Malaria control in Vietnam: the Binh Thuan experience

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Abstract
Objective The National Malaria Control Program (NMCP) in Vietnam is based on application of insecticide-treated bed nets (ITNs), spraying of insecticides and early microscopic diagnosis of malaria and treatment (EDTM) with artemisinin drugs. This study explores the implementation of the NMCP at provincial level and its impact on malaria incidence (mi) and prevalence in Binh Thuan in southern Vietnam. Methods Data on implementation of EDTM, distribution of ITNs, annual mi and Plasmodium index (pi) were derived from intervention logbooks and surveillance records kept by the provincial Malaria Station since 1988. The relation between interventions and the change of pi over time was analysed with Generalized Estimating Equations. Results Control activities focused on the highly endemic zones where ITNs were distributed free of charge to ethnic minority groups, including twice yearly re-impregnation, from 1992 onwards. This almost completely replaced insecticide spraying. Complete ITN coverage of these groups was achieved in 1995, constituting 40% of the entire population. In all malaria endemic communes, primary health care posts were consecutively upgraded or installed, mainly between 1992 and 1995, offering EDTM with artemisinin drugs free of charge. Before 1994, mi peaked to over 50/1000, pi to over 16% in the highly endemic zones. In 1998, these had decreased to below 9/1000 and 4% respectively. The effects of the interventions could not be discerned with statistical significance. Conclusion Malaria incidence and prevalence declined significantly in Vietnam, possibly due to the malaria control efforts, but coinciding with rapid socioeconomic changes.