Malaria on the decline due to concerted awareness efforts

"Please sleep under the insecticide-treated nets," runs the message on a large banner erected for Malaria Day on 25 April. In Cambodia, that message is sinking in.

Malaria, one of the world's deadliest diseases, appears to be on the retreat in Cambodia as the number of infections and deaths due to the disease has decreased in recent years thanks to better health education and concerted efforts at mosquito net distribution and village-level treatment, officials said.

Duong Socheat, director of the National Centre for Parasitology, Entomology and Malaria Control, said 100,000 malaria cases were reported in 2006, falling to 59,000 in 2007. Although the downward trend is believed to be continuing, data for the first three months of this year are not yet available.

"There were 396 deaths [from malaria] in 2006 and 241 deaths in 2007," Socheat said, "so it decreased from 2.81 percent to 1.68 percent for every 100,000 people. This is a real success."

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Early intervention

Preventing malaria in its early stages and treating it rapidly is key to this success, according to health officials. Wide-scale distribution of insecticide-treated nets and providing awareness training to village volunteers on the frontlines in the battle against the disease have also been crucial.

Some 557,000 mosquito nets were distributed free in 2007, and in 2008, one million nets will be distributed to the most needy communities, Socheat said.

"Mosquito nets will reach [everyone] in 2010," he said. At present, only 54.2 percent of Cambodians have received them.

"Community-based participation is very crucial in combating malaria," Socheat said, adding that village health volunteers were trained to test blood for infection, make diagnoses and provide medication.

Awareness campaigns

For Malaria Day, provincial officials, villagers and students launched province-wide campaigns to raise awareness about the disease, he said. Such campaigns have been ongoing for some time: in 2004 a village health volunteers programme was launched and now reaches 100 villages in the provinces of Ratanakkiri, Kratie, Kampot and Koh kong.

Not only bed nets are distributed. People in remote areas who spend much of their time in forests foraging for food and hunting are most vulnerable to malaria. A discussion is under way about distributing hammocks that have treated nets attached for free or to sell them at extremely low prices.

Battambang Province provides an example of the successes and challenges in fighting malaria. Ouk Vithiea, communicable disease control unit manager in charge of malaria and dengue fever at Battambang's Provincial Health Department, said the province had experienced a significant decrease in malaria cases. Some 10,000 people in the province were infected in 2006, with 44 deaths, but in 2007 those figures dropped substantially to 600 cases with 25 deaths.

Vithiea said he remains concerned about those people living in forested areas of the province such as Samlot and Sampov Loun districts because they remain at high risk of contracting malaria.

In 2007, some 12,000 new mosquito nets were handed out to villagers and more than 20,000 nets were re-treated with insecticide, according to Vithiea. In 2008, an additional 20,000 nets will be distributed and 40,000 nets re-treated, he said, adding that new settlers and migrant workers in the forested areas of Battambang remained vulnerable and difficult to reach.

Keo Sokha, malaria programme officer for the NGO Partners for Development in Koh Kong province, which borders Thailand, told IRIN that education programmes and growing awareness of the malaria threat had been crucial in reducing infections. Malaria awareness campaigns had reached the schools, with third- to fifth-grade primary school students in Koh Kong province learning how to prevent and treat the deadly disease. "I think that education about malaria is one of the successful factors in fighting malaria," Sokha said.