Karen Department of Health and Welfare of Annual Report 2011

Program Services
The KMCP applies international standards set by the World Health Organization (WHO) for
reducing malaria burden, including early diagnosis and treatment (EDT), widespread use of
long-lasting insecticide treated nets, and malaria education. 4 Patients are screened with a rapid
diagnostic test (RDT) that is low in cost and highly accurate (Paracheck®Pf), or with microscopy
where available.
Artemisinin-based combination therapy (ACT) is administered following the Directly Observed
Therapy protocol (DOT), by which a clinic worker watches the patient while they are taking the
dose and for 30 minutes afterward to make sure it is ingested, since patients with severe
malaria are prone to vomiting. (ACT is recommended by the Burmese Border Guidelines 1 and
other regional authorities.)
The program has a strong focus on prevention. Insecticide-treated nets are distributed to every
household, and workers make house visits to monitor net use. In an August, 2005 survey of the
original target population, two years after initiation of the program, more than 90% of people
reported sleeping under a net every night. Clinic health workers educate villagers about
malaria, explaining how to identify the symptoms, and the importance of seeking immediate
treatment and of adhering to the full course of therapy. Villagers learn how to care for their
nets and to reduce the number of mosquitoes by cutting bushes around the houses and
eliminating nearby standing water.
An essential aspect of KDHW’s KMCP has been its method of expansion. The program has
relied increasingly on locally trained Village Health Workers (VHWs) to carry out the important
less technical day-to-day aspects of the program. Recruitment of VHWs evolved organically.
KMCP medics often were unable to reach the more remote villages in their target areas while
continuing to provide normal services in the clinics. Therefore, they began training local
villagers to conduct house visits, to refer symptomatic villagers to the clinic, and to provide
patient follow-up. As it became clear that these villagers were an asset to the program and
would facilitate coverage expansion, KDHW decided to incorporate them officially into the
program. Currently VHWs are working with KMCP medics in 15 of the 34 KMCP areas.
Seroprevalence surveys, beginning with the baseline screening at inception of each program,
were conducted biannually through 2009 to monitor P. falciparum malaria burden in the target
populations of five groups of areas brought successively into the KMCP. Surveys were
conducted once each year in 2010 and 2011. VHWs work alongside KMCP health workers to
conduct seroprevalence screening. In order to sample randomly 10% of the target population,
the workers tested all the residents of every tenth house in each village, beginning with a house
that was randomly chosen. Results are shown in Figure 3 for 2008-2011. The early years are
not shown because the population changed each year with additions of new target areas, but
by 2008 all areas were included that were in the program through 2011.
Aggregate prevalence of Pf malaria has declined in the five areas by two thirds since June 2008,
and by half since June 2009. The decline cannot be evaluated statistically, however, because of
lack of comparison data from areas not in the KMCP.
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