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FOREST MALARIA IN VIETNAM: A CHALLENGE FOR CONTROL

Forest malaria is a complex but common phenomenon occurring in southeast Asia. We studied its epidemiology through a prospective community-based study in central Vietnam. A total of 585 individuals were followed for two years by active case detection and biannual cross-sectional surveys. The prevalence of antibodies to Plasmodium falciparum was constantly about 20% across surveys and the incidence rate of clinical episodes of P. falciparum malaria was 0.11/person-year. Multivariate analysis showed that regular forest activity was the main risk factor for clinical malaria and malaria infections. Untreated bed nets had a significant protective effect (60%), except for people regularly sleeping in the forest. The population-attributable fraction for regular forest activity was estimated to be 53%. Our results confirm the major role played by forest activity on the malaria burden in this area and provide the basis for targeting control activities to forest workers. New interventions based on insecticide-treated materials need to be urgently evaluated.

Received March 17, 2003. Accepted for publication May 29, 2003.

Acknowledgments: We thank all the study participants in Village 3 and the two Hamlet Health Workers for their effective contribution to the present study. We also thank the staff of the Provincial Malaria Station of Binh Thuan Province, the Institute of Malariology, Parasitology and Entomology in Ho Chi Minh City and the National Institute of Malariology, Parasitology and Entomology in Hanoi for their full and constant support of this study.

Financial support: This work was supported by the Belgian Cooperation in the framework of the Institutional Collaboration between the Institute of Tropical Medicine in Antwerp and the National Institute of Malariology, Parasitology and Entomology in Hanoi.

Authors’ addresses: Annette Erhart, Nico Speybroeck, Marc Coosemans, and Umberto D’Alessandro, Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp. Belgium, Telephone: 32-3-247-63-08, Fax: 32-3-247-63-59, E-mail: aerhart{at}itg.be. Ngo D. Thang, Le X. Hung, Tran Q. Tuy, and Le D. Cong, National Institute of Malariology, Parasitology and Entomology, BC 10 200, Tu Liem District, Hanoi, Vietnam, Telephone: 84-4-854-30-34, Fax: 84-4-854-30-15, E-mail: nimpe @netnam.org.vn. Nguyen Q. Hung, National Institute of Malariology, Parasitology and Entomology, BC 10 200, Tu Liem District, Hanoi, Vietnam and Institute of Malariology, Parasitology and Entomology, 699 Trang Hung Dao Street, District 5, Ho Chi Minh City, Vietnam. Le V. Toi, Institute of Malariology, Parasitology and Entomology, 699 Trang Hung Dao Street, District 5, Ho Chi Minh City, Vietnam, Telephone: 84-8-835-31-17, Fax: 84-8-839-07-34, E-mail: vmcpimpehcm{at}saigonnet.vn.

Reprint requests: Annette Erhart, Epidemiology Unit, Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp. Belgium.