Effectiveness and impact of the crossborder healthcare model as implemented by non-governmental organizations: case study of the malaria control programs by health poverty action on the ChinaMyanmar border

Background:In the Yunnan province of China,18 counties in six prefectures border Myanmar.Due to its particular combination of geographic features,climate conditions,and cultural landscape,the area provides a suitable environment for the spread of insect-borne diseases such as malaria.In five identified Myanmar Special Regions along the China-Myanmar border,economic development is lagging,people live in extreme poverty,and the healthcare system is fragile.Coupled with political and other reasons,this precludes malaria control work to be effectively carried out in Myanmar,resulting in a heavy burden of the disease.Frequent population movements and favorable conditions for malaria transmission on the border fuel difficulties in controlling and eliminating the spread of the disease in the area.Case presentation:To reduce the prevalence of malaria in the China-Myanmar border area and improve healthcare services for local residents in this particular environment,Health Poverty Action(HPA)has provided malaria aid in the area since the beginning of 2006,as a sub-recipient of the China Global Fund Malaria Programs.In this case study,we examined HPA’s activities as part of its malaria control programs in the area,analyzed and summarized the effectiveness and impact of the cross-border healthcare model as implemented by non-governmental organizations,and put forward suggestions for cross-border health aid models and for the prevention of malaria transmission in the Greater Mekong Subregion.Conclusions:HPA had carried out a great quantity of successful malaria control activities in border areas between China and Myanmar,strengthened the partnership and established the collaboration,coordination and cooperation channels among stakeholders.HPA has laid good groundwork and developed its valuable model that could be highlighted and referenced.

Malaria control along China-Myanmar Border during 2007–2013: an integrated impact evaluation

Background:Implementing effective interventions remain a lot of difficulties along all border regions.The emergence of artemisinin resistance of Plasmodium falciparum strains in the Greater Mekong Subregion is a matter of great concern.China has effectively controlled cross-border transmission of malaria and artemisinin resistance of P.falciparum along the China-Myanmar border.Methods:A combined quantitative and qualitative study was used to collect data,and then an integrated impact evaluation was conducted to malaria control along the China-Myanmar border during 2007-2013.Results:The parasite prevalence rate(PPR)in the five special regions of Myanmar was decreased from 13.6%in March 2008 to 1.5%in November 2013.Compared with the baseline(PPR in March 2008),the risk ratio was only 0.11[95%confidence interval(CI),0.09-0.14]in November 2013,which is equal to an 89%reduction in the malaria burden.Annual parasite incidence(API)across 19 Chinese border counties was reduced from 19.6 per 10000 person-years in 2006 to 0.9 per 10000 person-years in 2013.Compared with the baseline(API in 2006),the API rate ratio was only 0.05(95%CI,0.04-0.05)in 2013,which equates to a reduction of the malaria burden by 95.0%.Meanwhile,the health service system was strengthened and health inequity of marginalized populations reduced along the international border.Conclusion:The effective collaboration between China,Myanmar and the international non-governmental organization promptly carried out the core interventions through simplified processes.The integrated approaches dramatically decreased malaria burden of Chinese-Myanmar border.

Investigation and control of a Plasmodium falciparum malaria outbreak in Shan Special Region II of Myanmar along the China-Myanmar Border from June to December 2014

Background:From 2007 to 2013,intensive control measures reduced malaria burden by 90%along the China-Myanmar border.However,despite these measures a P.falciparum malaria outbreak was reported in the Shan Special Region II of Myanmar in June of 2014.Methods:Epidemiological,parasitological and entomological investigations were performed.Dihydroartemisinin piperaquine(DAPQ)was immediately administered to treat parasite positive individuals.Long lasting insecticidal nets(LLIN),indoor residual spraying(IRS)with insecticides and behavior change communication(BCC)were also provided for outbreak control.An embedded efficacy study was conducted evaluating DP.Molecular genotyping via polymerase chain reaction(PCR)was performed on the Kelch gene on chromosome 13.Results:All infections were identified as Plasmodium falciparum by RDT and microscopy.Two fatalities resulted from the outbreak.The attack rate was 72.8%(67/92)and the incidence density rate was 14.2 per 100 person-weeks.The positive rate of rapid diagnostic test(RDT)was 72.2%(65/90)and microscopically-determine parasite rate 42.2%(38/90).Adjusted odds ratio(OR)of multivariate logistic regression analysis for aged<15 years,15–45 years,inappropriate treatment from a private healer and lack of bed nets were 13.51(95%confidence interval,2.21–105.89),7.75(1.48–44.97),3.78(1.30–46.18)and 3.21(1.21–15.19)respectively.In the six surrounding communities of the outbreak site,positive RDT rate was 1.2%(4/328)and microscopically-determine parasite rate 0.6%(2/328).Two light traps collected a total of 110 anopheline mosquitoes including local vectors,An.minimus,An.sinensis and An.maculates.After intensive control,the detection of malaria attacks,parasites and antigen were reduced to zero between July 1 and December 1,2014.The cure rate of P.falciparum patients at day 42 was 94.3%(95%CI,80.8–99.3%).The PCR did not detect K13-propeller mutations.Conclusion:Imported P.falciparum caused the outbreak.Age,seeking inappropriate treatment and lack of bed nets were risk factors for infection during the outbreak.P.falciparum was sensitive to treatment with DAPQ.The integrated measures controlled the outbreak and prevented the spread of P.falciparum effectively.The results of this study indicate that malaria control on the China-Myanmar border,especially among special populations,needs further collaboration between China,Myanmar and international societies.

From control to elimination:a spatial-temporal analysis of malaria along the China-Myanmar border

Background: Malaria cases have declined significantly along the China-Myanmar border in the past 10 years and this region is going through a process from control to elimination.The aim of this study is to investigate the epidemiology of malaria along the border,will identify challenges in the progress from control to elimination.Methods:: National reported malaria cases from China and Myanmar,along with the data of 18 Chinese border counties and 23 townships in Myanmar were obtained from a web-based diseases information reporting system in China and the national malaria control program of Myanmar,respectively.Epidemiological data was analyzed,including the number of reported cases,annual parasite index and proportion of vivax infection.Spatial mapping of the annual parasite index(API)at county or township level in 2014 and 2018 was performed by ArcGIS.The relationship of malaria endemicity on both sides of the border was evaluated by regression analysis.Results: The number of reported malaria cases and API declined in the border counties or townships.In 2014,392 malaria cases were reported from 18 Chinese border counties,including 8.4%indigenous cases and 91.6%imported cases,while the highest API(0.11)was occurred in Yingjiang County.There have been no indigenous cases reported since 2017,but 164 imported cases were reported in 2018 and 97.6%were imported from Myanmar.The average API in 2014 in 23 Myanmar townships was significantly greater than that of 18 Chinese counties(P<0.01).However,the API decreased significantly in Myanmar side from 2014 to 2018(P<0.01).The number of townships with an API between 0 and 1 increased to 15 in 2018,compared to only five in 2014,while still four townships had API>10.Plasmodium vivax was the predominant species along the border.The number of reported malaria cases and the proportion of vivax infection in the 18 Chinese counties were strongly correlated with those of the 23 Myanmar townships(P<0.05).Conclusions: Malaria elimination is approaching along the China-Myanmar border.However,in order to achieve the malaria elimination in this region and prevent the re-establishment of malaria in China after elimination,continued political,financial and scientific commitment is required.

Lessons on malaria control in the ethnic minority regions in Northern Myanmar along the China border, 2007–2014

Background:For many countries where malaria is endemic,the burden of malaria is high in border regions.In ethnic minority areas along the Myanmar-China border,residents have poor access to medical care for diagnosis and treatment,and there have been many malaria outbreaks in such areas.Since 2007,with the support of the Global Fund to Fight AIDS,Tuberculosis and Malaria(GFATM),a malaria control project was introduced to reduce the malaria burden in several ethnic minority regions.Methods:A malaria control network was established during the period from 2007 to 2014.Multiple malaria interventions,including diagnosis,treatment,distribution of LLINs and health education,were conducted to improve the accessibility and quality of malaria control services for local residents.Annual cross-sectional surveys were conducted to evaluate intervention coverage and indicators of malaria transmission.Results:In ethnic minority regions where a malaria control network was established,both the annual malaria incidence(19.1 per thousand per year,in 2009;8.7,in 2014)and malaria prevalence(13.6%in 2008;0.43%in 2014)decreased dramatically during the past 5–6 years.A total of 851393 febrile patients were detected,202598 malaria cases(including confirmed cases and suspected cases)were treated,and 759574 LLINs were delivered to populations at risk.Of households in 2012,73.9%had at least one ITNs/LLINs(vs.28.3%,in 2008),and 50.7%of children less than 5 years and 50.3%of pregnant women slept under LLINs the night prior to their visit.Additionally,malaria knowledge was improved in 68.4%of residents.Conclusion:There has been great success in improving malaria control in these regions from 2007 to 2014.Malaria burdens have decreased,especially in KOK and WA.The continued maintenance of sustainable malaria control networks in these regions may be a long-term process,due to regional conflicts and the lack of funds,technology,and health workers.Furthermore,information and scientific support from the international community should be offered to these ethnic minority regions to uphold recent achievements.