MALARIA – CURRENT SITUATION AND INCREASED RISK

AMONG MOBILE AND MIGRANT POPULATIONS IN THE

CENTRAL HIGHLANDS

Quy Nhon Institute of Malariology, Parastology and Entomology (IMPE)

Population Mobility and Malaria Workshop

Hanoi – August 2016

MALARIA AND GLOBAL POPULATION MOBILITY

Malaria is increased in some areas (especially in Africa) due to

migration to other areas for economic and conflict reasons, etc.

(Pim Martens-2000)

The major mortality reason among migrants (Thailand, Sudan,

Somali, Rwanda, Congo)

The risk of malaria and mortality rate due to malaria are the

highest among migrants from Cambodia to Thailand, from

Mozambic to Malawi, from Ethiopia to West Sudan (South Africa

Workshop-2003, Marcia Caldas de Castro)

MALARIA AMONG MIGRANTS IN THE CENTRAL HIGHLANDS

Vietnam: Malaria has been decreasing in many areas

However, there is an increasing trend of informal migration to

the Central Highlands, of going to forest and sleeping on “ray”,

and of cross-border migration, leading to difficulties in

management of and access to health services.

The mortality and transmission risk is high among this group.

POPULATION MOBILITY

Internal migration in Vietnam includes long-term, short-term (temporary) or seasonal migration.

There is inadequate statistics in the national and large-scale data for internal migration in Vietnam with informal, short-term and seasonal migration.

informal migration: is migration to live in other areas without permission of the local agency.

POPULATION MOBILITY

Most of the internal migrants for economic reason who are

not included in the Government migration program are

called “Informal migrants”

Sleeping on “ray”: workers working on “ray” and sleeping

there for one or more nights to manage the harvest.

SOME FEATURES OF INFORMAL MIGRANTS IN THE CENTRAL HIGHLANDS

1. Ethnic minority: Cao Lan, Dao, Mông, Mường, Nùng, Tày, Thái. Mông migrants account for the majority.

2. Religion: Most of them are Protestants, some are Christians (among 17,232 Mông migrants, 13,957 people (81%) are Protestants).

3. Locations of departure: Cao Bằng, Lạng Sơn, Tuyên Quang, Hà Giang, Bắc Giang, Lai Châu, Thái Nguyên, Bắc Kạn, Lào Cai, Thanh Hóa, Quảng Ninh.

MIGRATION ORGANIZATION AND ACTIVITIES

4. Migration in reality is implemented strictly and under a certain procedure

with specific steps:

The main destination is the Central Highlands because of its rich

resources and popularity.

After the period of building new economy 1975-1998, forest and land

resources have been exploited and population has increased to over

4.5 million people.

The capacity of the Central Highlands in accommodating people is

limited, so there is no more capacity for receiving informal migrants in

agriculture-forestry sectors.

This is a great challenge for informal migrants in terms of

stabilization and development

Residence and economic activities

5. Residence location: in the middle of the jungle, in remote, far-flung areas with the main reason for collecting wood in the jungle, working on “ray”, hunting wild animals and avoiding the Government control.

6. Economic activities: destroying forests to make “ray”, exploiting timber for sale, hunting wild animals for meat (Violation of the Forest Development and Protection Law, Environmental Protection Law, Wildlife Protection and Development Law), but these activities take place daily and are increasing, sophisticated, bold and difficult to control.

No Period 1994-1999 2004-2009

1 Inside district migration 1,343,000 1,618,000

2 Inter-district migration 1,138,000 1,709,000

3 Inter-province migration 2,001,000 3,398,000

4 Inter-region migration 1,334,000 2,361,000

Internal migration in 1999-2009

Source: - Central Steering Committee for Census and Housing. Population and housing census of Vietnam in 2009. Main results.

Hanoi, June 2010. - Central Steering Committee for Census and Housing. Population

and housing census of Vietnam in 1999. Samples results. World Publishing House, Hanoi 2000

No Period No. of households

Average no. of informal migrants

Source

1 1991-1995 160,000 Gia Lai online

2 1996-2000 90,000

3 2001-2002 20,000

4 2003-2004 4,000 CT*

5 2005-2008 9,551 40,782

* On 12/11/2004, the Prime Minister issued Directive No.39/2004/CT-TTg on “Some solutions to deal with informal migration”

Informal migrants to the Central Highlands in 1991-2008

STATISTICS ON INFORMAL MIGRANTS FROM NORTHEN PROVINCES TO THE CENTRAL HIGHLANDS 2003

NO Province Informal migrants

Household Population

1 Cao Bằng 9,710 48,700

2 Lạng Sơn 8,500 41,550

3 Thanh Hoá 3,500 19,000

4 Lào Cai 3,200 20,000

5 Hà Giang 1,900 6,600

6 Tuyên Quang 860 4,800

Source: Lao động Newspaper No. 278/2003[6239]- 5/10/2003. Dak lak Newspaper No 8 [2602] - 4/4/2003

H’Mông 134,000

DISTRICTS HAVING INFORMAL MIGRANTS IN DAK LAK,

DAK NÔNG 2001 – 2003

PART I

MALARIA AMONG

INFORMAL MIGRATION COMMUNITY

Informal migration areas

Gender and ethnic features

Survey indicators

Quảng Sơn Dak r Mang

n Average age n Average age

Gender

Male 187

19.48±17.064

(1-70)

194 14.98±14.66

(0.17-65)

Female 219 17.21±15.77

(1-72)

225 18.29±16.35

(1--70)

H Mông 302 74.38 328 78.66

Tày 45 11.08 52 12.47

Ethnicity Nùng 59 14.53 37 8.87

Areas of departure before migrating to Dak Nong

B¾c C¹ n6% Cao B»ng

12%

Hµ Giang11%

Tuyª n Quang71%

Health and administration features in survey areas

T Quảng Sơn community Dak R Mang community

1 Transportation By motorbike but difficult By motorbike but difficult

2 Community Each village has 85-110 persons, 17-20 households far from each other

Each village has 80-120 persons, 16-20 households far from each other

3 House Temporary house with wooden or simple bamboo walls

Temporary house with wooden or simple bamboo walls

4 Area features Forest, Bamboo, small streams Forest, Bamboo, small streams

5 Health access Hard to reach, difficulties in transportation, 30km from health center

Hard to reach, difficulties in transportation, 25km from health center

6 Health No medical worker. Each cluster has only 1 herbal medicine practicioner

No medical worker. Each cluster has only 1 herbal medicine practicioner

7 Agencies One village leader apointed by local people

One village leader appointed by local people

DAK R MANG CUMMUNE with 2,257 INFORMAL MIGRANTS

Malaria knowledge of informal migrants

No Survey indicator

Quảng Sơn, (n=78

households)

Dakrmang (n=81) Total

% % % 1

Causes for Malaria

No information 71.79 75.31 73.58

2 Causes for malaria transmission Mosquito

bite 53.85 59.26 56.60

Mosquito net and sleeping in mosquito net of informal migrants

Survey indicators

Quảng Sơn, 406 persons

(n=78 household)

Dakrmang, 417 persons (n=81)

Total

% % %

Person/net ratio 2.94 2.96 2.95

Sleeping in mosquito net 54.68 51.56 53.10

Sleeping in forest 33.00 48.44 40.83

No Monitoring location Time Malaria parasites

rate Vector Community

1 Dak Mang-Dak Nông 5/2003 9.75 An.minimus H Mông

2 Dak Mang-Dak Nông 6/2004 5.50 An.minimus H Mông

3 Dak Mang-Dak Nông 12/2005 6.75 An.minimus H Mông

4 Quang Sơn-Dak Nông 12/2005 7.12 An.minimus H Mông, Mường

5 DakRu-Dak Nông 6/2004 2.45 An.minimus H Mông

6 Cư Róa-M drak-Dak lak 10/2005 8.66 An.minimus H Mông

7 Ea Trang- M drak-Dak lak 10/2005 7.00 H Mông

8 Krông á- M drak-Dak lak 10/2005 5.33 H Mông

9 Eapan-Eakar-Dak lak 11/2005 5,00 Thái, Tày, Nùng

10 Ea Ô Eakar-Dak lak 11/2005 8,33 An.minimus Mường, Dao

11 Ea Sô Eakar-Dak lak 11/2005 7,33 An.minimus Tày, Nùng

MALARIA- INFORMAL MIGRATION COMMUNITY

PART II

MALARIA

COMMUNITY SLEEPING ON “RAY”

HOUSE ON ‘RAY’

No Knowledge Correct answer Incorrect answer

Number % rate Number % rate

1 Mosquito is the reason for transmission of malaria 257 61.78 159 38.22

2 Malaria parasite is the reason for malaria 251 60.34 165 39.66

Malaria knowledge of people sleeping on “ray”

No Practice Sleeping in net Sleeping without

net

No % rate No % rate

1 Sleeping in mosquito net at home 347 83.41 69 16.59

2 Sleeping in mosquito net on “ray” 178 42.79 238 57.21

Use of mosquito net by people sleeping on “ray”

% rate of people sleeping on “Ray” receiving medicine for self-treatment

60.19 51.5262.26 58.12

0

10

20

30

40

50

60

70

Thanh Trµ Don Ia O Tæng

% nhËn thuèc

MALARIA – COMMUNITY OF PEOPLE SLEEPING ON “RAY”

Monitoring location Time % of parasites Vector

Dak Rin (Kon Tum)

7/2003 6.80 An.minimus

Ngọc Lây (Kon Tum)

8/2003 18.24 An.minimus

9/2003 8.85 An.minimus

I o ( Gia Lai)

9/2004 7.08 An.minimus

Sơn Thái (Khánh Hòa) 5/2004 29.77

An.minimus An.dirus

Community Survey Parasite (+)

% Year

Laos-Vietnam border (Quảng Trị) 1352 57 6.01 2010

Cambodia-Vietnam border (Dak Nong) 452 28 6.2 2012

Working in forest and sleeping on “ray” (Binh Dinh)

416 28 6.7 2011

(Binh Thuận) Working in forest and sleeping on “ray”

273 23 8.4 2012

Local residents 254 3 1.18 2012

Informal migration (Dak Nong) 417 36 8.6 2006

Informal migration (Dak Lak) 830 73 8.8 2011

API 2011 (Malaria active population) 0.17 2011

API 2012 (Malaria active population) 0.18 2012

MALARIA –MOBILE POPULATION COMMUNITY 2010-2012

Malaria-related mortality analysis 2003-2012 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Total Malaria-related mortality

39 20 13 25 13 14 16 8 6 7

Working in forest, sleeping on “ray”

12 10 6 15 10 10 6 6 3 5

Informal migration 9 1 1 2 2 1 3 2 2 0 Malaria-related mortality among mobile people

21 11 7 18 12 11 9 8 5 5

Tỷ lệ TV Dân di biến động

53.85 55.00 53.85

68.00

92.31

78.57

56.25

100.00

83.3371.43

0.00

25.00

50.00

75.00

100.00

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Malaria prevention measures for informal migrants

Vector prevention

Provide mosquito nets to people

Spray insecticide in households (practice) whenever malaria is increasing and potential

Patient management

Arrange health workers for residential clusters

Communication

Conduct health information, education and communication (IEC) to increase the rate of using mosquito nets

Malaria prevention measures for people sleeping on “ray”

Vector prevention

Provide hammocks with cover (research)

Spray insecticide in households (practice) whenever malaria is increasing and potential

Patient management

Provide medicine for self-treatment.

Conduct management before and after people going to forests or sleeping on “ray”.

Communication

Conduct health information, education and communication (IEC) to increase the rate of using mosquito nets and hammocks.

SOME DIFFICULTIES IN MALARIA PREVENTION

FOR MOBILE AND MIGRANT POPULATION

Difficulties in malaria prevention for informal migrants

Local agencies:

There are some interventions, but still a huge number of

informal migrants move to the Central Highlands

Health:

It is difficulty to access the health system because:

Not allowed by local government, therefore it’s difficult for the

health sector to take measures.

Living in far-flung forest, difficult transportation, mainly going

on foot, living far from health stations, so it is very difficult to

access services even if allowed.

Economic difficulty.

Difficulty in malaria prevention for people working in forest and sleeping on “ray”

Inefficient spray with temporary house on “ray”

Houses are sprayed with insecticide but people sleep on “ray” and work

in the forest

The habit of sleeping without mosquito net at home and on “ray”

increases malaria infections

The rate of receiving medicine for self-treatment is low

Use inadequate dose of medicine in self-treatment

It is very difficulty to take people with malaria to hospital in

emergencies leading to high mortality rate

Difficulties in malaria prevention for cross-border mobile population Cross-border mobile population (Vietnam-Laos, Vietnam-Cambodia)

spread malaria risk in a continous and complicated way.

Border quarantine is focused in border check points, but the mobility

and disease transmission mainly happen through informal path,

creating difficulty in malaria patient management.

Bilateral cooperation in malaria management???

REMARKS

Informal migrants continue to move to the Central Highlands

despite many Government Directives (39/2004/CT-TTg)

High incidence of malaria among informal migrants and people

working in the forest and sleeping on “ray”

Difficulty in malaria prevention for mobile and migrant

population

Measures are limited.

RECOMMENDATIONS

Give instructions about malaria prevention & control to mobile and migrant

population

Conduct survey and in-depth epidemiological evaluation of mobile and

migrant population

Study malaria prevention & control measures for mobile and migrant

population

The local government and health sector closely cooperate with each other

Provide budget

Thank you for your attention!