A significant collaboration for the malaria program with the army medics working in the border areas of Lao People’s Democratic Republic

In a significant collaboration between the Ministry of Health (MOH) and Ministry of Defence, Dr Chitsavang Chanthavisouk, WHO staff working on the malaria program, was given first time access with the MOH staff to meet the army personnel responsible for patrolling the border areas between Lao People’s Democratic Republic and Cambodia.

This is part of a Treatment Efficacy Study (TES) of the antimalarial drug (DHA-PIP) which will be carried out till August. This is an important link with the army medics and part of the push towards elimination. The team observed the army medics in their work and discusses about malaria testing, diagnosis and treatment, they provided training in blood smear preparation and explain how the medics should refer cases to the military hospital focal point for TES registration.

Since 2013, the Center for Malaria Parasitology and Entomology of Lao PDR (CMPE) under MOH has been working with the Military Institution of Diseases Prevention at the Central level and the work has now been extended to Provincial areas with high malaria disease burden.

Army medic practicing how to collect blood specimen in Khong District, Champassack Province

At these border areas, military personnel including two field medics are assigned to mobile teams on a three month rotation basis. Their work exposed them to malaria infection as they patrol the peripheral and border forested areas.

The army personnel accounts for over 10 percent of confirmed malaria cases among all cases reported from the southern provinces. When they get sick, they are referred back to the provincial hospital in case they become parasite carriers. To reduce the risk and provide early diagnosis and treatment of malaria, the army medics have been supplied with a malaria survival kit, which include rapid diagnostic tests (RDTs) and Artemisinin-based combination therapies (ACT) for prompt diagnosis and treatment. These survival kits are provided under the Global Fund Tuberculosis, Aids & Malaria program.

Blood specimen for Polymerase chain reaction (PCR) testing and thick and thin smear preparation for diagnosis of Plasmodium falciparum, and at least one dose of treatment (DHA-PIP) should be given for TES purpose once it is confirmed positive. Screening malaria falciparum case and blood specimen collection are essential for early diagnosis and treatment, and the work toward malaria elimination in the country. The results from the TES will be used for recommendation and decision making by the National Programme. Besides focusing on early diagnosis and treatment to reduce the incidence of malaria, long-lasting insecticidal nets (LLINs) have been distributed to the army.

Medic demonstrating blood sample collection for Polymerase chain reaction (PCR) testing used for the Treatment Efficacy Study (TES) conducted in Laos

The army medics were asked to provide an update on a monthly basis on malaria morbidity and mortality, if any. These reports are used by the National Programme for malaria surveillance and control, and commodity management.

Showing the prepared thick and thin smear for examination

Dr Chanthavisouk said this opportunity to work with the army medic has been useful, in aligning their diagnosis and treatment with the Ministry of Health work to achieve malaria elimination by 2030. She hopes to participate in more collaboration activities in the future.