1. Kanchanaburi, May 2007 A collaboration between: SMRU, MSF-F, AMI, IRC, ARC, MHD With the participation of TBBC and HIS/CCSDPT Malaria surveillance in camps for displaced population and migrants: Thai-Myanmar border 1995-2006

2. Camps situation: Background 1984: 7 camps in Tak province, 10,000 persons 1994: 32 camps from Mae Hong Son to Chumpon provinces, 77,000 persons During that period: Frequent malaria outbreaks during camps relocation 40% of total consultations due to malaria 1 st cause of mortality in the camps 1% of pregnant women dying of malaria each year 80% of malaria due to P. falciparum

3. Cure Rate (%) 1975 1980 1985 1990 1995 100 80 60 40 20 CQ SP M 25 M 15 Years P. falciparum resistance to antimalarials (Fansidar) (Mefloquine) (Chloroquine) 1991-92: First MAS trials 1994: MAS 3 in the camps

4. Established in mid-1995 to control epidemics and to develop a coherent malaria control program in the camps based on: –Weekly surveillance system –Reliable laboratory diagnosis with Q.C. –Unique treatment guideline based on mefloquine and artesunate combination therapy and regular update on new protocols Malaria Task Force

5. 199620012006 Total camps241110 Total population a 87,499120,080149,001 Camps reporting to MTF 21108 Population covered by MTF (in % of total popul) 83,344 (95.3%) 119,804 (99.8%) 137,934 (92.6%) a Population as reported by the Thai Burmese Border Consortium (TBBC) monthly report Population coverage Bangkok

6. Malaria morbidity & mortality 199620012006 Total consultations (all causes) * 163,346 * 551,506578,231 Malaria consultations (in % of total consult) 38,702 (23.7%) 15,079 (2.7%) 17,346 (3.0%) PF / 1,000 persons283.675.570.5 PV / 1,000 persons180.850.460.1 Malaria deaths (in % of total deaths) 41 (9.9%) 7 (2.3%) 3 (0.6%) * Probably underestimated, as some camps reported fever cases only

7. Malaria cases per 1,000 residents

8. Ratio PF/PV by age group

9. Ratio PF/PV in adults of Mae La

10. P. falciparum distribution by sex Mae La camp: adults

11. Malaria cases in clinics for migrant workers

12. ED and MAS 3 in the camps 1986 40% of consultations 1 malaria case/person/yr 24% of all deaths 1994-96: ACT in all camps ~ 25% of consultations 0.5 malaria case/person/yr 10% of all deaths 2001 3% of consultations 0.1 malaria case/person/yr 3% of all deaths 2006 3% of consultations 0.1 malaria case/person/yr <1 % of all deaths

13. Malaria prevalence in migrant workers – May 07 < 5yrs old5-15yrs old> 15yrs old MaleFemaleMaleFemaleMaleFemale Total screened 4430575965110 PF00 1 (1.8%) 1 (1.7%) 4 (6.2%) 3 (2.7%) PV/PM/PO 3 (6.8%) 1 (3.3%) 5 (8.8%) 2 (3.4%) 8 (12.3%) 4 (3.6%) (2006: PF 9.8% - PV 6.5%)

14. MAS efficacy

15. Conclusion No epidemics since 1997 in the camps for displaced population 4-fold reduction in malaria PF since 1996 in camps MAS still effective PF remains among the adult male population, particularly among those leaving the camps overnight and the migrants THEREFORE Malaria surveillance and regular reporting still needed especially in the mobile population Collaborative effort on both sides of the border necessary MAS efficacy monitoring essential

16. Thanks to: All laboratory teams & HIS officers for their timely contribution to the MTF weekly surveillance system Miss Kerala for collecting, storing and computerizing all those reports