Combating malaria: PATH’s ongoing efforts for a brighter, malaria-free future in Myanmar

The poor socioeconomic status prevalent in these regions exacerbates the burden of the disease, amplifying the challenges faced by communities already grappling with limited access to health care resources and infrastructure.

Although there was a notable decrease in cases between 2012 and 2020, there has been a resurgence from 2021 to 2023. The resurgence is attributed to various factors, including population movement and high levels of migration leading to a sudden increase in malaria caseload, and operational challenges due to safety and security concerns.

These factors hinder timely interventions and disrupt efforts to interrupt malaria transmission.

PATH’s malaria portfolio has expanded significantly. Since 2019, PATH's Myanmar country program has been actively involved in the national effort to combat malaria, concentrated in several key areas:

Strengthening surveillance and monitoring:

• PATH played a key technical role in transitioning Myanmar's malaria surveillance system from paper-based reporting to a digital platform using the District Health Information System 2 (DHIS2).
• We also contributed to developing an emergency response action plan for malaria outbreaks.
• Furthermore, PATH conducts assessments to identify shortcomings in surveillance systems at the township level.

Combating P. vivax malaria:

Myanmar faces a resurgence of P. vivax malaria, jeopardizing the 2030 elimination goal with cases rising from 43,578 in 2020 to 103,216 in 2022. PATH's Partnership for Vivax Elimination (PAVE) project supports Myanmar in accelerating the elimination of P. vivax malaria, the country's dominant malaria parasite strain. Ensuring the elimination of P. vivax malaria requires a radical cure which means complete clearance of the malaria parasite from the patient, both blood and liver. The project aims to revise radical cure policies, implement new treatment protocols, and ensure robust regulatory systems.

As PAVE advances toward malaria elimination, significant strides have been made in improving treatment adherence and policy advocacy, as illustrated in recent initiatives and milestones.

PAVE developed the optimized radical cure road map in 2020, followed by primaquine (PQ) adherence counseling tools in 2021. In the following year, PAVE organized the first technical advocacy meeting for optimized radical cure tools at the national level, alongside the introduction of a pharmacovigilance system of antimalarial medication in Myanmar. This set the foundation for a more effective approach in combating malaria, through improved patient adherence and systematized treatment protocols.

In 2023, PAVE continued its momentum by advocating to the National Malaria Control Program (NMCP) to implement operational research for glucose-6-phosphate dehydrogenase (G6PD) testing.

This testing is necessary to identify G6PD enzyme deficiency, a prevalent blood disorder in Myanmar. This deficiency can lead to the rupture of red blood cells in patients who are deficient in the G6PD enzyme and take a certain dose of primaquine.

They also organized a central-level working group focused on PQ-adherence counseling and the integration of the PQ 7-day regimen into national treatment guidelines (NTG). The strategic efforts of PAVE have led to the nationwide use of the tools for PQ-adherence treatment and counseling.

Additionally, the PQ 7-day regimen is set to be integrated into the national treatment guideline and a pharmacovigilance system is being developed at the national level.

Strengthening local leadership:

• The Digital Community Health Initiative (DCHI) project enhances malaria surveillance system at the sub-national level.
• PATH collaborates with data focal persons of Rakhine state and Tanintharyi Region to enhance the malaria surveillance system.

It is important for all malaria implementing partners, including the national program, to use the same platform for tracking and monitoring malaria cases. But many implementing partners collect data via carbonless paper-based reporting, and then enter the data into their own systems. The data from implementing partners is shared with the NMCP at the central level through Google Drive.

However, township focal persons from NMCP do not have direct access to Google Drive to obtain comprehensive NMCP and implementing partners' malaria data. This has led to parallel reporting systems among key stakeholders and reliance on paper-based reporting, making it challenging for township focal persons to promptly review the complete malaria situation in their respective areas and implement evidence-based interventions.

To address these challenges, all malaria data from partners will soon be integrated into the NMCP server to provide access to comprehensive malaria data. In Myanmar, the national program aims to merge the various reporting systems for collecting electronic case data from different implementing partners into a single DHIS2 database, approaching the “one malaria surveillance system.”

“Our efforts focus on equipping these essential personnel with the knowledge, skills, and tools necessary to effectively manage and utilize data, ensuring a robust, dedicated, and proactive approach to malaria surveillance within our target areas," said Dr. Wah Wah Thaw, Program Manager of Malaria and Digital Health.

In the pursuit of establishing a unified “one malaria surveillance system,” PATH is focusing on strengthening the township-level malaria surveillance system and enhancing the capacity of township-level data management focal persons.

Digital Square, a partnering organization, plays a crucial role in this effort by developing training packages and modules for Microsoft Excel, Quantum Geographic Information System (QGIS), and data management.

The training sessions aim to improve the proficiency of township malaria focal persons in Excel, enabling them to efficiently organize, analyze, and visualize malaria surveillance data. Additionally, participants are trained to create informative and geospatially accurate maps using QGIS.

During the training sessions, participants were also introduced to the basics of data management and surveillance using examples from their daily work activities to explain the concepts. They were educated about data storage options, file naming systems, and data quality assurance.

Emphasis was placed on the role of the Vector-Borne Diseases Control Unit (VBDC) staff in malaria data management. In the hands-on practice session, participants compiled hypothetical malaria data and prepared to use the NMCP data and implementing partner data. They also learned how to use pivot tables to combine data.

As part of DCHI’s capacity-building activities, the Digital Square team is developing digital literacy modules, including the fundamentals of working with the DHIS2 application, to improve digital skills and readiness to use DHIS2-based applications effectively.

All participants, including government officials from state and regional health departments and township medical officers, welcomed and encouraged DCHI training for the clear instruction and helpful demonstrations. Furthermore, based on verbal communication with the regional health department, township-level data focal persons who participated in the previous training showed more interest in data management after participating in the training.

Looking ahead, PATH remains committed to supporting Myanmar’s goal of eliminating malaria by 2030. By collaborating with Myanmar’s National Malaria Control Program and other stakeholders, PATH continues to play a vital role in achieving a malaria-free future for Myanmar.