Cross-border malaria control for internally displaced persons: observational results from a pilot programme in eastern Burma/Myanmar.
OBJECTIVE
To document the feasibility of a cross-border community based integrated malaria control programme implemented by internally displaced persons in eastern Burma/Myanmar.


METHODS
This pilot study was conducted from February 2003 through January 2005 in seven villages of displaced ethnic Karen. Interventions comprised early diagnosis of Plasmodium falciparum and treatment with mefloquine and artesunate, distribution of long-lasting insecticide treated nets (LLITNs), and educational messages. The primary outcome measure was P. falciparum prevalence during bi-annual universal screenings with the Paracheck-Pf (Orchid Biomedical Systems, Goa, India) device. Secondary outcomes were P. falciparum incidence and process indicators related to net use and malaria knowledge, attitudes and practices (KAP).


RESULTS
P. falciparum prevalence in original programme areas declined from 8.4% [95% confidence interval (CI) 8.3-8.6] at baseline to 1.1% (95% CI 1.1-1.2) in the final screening. Annual incidence in original areas declined from 232 to 70 cases/1000/year [incidence rate ratio 0.30 (95% CI 0.24-0.39)]. The proportion of household members sleeping under a LLITN improved from 0% to 89% and malaria KAP improved in all areas.


CONCLUSIONS
Integrated malaria control organized and implemented by displaced persons is feasible in eastern Burma/Myanmar. The decline in P. falciparum prevalence and incidence suggest that it may be possible to reduce the burden of disease and the reservoir of malaria in eastern Burma/Myanmar, with implications for malaria control in the greater Mekong region.
Richards
Adam K
AK
Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA 90024, USA. arichar2@jhmi.edu
Banek
Kristin
K
Mullany
Luke C
LC
Lee
Catherine I
CI
Smith
Linda
L
Oo
Eh Kalu Shwe
EK
Lee
Thomas J
TJ
D000962:Antimalarials / Q000627:therapeutic use*; D001512:Bedding and Linens; D004641:Emigration and Immigration; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006287:Health Planning Guidelines; D006801:Humans; D015994:Incidence; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D009032:Mosquito Control / Q000379:methods; D002052:Myanmar / Q000453:epidemiology / Q000208:ethnology; D010865:Pilot Projects; D015995:Prevalence; D012036:Refugees
D000962:Antimalarials