Cambodia Malaria Elimination Project (CMEP)

The Challenge

Malaria prevention and control efforts by the Royal Government of Cambodia and the U.S. President’s Malaria Initiative, with URC as a key implementing partner, have led Cambodia closer to achieving malaria elimination by 2025.

Challenges in scaling up and maintaining malaria elimination efforts include the high transmission rate in forest goer and mobile and migrant populations along Cambodia’s borders. Well known as epicenters for multidrug-resistant malaria development, these border areas and hard-to-reach populations have required intensified coverage of targeted services.

While Cambodia’s National Center for Parasitology, Entomology and Malaria Control (CNM) already made great strides in malaria control efforts, more control measures were needed. With the support of the Cambodia Malaria Elimination Project (CMEP), they expanded the model elimination package to all operational districts (ODs), strengthened surveillance efforts, and improved the decentralized capability to prevent, diagnose, and treat malaria to reach elimination targets. An elimination package incorporating the 1-3-7 surveillance approach – to report confirmed malaria cases within one day, investigate confirmed cases within three days, and apply control measured to prevent further transmission within seven days – as well as directly observed therapy (DOT) and follow-up microscopy were all used to successfully reduce the number of malaria cases in pilot ODs.

Overview and Objectives

The Cambodia Malaria Elimination Project built on URC’s 20-year legacy of working with the Ministry of Health and CNM to eliminate malaria and control the spread of drug-resistant malaria in the Greater Mekong Subregion. This includes implementation of the USAID Control and Prevention of Malaria Project from 2011 to 2016 and its predecessor project, Malaria Control in Cambodia.

CMEP supported CNM to implement a full suite of malaria control and elimination activities. These included the use of the model elimination package in target ODs, as well as prevention, testing and case finding, surveillance, and monitoring and evaluation in all nine project ODs.

The nine target ODs of the CMEP project were located in Pursat, Battambang, and Pailin Provinces.

Achievements

Between 2000 and 2019, the number of malaria cases in Cambodia decreased by 80%. Malaria deaths declined by 100% to zero deaths nationwide. Cambodia is on track to eliminate Plasmodium falciparum (Pf) malaria by 2023, and all species of malaria, including Plasmodium vivax (Pv), by 2025. Seven out of the nine project-supported ODs reached elimination status by 2020. CMEP implemented partial elimination activities in the two remaining ODs as they transitioned from control to elimination. The project successfully contributed to the reduction of multidrug-resistant P.f. malaria. URC’s achievements under CMEP included:

• 1-3-7 surveillance strategy activities were successfully implemented in five elimination ODs. 82% were notified within one day, 76% were investigated within three days, and 93% were responded to within seven days.
• More than 800,000 individuals were reached through interpersonal communication in elimination and transitional ODs.
• 98% of suspected malaria cases were tested in all project ODs, and 91% of confirmed positive cases received treatment according to National Treatment Guidelines. 

“I am very much impressed with the work CMEP is doing in the field during this crisis time and also to see that the 1-3-7 approach has remarkably reduced malaria cases in Cambodia. The case based surveillance tool that is used to know the travel history of malaria patients could be a useful tool in the era of the COVID-19 crisis and could be adapted for contact tracing of positive corona virus patients,” says U.S. Ambassador to Cambodia, Mr. W. Patrick Murphy while visiting the CMEP office during the COVID-19 partial lockdown.

URC is currently implementing the Cambodia Malaria Elimination Project 2 (CMEP2).

USAID Cambodia interviewed Dr. Sokomar Nguon – URC’s CMEP Senior Technical Advisor – for their Health Champion series. Dr. Sokomar worked diligently to decrease malaria cases in the Battambang, Pailin, and Pursat Provinces. These border provinces have experienced some of the highest rates of malaria transmission among mobile and migrant populations.