Lack of funding to monitor migrant patterns in Vietnam risks worsening the spread of drug-resistant malaria, health experts said on the sidelines of a World Health Organization (WHO) annual regional meeting in Hanoi which closed on 28 September.
Resistance to the anti-malaria drug artemisinin can spread due to widespread migration across borders and internally within Vietnam, said John Ehrenberg, director of Combating Communicable Diseases in WHO’s regional office in Manila.
Reports of drug resistance - when an artemisinin combination therapy (ACT) takes longer to treat infections - have been recorded along the Thailand-Myanmar border, in Myanmar and in southern Vietnam. Studies showing drug resistance along the Thai- Cambodian border date back to 2005.
Eva Christophel, team leader in malaria at WHO’s office in Manila, said while Vietnam has promoted ACTs and improved surveillance and detection of suspected infections, its migrant communities must be studied more closely to prevent the spread of drug resistance.
Between 2000 and 2011 reported deaths by malaria fell from 148 to 14, while confirmed cases fell from over 74,000 to just over 16,500, according to the National Institute of Malaria Parasitology and Entomology in Hanoi.
Migrant populations have to be monitored to control the resurgence of malaria as well as new cases of drug resistance, said Nguyen Manh Hung, the director-general of the institute.
“With uncontrolled movement of seasonal workers, especially those for forest exploitation and other forest-based activities, it’s difficult to contact them for malaria control,” he said.
Much of Vietnam's forest-based activity is in the country’s Central Highlands, where migrants, mostly from the Mekong Delta, make a living from logging and fuel the country's lucrative wood-processing industry.
Migrants make up some 25 percent of the country’s largest cities, based on government figures reported to the International Organization of Migration.
“Special programmes” needed
“Currently Vietnam does not have enough money available to do what has to be done to address the artemisinin-resistance issue,” said WHO’s Christophel. “You need to have special programmes. A bednet is only given to people who register [with authorities]. If you are not registered then how are you going to get your bednet,” she said, referring to workers in the informal sector.
Vietnam receives most of its funding to combat malaria from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Since 2004 Vietnam has received more than US$40 million in grants to combat the disease from the fund.
To fight malaria, farm owners need to distribute insecticide treated bednets to migrant workers they employ, she said. It is also important to equip workers in forested areas with tests, drugs and bednets, as well as train peer health workers on malaria diagnosis and treatment.
Mosquitoes infected with malaria-infested parasites in Vietnam are mostly found in forest areas. In 2008 forests covered almost 39 percent of the country, or some 13 million hectares.
“You need do some surveys, you need to get additional supplies because these people are moving; the more they move the more supplies they need, and you need to train people,” Christophel added.
Studies published in April 2012 of 3,200 patients along the northwestern border of Thailand near Myanmar from 2001 to 2010 indicated a steady increase in drug resistance from 0.6 percent of surveyed patients to 20 percent after a decade.