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World Malaria Day is a day to recognise the global effort to provide effective control of the disease. Malaria is one of the leading causes of death in the developing world, infecting more than 500 million people a year and killing more than a million. About two years ago a new strain of drug resistant malaria emegerd in Cambodia, sparking fears it could spread and lead to widespread health problems.
Presenter: Robert Carmichael
Speakers: Dr Duong Socheat, National Centre for Malaria Control; Dr Steven Bjorge, WHO malaria specialist
CARMICHAEL: In recent decades, the area around the town of Pailin in western Cambodia has been the source of several drug-resistant malaria strains.
Dr Steven Bjorge of the World Health Organisation's office in Phnom Penh explains that one malaria strain in Africa that is resistant to choloroquine which was for years the standard medical treatment has been proven to have originated in western Cambodia.
Reason enough, then, for the concern expressed last year by health experts over the news that another drug-resistant strain had emerged in Pailin.
In this case, the resistance found in Pailin is to the standard drug treatment called ACT used against the falciparum strain of malaria.
ACT, which is a combination of drugs, normally eliminates the parasite from the body within two or three days. But Pailin's falciparum parasite, which has built up some resistance to ACT, now takes twice as long to clear.
Since ACT is the standard treatment worldwide for malaria, full resistance would be a huge public health problem in combating a disease that kills around one million people a year, most of them in Africa.
BJORGE: And so the fear is that again the drug-resistant parasite, for example from western Cambodia, will move to Africa, and Africa has a malaria problem many magnitudes worse than anything in southeast Asia
CARMICHAEL:The number of people dying from malaria in Cambodia is low relative to many African countries. Last year the disease killed around 270 Cambodians - a figure that has declined from around 800 deaths ten years ago.
But concerned at the public health implications for Cambodia, the region and possibly the world donors last year implemented a containment plan that saw a huge tract of land around Pailin designated as Zone 1 the main area for targeting the problem.
A buffer area comprising around half of the rest of Cambodia is known as Zone 2, while the rest of the country is classed as Zone 3.
BORGE:We have emerging tolerance which undoubtedly will lead to full-blown resistance if it continues. So what we've done now in Zone 1, increasingly in Zone 2 and then under Global Fund Round 9, what we'll do in Zone 3 is provide early diagnosis and treatment together with mosquito control through insecticide-treated bednets.
CARMICHAEL: Dr Duong Socheat, who heads the government's anti-malaria effort, says aspects of the containment plan include educating people on the correct drug use should they contract malaria, cracking down on fake or substandard medicines, and treating malaria in Zone 1 with a new combination known as DHA.
Another key element is that every village in Zone 1 now has at least one volunteer trained to test for malaria in fellow villagers.
Dr Duong Socheat is hopeful that not only will these efforts turn around the problem of the resistant strain, but that in another decade there will be no deaths from malaria in Cambodia.
So how is the containment programme going?
DR DUONG SOCHEAT: If you look deep you can see very good results.
CARMICHAEL: Dr Duong Socheat explains that last year there were no deaths from malaria in Zone 1, adding that the zone also showed no increase in the number of malaria cases.
He says a key challenge in the coming decade will be dealing with migrant workers. If they contract the resistant form of malaria, they could transfer that to their home provinces.
DR DUONG SOCHEAT: This is the main issue. The migrant, they move from the eastern part to the western part to look for the job for the crop season and come back with malaria.
CARMICHAEL:Next week, after the country has marked World Malaria Day on Sunday, health workers will move into a dozen villages in Pailin that are most afflicted by malaria.
The initiative - the first in Cambodia's treatment of the disease - will see them take blood from every villager in each village, test it at a lab in Phnom Penh, and within 48 hours treat anyone who is infected with the disease but not exhibiting the symptoms.
WHO's Dr Steven Bjorge says this effort, along with the entire containment plan, gives him some hope that they are making progress.
DR STEVE BJORGE: We feel that in Zone 1 we are having some success. It's still early in the game and so we're trying to gather the data and evaluate it, but we think that we're having some impact.
Presenter: Robert Carmichael
Speakers: Dr Duong Socheat, National Centre for Malaria Control; Dr Steven Bjorge, WHO malaria specialist
CARMICHAEL: In recent decades, the area around the town of Pailin in western Cambodia has been the source of several drug-resistant malaria strains.
Dr Steven Bjorge of the World Health Organisation's office in Phnom Penh explains that one malaria strain in Africa that is resistant to choloroquine which was for years the standard medical treatment has been proven to have originated in western Cambodia.
Reason enough, then, for the concern expressed last year by health experts over the news that another drug-resistant strain had emerged in Pailin.
In this case, the resistance found in Pailin is to the standard drug treatment called ACT used against the falciparum strain of malaria.
ACT, which is a combination of drugs, normally eliminates the parasite from the body within two or three days. But Pailin's falciparum parasite, which has built up some resistance to ACT, now takes twice as long to clear.
Since ACT is the standard treatment worldwide for malaria, full resistance would be a huge public health problem in combating a disease that kills around one million people a year, most of them in Africa.
BJORGE: And so the fear is that again the drug-resistant parasite, for example from western Cambodia, will move to Africa, and Africa has a malaria problem many magnitudes worse than anything in southeast Asia
CARMICHAEL:The number of people dying from malaria in Cambodia is low relative to many African countries. Last year the disease killed around 270 Cambodians - a figure that has declined from around 800 deaths ten years ago.
But concerned at the public health implications for Cambodia, the region and possibly the world donors last year implemented a containment plan that saw a huge tract of land around Pailin designated as Zone 1 the main area for targeting the problem.
A buffer area comprising around half of the rest of Cambodia is known as Zone 2, while the rest of the country is classed as Zone 3.
BORGE:We have emerging tolerance which undoubtedly will lead to full-blown resistance if it continues. So what we've done now in Zone 1, increasingly in Zone 2 and then under Global Fund Round 9, what we'll do in Zone 3 is provide early diagnosis and treatment together with mosquito control through insecticide-treated bednets.
CARMICHAEL: Dr Duong Socheat, who heads the government's anti-malaria effort, says aspects of the containment plan include educating people on the correct drug use should they contract malaria, cracking down on fake or substandard medicines, and treating malaria in Zone 1 with a new combination known as DHA.
Another key element is that every village in Zone 1 now has at least one volunteer trained to test for malaria in fellow villagers.
Dr Duong Socheat is hopeful that not only will these efforts turn around the problem of the resistant strain, but that in another decade there will be no deaths from malaria in Cambodia.
So how is the containment programme going?
DR DUONG SOCHEAT: If you look deep you can see very good results.
CARMICHAEL: Dr Duong Socheat explains that last year there were no deaths from malaria in Zone 1, adding that the zone also showed no increase in the number of malaria cases.
He says a key challenge in the coming decade will be dealing with migrant workers. If they contract the resistant form of malaria, they could transfer that to their home provinces.
DR DUONG SOCHEAT: This is the main issue. The migrant, they move from the eastern part to the western part to look for the job for the crop season and come back with malaria.
CARMICHAEL:Next week, after the country has marked World Malaria Day on Sunday, health workers will move into a dozen villages in Pailin that are most afflicted by malaria.
The initiative - the first in Cambodia's treatment of the disease - will see them take blood from every villager in each village, test it at a lab in Phnom Penh, and within 48 hours treat anyone who is infected with the disease but not exhibiting the symptoms.
WHO's Dr Steven Bjorge says this effort, along with the entire containment plan, gives him some hope that they are making progress.
DR STEVE BJORGE: We feel that in Zone 1 we are having some success. It's still early in the game and so we're trying to gather the data and evaluate it, but we think that we're having some impact.
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