Medical Action Myanmar, Yangon, Myanmar; Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Lancet Infect Dis. 2022 Jun;22(6):e171-e175. doi: 10.1016/S1473-3099(21)00256-5. Epub 2021 Dec 22.
The countries of the Greater Mekong subregion-Myanmar, Thailand, Laos, Cambodia, and Vietnam-have set a target of eliminating all Plasmodium falciparum malaria by 2025. Generous funding has been provided, principally by The Global Fund to Fight AIDS, Tuberculosis, and Malaria, to achieve this objective and thereby prevent the spread of artemisinin-resistant Plasmodium falciparum to India and Africa. As the remaining time to reach agreed targets is limited and future external funding is uncertain, it is important to be realistic about the future and spend what remaining funding is left, wisely. New, labour intensive, vertical approaches to malaria elimination (such as the 1-3-7 approach) should not be promoted as these are unproven, likely to be ineffective, costly, and unlikely to be sustainable in the most remote areas where malaria prevalence is highest. Instead, the focus should be on reducing the malaria burden more rapidly in the remaining localised high transmission foci with proven effective interventions, including mass drug administration. Well supported community-based health workers are the key operatives in controlling malaria, but their remit should be broadened to sustain the uptake of their services as malaria declines. This strategy is a sustainable evolution, which will improve rural health care while ensuring progress towards malaria elimination.
大湄公河次区域的国家——缅甸、泰国、老挝、柬埔寨和越南——设定了到 2025 年消除所有恶性疟疾病例的目标。为实现这一目标，从而防止耐青蒿素恶性疟原虫传播到印度和非洲，全球抗击艾滋病、结核病和疟疾基金提供了慷慨的资金。由于实现商定目标的剩余时间有限，未来的外部资金也不确定，因此，对未来持现实态度并明智地使用剩余资金非常重要。不应推广新的、劳动密集型的疟疾消除垂直方法（如 1-3-7 方法），因为这些方法未经证实，可能无效、昂贵，并且在疟疾流行率最高的最偏远地区不太可能可持续。相反，重点应放在通过在剩余的局部高传播焦点地区实施经过验证的有效干预措施，包括大规模药物治疗，更快速地降低疟疾负担。有充分支持的以社区为基础的卫生工作者是控制疟疾的关键执行者，但应扩大他们的职责范围，以维持其服务的普及，因为疟疾正在减少。这一策略是一种可持续的演变，将改善农村医疗保健，同时确保在消除疟疾方面取得进展。
