Global IssuesSOUTH-EAST ASIA: Malaria Control Drive Reaches Out to Migrant Workers
As efforts to control malaria intensify in the region, the significance of a busy health clinic in Mae Sot, a Thai town close to the Burmese border, stands out even more.
It is the Mae Tao clinic that an increasing stream of Burmese migrants heads for in order to get treatment for malaria, after they cross Thailand’s porous western border.
'We treated 7,000 patients for malaria last year; 70 percent were from Burma,' says the clinic’s well-known founder, Dr Cynthia Maung. 'The number of patients increase by 10 percent every year,' said Dr Cynthia, a member of the Karen ethnic minority, many of whom fled military-ruled Burma two decades ago to escape oppression.
The malaria patients going to the Mae Tao clinic, who are among the nearly 120,000 who come for care every year to this health outpost, are a vulnerable, mobile population, she reveals during a telephone interview from the border. 'They come from far away places inside Burma. People don’t have exact locations and have no access to good health care.'
The Mae Tao clinic is one in a vast network of health clinics that has sprouted up along the frontlines of Thailand’s battle to control the spread of malaria. Currently, 900 clinics dot the borders that this South-east Asian kingdom shares with Burma, also known as Myanmar, and Cambodia.
'The health ministry supports 400 of these border clinics while another 500 malaria posts are supported by the Global Fund,' says Dr Wichai Satimai, director of the bureau of vector-borne disease at the Thai public health ministry. 'They offer a combination of health care and also have awareness efforts to stop the spread of malaria.'
The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria was created in 2002 to combat the three deadly diseases in the developing world.
The challenges that Thailand faces in bringing malaria under control are similar to that of neighbouring Burma and Cambodia. All three countries are grappling with the spread of the deadly malaria parasite that has developed resistance to the effective anti-malaria drugs available today.
In view of this, public health officials are monitoring migrant workers and other mobile populations that move from areas that are malaria-infested to places with low prevalence, consequently helping to spread the disease.
'We are afraid of the drug-resistant malaria being spread by migrant workers,' Dr Wichai told IPS. 'This has happened before, when drug-resistant malaria spread from the Thai-Cambodian border inland, even to the Thai- Myanmar border.'
Thailand is home to over two million migrant workers, majority of them from Burma in search of work in farms, construction sites, fishing boats and garment factories after fleeing conflict or economic hardship at home. The country is also a magnet for migrant workers from Laos and Cambodia.
Concerns are similar in Cambodia, where malaria is more prevalent in western provinces like Pailin, close to the Thai border, than in the central and eastern parts of the country. But its vulnerable migrant workers are domestic job seekers.
'Migrant workers are at high risk for malaria because they generally are poor, lack access to health services and also travel,' says Dr Najibullah Habib, team leader of the Malaria Containment Project at the Cambodia office of the World Health Organisation (WHO). 'Migrant workers are a vehicle to spread the resistant parasite.'
In an effort to reach this vulnerable group, malaria prevention programmes have been introduced in the corn and cassava farms that are a magnet for poor Cambodians in search of jobs, Habib said during a telephone interview from Phnom Penh. 'We try to engage farm owners to provide the workers with bed nets.'
Efforts to control malaria over the past decade have resulted in a dramatic drop in the cases of deaths and malaria infection. Malaria deaths dropped by 60 percent between 1998 to 2007 in the region through which flows South- east Asia’s largest body of water, the Mekong River, according to a report released in early 2010.
Malaria incidence rates dropped by 25 percent during the same period, says the report ‘Malaria in the Greater Mekong Subregion 2010’, which focuses on Burma, Cambodia, Laos, Thailand, Vietnam and China’s southern Yunnan province.
Burma, which has a weak public health system, had the most number of malaria cases in 2007 -- 200,679 people infected, or 3.55 cases per 1,000 people. It recorded 2.91 deaths per 100,000 people, the highest in the region.
Thailand, by contrast, had 33,178 malaria cases and 0.15 deaths per 100,000 people in 2007, while Cambodia had 42,518 cases and 1.68 deaths per 100,000 people in that year, the last recorded in the report.
But this picture conceals the troubling trend that haunts health workers. 'Since the 1970s, the Cambodia-Thailand border has been the global epicentre for emerging resistance to anti-malarial drugs,' notes the report. 'It is the area (where) parasite resistance to chloroquine first developed.'
Today, doctors in the region are grappling with malaria resistance to artemisinin, the active ingredient in the anti-malarial drug artesuante. It is currently the most potent drug against plasmodium falciparum malaria, the strain responsible for most of the one million deaths from malaria in 2008.
'We have to be more aggressive against the deadly plasmodium falciparum parasite,' says Dr Charles Delacollette, coordinator of the WHO’s Mekong Malaria Programme. 'Winning the war against this parasite is a challenge.'
© Inter Press Service (2010) — All Rights ReservedOriginal source: Inter Press Service