derived drugs with otherpartner drugs in the treatment offalciparum malaria.In Zone 1 it isdihydroartemisinin-piperaquine (DHA-P); in Zone 2 it is artesuna-te plus mefloquine (A and M) and atovaquone proguanil in Thai-land, Dr. Habib pointed out.

    ....from page 1

    To avoid getting malaria, people should protect themselves from beingbitten by female nail mosquitoes bysleeping in a mosquito net. Peoplewho have malaria must take proper me-dicines as prescribed by a physician.

    This is Lesson 11 at Grade 5 in Cam-bodia which young Cambodian stude-nts are taught at school as part of the curriculum for their Applied Sciencestudy.

    However, like other lessons about such diseases as typhoid and den-gue fevers, malaria is not an inter-esting lesson for many students who

    live in non-malaria infested areas. But for 14-year-old Seub Saren

    who has attended a school in Siem-reap Provinces Srey Snom District, she finds this knowledge about malar-ia particularly interesting and useful for her family when they moved to Pailin, where malaria posed a serious health threat to migrant workers like her family.

    After she returned from school, she told the family how to protect our-selves from malaria, says her father, Se Seub, who is now living and working in Pailin with his wife and four children.

    Seub says he was sick with ma-laria when he came to work in Pailin three years ago and that he had to go back to Siem Reap for treatment.

    However, he says he has neverbeen sick with the disease duringthe last few years after learning toprotect himself and his family as hisdaughter taught them.

    Seub Saren says she knows very well about malaria from the lessons she has learned at school, which was why she could educate her family how to prevent the disease.

    Like Seub Saren, other fifth graders in Pailin can also easily score a good mark for the lesson about malaria.

    Nuon Phon, a Grade 5 teacher at Pailins Phoum Thmei Primary School, says his students are enthu-siastic to learn about malaria, be-cause Pailin is a malaria infested area, so they are very interested.

    Unlike many other lessons about Science that is complicated and dif-ficult to learn, Nuon Phon says teaching malaria as a subject in Pai-lin is very practical and relevant.

    I asked them where they lived; they said they lived in the mountainous are-as, says Phon as he explains the meth-odology he uses to teach his students.

    Then, I asked Have you had malaria before? They said Yes, hecontinues. So, do you want to havemalaria? they said No.

    What should you do? he asks and he would prod the students withmore follow-up questions.

    Moeun Chhean Nariddh

    In order to reduce selection pressure, it is imperative to use artemisinin-derived drugs with other partner drugs in the treatment of falciparum malaria.

  • 72

    Law Enforcers to Get Tough on Counterfeit Medicines Reaching Out To Migrant Workers At The Thai Border

    Dr. Doung Socheat, Director of CNM, addressing the workshop. Pix by WHO/Sonny Krishnan Workers from Cambodia making their way to Thailand at the border crossing in Sampov Loun. Pix by WHO/Sonny KrishnanCambodian malaria experts and senior police officers have

    agreed that better cooperation and concerted efforts are needed to effectively combat malaria as well as curb the sale and smuggling of counterfeit and substandard drugs in Cambodia.

    The Ministry of Health has done a lot of work, but it would not be able to do anything without the coopera-tion of the police, explained Gen-eral Ben Rath, Vice Commissioner for Phnom Penh Municipal Police, during a workshop on Strengthen-ing Law Enforcement for Investiga-tion of Counterfeit Medicines and Artemisinin Monotherapy, which was held in Siem Reap Province from November 10 to 12, 2010.

    The National Centre for Para-sitology, Entomology and Malaria Control or CNM that receives tech-nical assistance from WHO, with support from the Global Fund and in cooperation with the Ministry of Interior organized the three-day training of trainers workshop for 55 senior police officers from 24 cities and provinces across the country.

    The workshop was to improve the investigative skills of the Cambodian senior police officers to identify and crackdown on fake and substand-ard malaria drugs that have been smuggled and sold in the country.

    Besides the cooperation between CNM and the police, General Ben said it was important for the Minis-

    try of Health to encourage local au-thorities to provide more support to the crackdown on counterfeit and substandard drugs in Cambodia, particularly in the rural areas.

    Weve done a lot in Phnom Penh, but not much in the provinces where people are more vulnerable due to the lack of knowledge, he said.

    Malaria parasites in the Asso-ciation of Southeast Asian Nations region or ASEAN are now resistant to almost all anti-malarial drugs, with the exception of drug combi-nations containing derivatives of ar-temisinin (artemisinin-based com-bination therapy, or ACT). Because artemisinin derivatives are remark-ably rapid in their anti-m

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