Successful Elimination of Falciparum Malaria Following the Introduction of Community-Based Health Workers in Eastern Myanmar

Background: In recent years, substantial progress in malaria control has been made in Myanmar which has 85% of the malaria in the Greater Mekong subregion. The residual burden of disease now remains primarily in remote areas where currently recommended malaria elimination approaches are generally not feasible.Method:Medical Action Myanmar introduced community health workers (CHWs) to deliver early diagnosis and treatment for malaria in hard-to-reach communities in Mon state, East Myanmar. We conducted a retrospective analysis to assess the impact of this intervention. The decline in malaria incidence and prevalence in febrile patients was assessed using negative binomial regression mixed effects models.Results: Between 2011 and 2018, a network of 172 CHWs serving a population of 236,340 carried out 260,201 malaria rapid diagnostic tests (RDTs) to investigate acute febrile illness. The median (IQR) blood examination rate was 1.33% (0.38–3.48%) per month. The incidence of P. falciparum malaria (including mixed infections) declined by 70% (95% CI: 65–75%) each year of CHW operation. P. vivax malaria incidence declined by 56% (95% CI: 50–62%) per year. Malaria RDT positivity rates for P. falciparum and P vivax declined by 69% (95% CI: 62–75%) and 53% (95% CI: 47–59%) per year respectively. Between 2017 and 2018 only one imported P. falciparum case was detected in 54,961 RDTs.Interpretation: The introduction of CHWs providing community-based malaria diagnosis and treatment, integrated in basic health care services, in remote communities in Mon state led to a dramatic reduction in malaria. Within six years, P. falciparum was eliminated.Funding: The malaria project was supported by The Global Fund to fight AIDS, Tuberculosis and Malaria and Medical Action Myanmar. This retrospective analysis has been conducted with the support of The Wellcome Trust.Declaration of Interest: We declare no competing interests.Ethical Approval: This is not a trial or a description of prospective clinical research. It did not require ethical approval. It is a description of how a malaria control implementation in Myanmar was conducted in cooperation with the Myanmar National Malaria Control Programme, and what impact that had. The implementation was in accordance with, and part of, the National Malaria Control programme (who subsequently took over parts of the project). It is a description of best practice. We have published about this project earlier. ERB approval was also not required.