Summary 

More than 30,000 people die from malaria each month – mostly children.  Dr. Ohrt has committed his life to eliminating drug-resistant malaria.  In 2016, the first published report of nearly incurable malaria parasites crossing borders from Cambodia to Vietnam (Imwong et al, 2017).  Dr. Ohrt and his family are moving this month to this cross-border area (Mondulkiri Province, Cambodia) to help facilitate the rapid elimination of these deadly strains; malaria has increased 2-fold in the first 9 months of 2017 in this province.  If these strains reach Africa, we estimate 7+ million lives are at risk over the next decade; history appears to be repeating itself (Trape 2001).  Base on this threat, WHO’s goal is to eliminate drug-resistant Pf malaria in Cambodia by 2020 (WHO 2015).  A recent high profile article illustrates the threat and describes where ConsortiumHA will be working beginning in in Jan 2018 (New York Times, Nov 2017).

Challenge

In 2015-2016, in partnership with the Vietnam National Malaria Control and Elimination Program, Dr. Ohrt’s team implemented in Phu Yen Province a smartphone-based information system based on a Bill & Melinda Gates background paper (Ohrt et al 2015) to document where malaria transmission was actually occurring (forest hot spots).  We found each household had 4.3 treated nets (where there is little or no transmission), but <20% of people sleeping in the transmission hot spots actually used one (Ohrt 2016, Ngo 2016).  We believe this challenge is due to the provision of nets people did not want to use, the lack of effective monitoring and a poor understanding by the population at risk of the threat.  We also observed problems with complete treatment of malaria patients.  We have visited four different provinces in Cambodia; observations reveal similar challenges.

Solution

In order to achieve WHO’s ambitious goal, we cannot continue with “business as usual.”  We need decisive action now!  We believe these parasites can be rapidly eliminated through greatly improved targeting of a package of vector-control and treatment interventions.  Dr. Ohrt’s team’s efforts in in Phu Yen Province, Vietnam led in part, to the greatest decrease in malaria in Vietnam of any province (81%) from 2015 to 2016.  Our study district in Phu Yen has only had 9 cases of malaria in the first 10 months of 2017, progressively decreasing ~290/year in 2013 and 2014.

To provide on-going quality monitoring to make sure available resources are reaching the target locations and populations, we have developed a “Red-to-Green, keep it Green” mapping system for prevention and treatment usage monitoring (Ohrt 2016).  We will extend our system to ensure malaria patients are treated correctly, completely and with quality drugs in three very challenging districts in Cambodia.  We will also extend the effort to map key transmission hot spots, make sure people are using treated bed nets and enhance the mosquito-prevention package similar to what a Western soldier would use (e.g. treated clothing, repellent and safer sleeping, sitting and bathing areas).

Long-Term Impact

 

We intend with this project’s results to demonstrate how to rapidly decrease malaria in this important cross-border area.  Through partnerships, we will facilitate the scaling of the new approach, hopefully in time to eliminate these challenging parasites before all drugs are lost, at which time it will be nearly impossible.

The US CDC estimates the direct costs for malaria (e.g., illness, treatment, premature death) to be at least $12 billion per year. The cost in lost economic growth is many times more than that (US CDC 2016).   If we do not act rapidly and effectively now, these costs will be much higher!

  • Videos (click here for 5-minute version and here for 20-minute version)
  • Narrative, timelines and budget (click to open)
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  • Address: Bonnie Ohrt, Accountant, Consortium for Health Action, 13949 Shoreside Cr.
    Savage, MN 55378.
  • Email: Bonnie Ohrt <bonnie.ohrt@gmail.com>
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