Health staff from Lamong village in Attapeu province provide malaria medication in people’s homes as part of the Mass Drug Administration. --Photo ©WHO/Rita Reyburn

World Malaria Day: Laos adopts innovative strategies to accelerate elimination

On April 25, the world marked World Malaria Day, whose theme this year is “Harness innovation to reduce the malaria disease burden and save lives”.
In Laos, a blend of traditional and innovative, evidence-based approaches is helping the country move closer to eliminating all malaria by 2030 and the deadliest strain by 2023.
Malaria now affects only a very small proportion of the population of Laos, mostly in ethnic communities in remote, forested areas.
Epidemiological investigations have found transmission most likely when people sleep overnight in the forest or crop fields, or stay in villages on the edge of the forest. Evenings and nights are when mosquitoes infected with malaria parasites are most likely to bite, including those infected with P. falciparum, which causes the most severe illness.
A relatively small number of communities - 60 villages, with 24,000 people – face the highest risk of malaria transmission, reporting 68 percent (1,851/2,728) of all P. falciparum cases in January 2020 - October 2021.
To work towards zero malaria, especially that caused by P.falciparum in these highest-risk communities, the Lao government’s accelerator strategies include activities tailored to the local context, and informed by local data and disease patterns.
The national malaria programme is supported by the Lao Country Office of the World Health Organisation (WHO) and WHO’s Mekong Malaria Elimination (MME) Programme. 
These comprise complementary approaches - innovation and traditional public health tools:
Innovative approaches:
-  Two rounds of mass drug administration are given to everyone aged 7-49 to kill any malaria parasites in the body. This method treats people with malaria who do not have symptoms as well as those with symptoms. With a high coverage of medication, the malaria parasite is cleared from the community, eliminating the reservoir of malaria infection.
-  Monthly intermittent preventive treatment is then provided to people who sleep overnight in the forest or fields. This protects people from being reinfected with malaria parasites while they are in high-risk areas.
Traditional malaria control tools
- People in communities are provided with insecticide-treated bed nets for all sleeping locations -  villages, forests and fields.
- Active surveillance includes door-to-door visits to screen and test people with symptoms every two weeks to ensure that any cases of malaria are detected promptly.
-  Community engagement is conducted at all levels including advocacy from senior political leaders to community leaders and health education delivered by the village malaria worker during door-to-door visits every two weeks.
The accelerator strategy was adopted after a pilot project was conducted in 2020 in Khammuan province, targeting 5 of the 60 highest-risk villages with about 1,200 people. The impact was impressive, with a 95 percent reduction in malaria cases during the peak malaria season in 2021 compared to the year before.
In March 2022, the first round of mass drug administration was completed in the remaining 55 target villages with a high coverage estimated at 85 percent. The second round started in April to end before the peak malaria season.
The programme follows Laos’ investment in malaria data management systems that have ensured the country can effectively identify and respond to malaria cases.
WHO Representative to Laos, Dr Ying-Ru Jacqueline Lo, said “World Malaria Day is an opportunity to acknowledge the strong political support, governance and community ownership that are key to the programme’s success – despite responding to the COVID-19 pandemic.”
“In Laos, political leadership at all levels has been strong and impressive, including provincial and district political leaders joining activities in the communities. Community engagement and participation has been excellent. We have seen this in many ways including that people have walked long distances from their fields back to their villages to participate in the programme and benefit from its protection,” Dr Lo added.

ByTimes Reporters
(Latest Update April 27, 2022)