Kanchanaburi, May 2007

A collaboration between: SMRU, MSF-F, AMI, IRC, ARC, MHD

With the participation of TBBC and HIS/CCSDPT

Malaria surveillance in camps for displaced population and

migrants:Thai-Myanmar border

1995-2006

Camps situation: Background

• 1984: 7 camps in Tak province, 10,000 persons• 1994: 32 camps from Mae Hong Son to Chumpon

provinces, 77,000 persons

During that period:• Frequent malaria outbreaks during camps

relocation• 40% of total consultations due to malaria• 1st cause of mortality in the camps• 1% of pregnant women dying of malaria each

year• 80% of malaria due to P. falciparum

Cu

re R

ate

(%

)

1975 1980 1985 1990 1995

100

80

60

40

20

CQSP

M25

M15

Years

P. falciparum resistance to antimalarials

(Fansidar)

(Mefloquine)

(Chloroquine)

•1991-92: First MAS trials•1994: MAS3 in the camps

• Established in mid-1995 to control epidemics and to develop a coherent malaria control program in the camps based on:– Weekly surveillance system– Reliable laboratory diagnosis with Q.C.– Unique treatment guideline based on

mefloquine and artesunate combination therapy and regular update on new protocols

Malaria Task Force

1996 2001 2006Total camps 24 11 10

Total populationa 87,499 120,080 149,001

Camps reporting to MTF

21 10 8

Population covered by MTF(in % of total popul)

83,344(95.3%)

119,804(99.8%)

137,934(92.6%)

a Population as reported by the Thai Burmese Border Consortium (TBBC) monthly report

Population coverage

Bangkok

Malaria morbidity & mortality

1996 2001 2006

Total consultations (all causes)

163,346** 551,506 578,231

Malaria consultations (in % of total consult)

38,702(23.7%)

15,079(2.7%)

17,346(3.0%)

PF / 1,000 persons 283.6 75.5 70.5

PV / 1,000 persons 180.8 50.4 60.1

Malaria deaths (in % of total deaths)

41(9.9%)

7 (2.3%)

3 (0.6%)

* Probably underestimated, as some camps reported fever cases only

Malaria cases per 1,000 residents

0.0

50.0

100.0

150.0

200.0

250.0

300.0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006Years

Mala

ria c

ase

s per

1,0

00 c

am

p r

esi

dents

P. falciparum malariaP. vivax malaria

Ratio PF/PV by age group

0.0

0.5

1.0

1.5

2.0

2.5

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006Years

Rati

o P

F/PV

< 5yrs 5-15yrs > 15yrs

PV predominant

PF predominant

Ratio PF/PV in adults of Mae La

0.0

0.5

1.0

1.5

2.0

2.5

1998 1999 2000 2001 2002 2003 2004 2005 2006

Years

Rati

o P

F/PV

Permanent residents Non permanent residents

P. falciparum distribution by sex

16%

3%

79%

2%

Male-resident

Female-resident

Male-non permanent resident

Female-non permanent resident

Mae La camp: adults

Malaria cases in clinics for migrant workers

0

200

400

600

800

1000

1200

1400

Feb

-04

May

-04

Aug

-04

Nov

-04

Feb

-05

May

-05

Aug

-05

Nov

-05

Feb

-06

May

-06

Aug

-06

Nov

-06

Months

To

tal m

alar

ia c

ases

P. falciparum P. vivax

4%

13%

56%

3%

9%

15%

Male <5yrs

Male 5-15yrs

Male >15yrs

Female <5yrs

Female 5-15yrs

Female >15yrs

ED and MAS3 in the camps

1986

40% of consultations

1 malaria case/person/yr

24% of all deaths 1994-96: ACT in all camps

~ 25% of consultations

0.5 malaria case/person/yr

10% of all deaths 2001

3% of consultations

0.1 malaria case/person/yr

3% of all deaths2006

3% of consultations

0.1 malaria case/person/yr

<1 % of all deaths

Malaria prevalence in migrant workers – May 07

< 5yrs old 5-15yrs old > 15yrs old

Male Female Male Female Male Female

Total screened

44 30 57 59 65 110

PF 0 01

(1.8%)1

(1.7%)4

(6.2%)3

(2.7%)

PV/PM/PO3

(6.8%)1

(3.3%)5

(8.8%)2

(3.4%)8

(12.3%)4

(3.6%)

(2006: PF 9.8% - PV 6.5%)

MAS efficacy

Conclusion

• No epidemics since 1997 in the camps for displaced population

• 4-fold reduction in malaria PF since 1996 in camps• MAS still effective• PF remains among the adult male population, particularly

among those leaving the camps overnight and the migrants

THEREFORE• Malaria surveillance and regular reporting still needed

especially in the mobile population• Collaborative effort on both sides of the border necessary• MAS efficacy monitoring essential

Thanks to: • All laboratory teams & HIS officers for their timely contribution to the MTF weekly surveillance system

• Miss Kerala for collecting, storing and computerizing all those reports