In recent years, with the synchronous and active implementation of prevention and control measures; the malaria situation in Thua Thien‐Hue has clearly changed. Compared to 1991, the number of people with malaria decreased by 93.14% (14,245/977), the rate of malaria parasites on blood smears decreased by 91.73% (11.97/0.99), and there are no more deaths due to malaria.
In recent years, with the synchronous and active implementation of prevention and control measures; the malaria situation in Thua Thien‐Hue has clearly changed. Compared to 1991, the number of people with malaria decreased by 93.14% (14,245/977), the rate of malaria parasites on blood smears decreased by 91.73% (11.97/0.99), there are no more deaths due to malaria (in 1991 there were 66 cases) and malaria epidemics have been controlled and have not occurred for many years. Domestic malaria has basically been pushed back in the endemic areas, but the current situation is that imported malaria due to infection from other places returning to the locality has caused fluctuations, affecting the stability of the situation. The risk of malaria disaster returning is a constant warning and concern if there is no solution to build and develop sustainable malaria prevention factors in terms of organization, technical expertise and society to maintain long‐term achievements.
With the current low malaria situation in Thua Thien‐Hue, one of the desired organizational solutions is how to manage malaria patients at each household level. The local grassroots health system carries out the work of caring for and protecting people’s health in 9 administrative units including 1,024 medical staff at the district and city levels; 629 medical staff at the commune, ward and town levels and especially 1,317 medical staff in villages and residential groups covering 150 communes, wards and towns in the whole province. On average, each commune, ward and town has 4 medical staff and 9 medical staff in villages and residential groups. Since 2005, a plan has been implemented to increase the number of doctors covering all health stations to improve the quality of work. The frontline medical network is being strengthened and managed to effectively respond to the work of caring for and protecting people’s health, including malaria prevention.
To implement malaria management to each household, to have sustainable factors to maintain long‐term results, the Health Station and medical staff in villages and residential groups are mobilized to participate in work within assigned functions and tasks, and at the same time are responsible for building and developing a system of family health collaborators with the following solutions:
- Know the situation in the village, residential group to isolate the subjects who often have contact with or go into the malaria‐endemic area or leave the protected area in the malaria‐endemic area with the risk of contracting malaria and the subjects who have contact with and are likely to contract malaria due to infection elsewhere. Make a list of households and family members who are at risk. Make a malaria management book for these households with necessary information such as full name, age of each person, activities that have the risk of contracting malaria, the development of the disease situation, disease prevention and control measures, etc.
- After consolidating the village and residential health system to operate effectively, management needs to be extended to households by mobilizing each household to have a malaria prevention collaborator with certain knowledge to take care of the health of family members when they are far from medical facilities. These collaborators are trained on‐site, each training session should only be organized once with knowledge about the causes of the disease, how to prevent the disease, how to recognize when infected with malaria, how to use anti‐malarial drugs, signs of severe malaria must be taken immediately to the nearest medical facility for timely examination and treatment, especially for children and pregnant women. Malaria management is strictly implemented at the household level when each household has a fully trained medical collaborator, working on a voluntary basis for the health of each family member. In addition to malaria prevention, family health collaborators can gain additional knowledge from other community health programs to enrich their home health care activities.
- Village and residential group health workers are responsible to the Village Chief, Village Chief, Residential Group Chief and Commune Health Station Chief for managing the activities of malaria prevention collaborators in each household. Guide and support collaborators of each household to promote disease prevention methods such as sleeping under mosquito nets regularly when in malaria‐endemic areas or when entering malaria‐endemic areas, including when going to the forest, sleeping in the fields, treating mosquito nets with chemicals during campaigns, clearing bushes, unclogging sewers, not leaving stagnant water around the house, moving livestock pens far from the house, not building houses near streams or forests… In addition, it is necessary to take preventive medicine when leaving the protected area and ask for self‐treatment medicine when having a fever if away from a medical facility for a long time with instructions for use from medical staff when providing medicine. If a family member has a fever for the first time in a malarial area or when returning from a malarial area, regardless of the cause of the fever, the collaborator must immediately notify the village or residential group health center and coordinate to take the patient to the nearest civilian or military medical facility for examination, blood test and timely treatment; do not let the disease turn into malignant malaria causing death.
- On a weekly basis, the Health Station is responsible for inspecting the activities of village and residential group health workers to collect information; at the same time, coordinate with village and residential group health workers to take turns visiting households with people infected with malaria or those at risk of malaria to review and compare the monitoring list and malaria management book that has been established. After the inspection, the Health Station will instruct village and residential group health workers and malaria prevention collaborators in families on tasks that need to be performed better to improve management capacity.
One of the factors for sustainable malaria control in terms of organization is to complete the grassroots health network, especially the commune, village and residential group health systems that operate effectively, meeting the task of malaria control at the front line. This issue has been built and consolidated over the past time with the desire to change the situation at the grassroots level. However, in the implementation process, a requirement has been set that it is necessary to build and develop a system of health collaborators in each family to be able to manage malaria at the household level, ensuring coverage of activities. Sustainability will be more certain when the grassroots health system has the presence of health collaborators in each family, not just stopping at the village and residential group health. Although this desire is complicated and difficult to implement, it will bring practical results to the task of malaria control in the current period. It is necessary to build a pilot model, then learn from experience to develop and replicate.
Author: Dr. Nguyen Vo Hinh,
Director of the Center for Malaria and Parasitology Prevention and Control, Thua Thien‐Hue
