IRIN
MYANMAR: Malaria risk high in cyclone-hit delta
24 July 2008


YANGON, 24 July 2008 (IRIN) - The risk of malaria remains high in 
Myanmar's cyclone-affected Ayeyarwady Delta, health officials warn, 
almost three months after Cyclone Nargis struck.

Close to 140,000 people were killed or registered missing when the 
category four storm hit the southern coastal area on 2 and 3 May, 
affecting some 2.4 million people.

"As the rainy season is ongoing, there is still a high risk of malaria 
transmission," Leonard Ortega, a medical officer with the World Health 
Organization (WHO) in the former Burmese capital of Yangon, told IRIN.

There was always a possibility of a malaria outbreak, though very 
difficult to quantify, due to the destruction of the storm, coupled with 
the sheer size of the affected area, he said.

The delta comprises about 23,500 sqkm - almost twice the size of Lebanon 
- of labyrinthine inland rivers and waterways.

Yet according to the National Malaria Control Programme, since Nargis 
struck, there have been very few cases of the mosquito-borne disease, 
with the UN Children's Fund (UNICEF) reporting just over 100.

"So far we have been able to control malaria [in the cyclone areas]," 
Osamu Kunii, UNICEF's health and nutrition chief in Yangon, said, 
despite heavy monsoon rains over the past few months.

The townships most at risk include Labutta, Bogale, Ngaputaw and 
Myaungmya, UNICEF said.

But according to Ortega, the cyclone and accompanying tidal surge 
created a number of risk factors.

The influx of salty water inland created perfect breeding sites for 
Anopheles sundaicus, the principal malaria vector in coastal areas, 
while the early onset of this year's monsoon rains created favourable 
breeding grounds for Anopheles dirus and minimus, the main malaria 
vectors in inland areas.

In addition, there is a high chance the mosquitoes would seek humans to 
feed on, since the cyclone killed large numbers of animals, he added.

Having no protective shelter and going to the forest for food, fuel or 
building materials would also make people more vulnerable to malaria, 
the WHO official said.

The serious disruption to basic health services, including the malaria 
control programme, could also lead to an increase in malaria 
transmission in the delta.

Prevention programmes

WHO and its partners continue to work on malaria prevention, 
distributing a guide on prevention and control, as well as anti-malaria 
drugs, insecticides, diagnostic kits, and long-lasting mosquito nets. It 
has also provided training for NGOs and volunteers.

Moreover, WHO has mobilised regional surveillance officers from other 
parts of the country and in cooperation with the Ministry of Health and 
deployed them to areas across the delta to monitor any outbreaks.

In collaboration with NGOs and the Ministry of Health, WHO set up an 
early warning and response system for communicable diseases. It also 
supports the health ministry and some NGOs in revitalising basic health 
services.

To mitigate the risk factors, UNICEF is providing bed netting, 
insecticides and drugs in high-risk areas, reaching many pregnant women 
and children under five, Kunii said.

Early detection and treatment of malaria and the use of 
insecticide-treated mosquito nets are seen as key measures to prevent 
potential outbreaks, Ortega said.

If outbreaks do occur, such interventions would be further intensified 
and indoor residual spraying would be undertaken where appropriate, he 
added.

An ongoing problem

Malaria - which kills some 2.7 million people worldwide annually - is 
reportedly the leading cause of morbidity and mortality in Myanmar.

According to WHO, a major risk group is adults who work in gem mining, 
logging, agriculture, plantations and construction in the forests. Such 
internal migrant workers lack access to laboratory and treatment 
services.

As a result, about 70 percent of reported malaria cases in Myanmar are 
older than 15, and about 60 percent are related to forestry work.

Given poor access to healthcare in remote areas where most cases 
originate, the total malaria burden is likely to be much higher than 
reported. Moreover, self-treatment is common, and reporting does not 
include cases treated in the private sector or with traditional 
medicine.

Since 1999, reported malaria mortality has declined, but the number of 
reported cases has increased. The latter is probably explained by 
improved availability and use of malaria treatment services, the world 
health body reports.


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