title: Progress of partial integration of malaria control with other vector borne diseases control in northern Thailand.
abstract: Thailand partially integrated the malaria program into the provincial and local Public Health system starting in 2003 by adding it to the control of other vector borne diseases and by transferring some activities to the Public Health Department. This study evaluates the results of this transfer on 8 high malaria incidence districts of Mae Hong Son and Chiang Mai Provinces. Indicators were measured for all community hospitals, Vector Borne Disease Control Units, (VBDU), health centers (HC), malaria clinics, and malaria posts in 2003 and 2004 during the first two years of partial integration. The number of Vector Borne Disease Control staff decreased 1.8 - 3%, and their operational budgets decreased 25%. The VBDU staff did all the indoor residual spraying (IRS), insecticide treated net (ITN) work and entomology surveys, they took 80.6% of the blood films, and treated 72% of the patients, while Public Health system did the remainder. The Annual Parasite Incidence (API) (1 - 10/1,000) and IRS coverage (88 - 100%) remained adequate in most areas during the first years after partial integration, but the API increased (to 31.6 - 57.6/1,000) in some populations. The percentage of insecticide treated bed net coverage was adequate in Mae Hong Son (95.4%), but inadequate in Chiang Mai (52.2%). Early diagnosis and prompt treatment (4 - 23 days), hospitals reporting disruption of anti-malarial drugs (3 of 7), and health centers having all needed equipment, training, and drugs for malaria diagnosis (9%) remain inadequate. If the program is allowed to diminish, malaria could spread again among the population. Integration of antimalarial activities into the general Public Health system has only been partially successful. We recommend the integration process and results should be monitored and evaluated to find and mitigate problems as they occur, and modify the integration process if needed.
authors.affiliation: Vector Borne Disease Section, Office of Disease Prevention and Control No. 10, Chiang Mai, Thailand. suwannapa@yahoo.com
authors.forename: Wannapa
authors.initials: W
authors.lastname: Suwonkerd
authors.forename: Robert
authors.initials: R
authors.lastname: Vryheid
authors.forename: Nantawan
authors.initials: N
authors.lastname: Suwannachote
mesh_terms: D000818:Animals; D000962:Antimalarials / Q000600:supply & distribution / Q000627:therapeutic use; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D007303:Insect Vectors; D057148:Insecticide-Treated Bednets; D007306:Insecticides; D008288:Malaria / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D009032:Mosquito Control / Q000458:organization & administration*; D015397:Program Evaluation; D018571:Sentinel Surveillance; D013785:Thailand / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D007306:Insecticides