Balancing act: managing malaria elimination and antimalarial resistance in Viet Nam
Although malaria cases and deaths have been steadily declining in Viet Nam, antimalarial drug resistance remains an ongoing concern in the country. Out of the 6 artemisinin-based combination therapies (ACTS) used to effectively treat P. falciparum (the deadliest strain of the disease) and chloroquine-resistant P. vivax malaria, there is confirmed resistance to at least 2 within the country. Artemisinin resistance was first confirmed in neighbouring Cambodia in 2008 and has since spread to other countries in the Greater Mekong subregion, including Viet Nam. As a result, efforts to test for malaria, track the presence of antimalarial drug resistance and monitor drug efficacy are even more important.
VU Thi Anh Tuyet & BUI Thi Luan, from Viet Nam's National Institute of Malariology, Parasitology & Entomology, take a blood sample for a malaria rapid diagnostic test in Xa Ho Village, an isolated settlement on the edge of the forest in Lai Chau Province.
Health workers perform a malaria rapid diagnostic test
Vu Thi Anh Tuyet (centre) and Bui Thi Luan (left) work for the National Institute of Malariology, Parasitology and Entomology (NIMPE), the institution tasked with eliminating malaria in Viet Nam. Based in Hanoi, they travelled the 11-hour journey with a team of malaria workers and doctors to test for and treat malaria in Muong Te district, Lai Chau Province. Located in a forested and mountainous region of north Viet Nam, the remote villages that Tuyet and Luan visit are inhabited by the La Hu, a hill tribe.
Staff members from Viet Nam's National Institute of Malariology, Parasitology & Entomology, collect and input patient data into Viet Nam’s malaria surveillance system in Xa Ho Village, an isolated settlement on the edge of the forest in Lai Chau Province.
Health staff collect and input patient data into Viet Nam’s malaria surveillance system
Tackling resistance to antimalarial drugs requires commitments from health workers to perform tests and collect comprehensive data which can be used to detect treatment failures. Trieu Viet (right) has travelled with his outreach team to conduct malaria testing among the La Hu hill tribe. The rapid diagnostic test used on this young girl can provide results within 15 minutes. Once the results appear, Doctor Nguyen Thi Thanh Thuong (centre) completes the patient health forms while NIMPE representatives, Nguyen Xuan Thang (left with red shirt) and Duong Anh Tuan (far left) feed the data into Viet Nam’s online malaria management system.
VU Thi Anh Tuyet, from Viet Nam's National Institute of Malariology, Parasitology & Entomology, take a blood sample for a malaria rapid diagnostic test in Xa Ho Village, an isolated settlement on the edge of the forest in Lai Chau Province.
A health worker prepares blood samples from a suspected malaria patient
To monitor drug efficacy, WHO and partners work with the NIMPE to conduct therapeutic efficacy studies (TES). TES include collecting blood samples (pictured) from malaria patients to detect parasites by microscopy, monitoring complete cure or treatment failures over a 42-day period, and keeping national malaria treatment guidelines up-to-date with effective antimalarial drugs. Most of Viet Nam’s TES sites are located in the central highlands where antimalarial drug resistance is present.
TRIEU Viet, from Viet Nam's National Institute of Malariology, Parasitology & Entomology, and other health workers work their way over a stream to reach Xa Ho village an isolated settlement on the edge of the forest in Lai Chau Province.
Malaria outreach teams en route to perform test and treat services
Trieu Viet (right) from the NIMPE’s Clinical Experimental Research Department navigates a flooded path on the way to a malaria-endemic village in Viet Nam. During the rainy season, flooding and landslides can make it harder for people from remote communities to visit their local health centres and test for malaria. This can also complicate follow-up visits in the event of drug failures. Outreach teams like Trieu Viet’s are important in driving down malaria cases among Viet Nam’s isolated communities.
VA Ki Bo, 8, recovers from malaria in Xa Ho Village, an isolated settlement on the edge of the forest in Viet Nam’s Lai Chau Province.
Portrait of a former malaria patient
Eight-year-old Va Ki Bo is a member of the La Hu hill tribe and a recovered malaria patient. In recent years, the NIMPE has stepped up efforts to actively search for malaria in hotspot areas like Bo’s home Lai Chau Province. In 2020, Viet Nam’s cases reduced by 70% when compared to 2019. At the same time, testing rates remained stable with only a 6% decline.
Health worker LY Thi Nhieu prepares malaria medicines in Pa U Commune Health Station, Lai Chau Province.
A provincial health worker organizes medication used to treat malaria patients
Ly Thi Nhieu, a health worker from Pa U commune checks the stocks of antimalarial drugs at her Health Station in Lai Chau Province. Malaria tests and treatments have a short shelf-life, so they must be restocked regularly. With lower caseloads, health workers like Nhieu must source increasingly smaller quantities of drugs within a shorter time frame. This ensures that patients receive the full dosage of malaria medication, in line with national treatment guidelines.
Hoang Bich Hang prepares the microscope slide of blood smears taken from a malaria patient in Viet Nam's National Institute of Malariology, Parasitology & Entomology.
A technician prepares a microscopic slide in a laboratory
Hoang Bich Hang prepares the microscope slide of blood smears taken from a malaria patient in the NIMPE’s laboratory in Hanoi. Microscopic examination remains the main reference tool for laboratory confirmation of malaria. Microscopy is also required to verify treatment failure before patients can be given any second-line antimalarial drugs.
View over Co Lo Village in Lai Chau Province, Viet Nam
View over Co Lo village in Lai Chau Province
Viet Nam has pledged to eliminate the deadly Plasmodium falciparum malaria parasite by 2023. This is a shared goal among 4 other Greater Mekong subregion countries (Cambodia, Lao People’s Democratic Republic, Myanmar and Thailand). Although antimalarial drug resistance remains a reality, lower case numbers, regular drug efficacy surveillance and the availability of efficacious ACTs in Viet Nam make it possible to eliminate this species of the parasite within the next 2 years.