Progress & ImPact serIes - Roll Back Malaria - World Health ...

Public health services in the region generally
aim to provide a parasite-based diagnosis using
microscopy or RDTs and all countries with
falciparum malaria have adopted ACTs. However,
in Bangladesh, Cambodia, India, and Indonesia,
more than half of fever cases are treated in the
private sector, where the quality of diagnosis
and treatment is variable. Since many of the
populations most affected by malaria are located
in areas not served by either public or private
services, several countries have developed
extensive programmes for community-based
malaria diagnosis and treatment through
volunteers in high-risk areas.
Counterfeit and substandard antimalarial
medicines including artesunate are in circulation
throughout the Mekong subregion and the
problem is more pronounced in border areas.
National governments and WHO are cooperating
with Interpol to take action against organized
criminals involved in counterfeiting. In addition,
oral artemisinin-based monotherapies are also
widely available, which are thought to contribute
to the emergence and spread of resistance to
artesunate that was reported in 2009 on the
Cambodia-Thailand border. A multinational
containment effort has started, involving tight
regulation and education of private sector
providers, education of the public, intensification
of preventive measures, and close surveillance
of potential cases of drug resistance. More
recently, WHO, together with Roll Back Malaria,
launched the Global Plan for Artemisinin
Resistance Containment to address and provide
guidance on this public health threat.
Resistance to the insecticides used to control
mosquitoes is widespread, although vector
control tools are currently effective in the vast
majority of settings. In May 2012, WHO released
the Global Plan for Insecticide Resistance
Management, which outlines the pillars of action
required to confront and overcome this threat,
many of which are already being implemented
(Box 3.3).
Summary
Several countries in the region have been
successful in reducing malaria, partly due
to increasing the coverage of antimalarial
interventions but also because of development
activities which have made habitats less suitable
for malaria vectors. Despite some progress, the
region still contains the highest numbers of
cases and deaths from malaria outside of Africa.
As malaria transmission has been controlled
it is increasingly concentrated in populations
and areas that have been least affected by
development such as tribal populations and
border areas, and where transmission can
be particularly intense due to highly efficient
vectors. Provision of services to these areas and
populations presents particular challenges and
requires more commitment and resources than
in easier to reach populations. Yet it is in these
areas that further efforts must be made in order
to make significant inroads on the remaining
burden of malaria outside of Africa and to prevent
the emergence of drug resistance.
DEFEATING MALARIA IN ASIA, THE PACIFIC, AMERICAS, MIDDLE EAST AND EuROPE
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