Arboshield Project
Project Coordinator:
Dr. Darouny PHONEKEO
Assistant Coordinator:
Dr. Phonepadith KHATTIGNAVONG
Consultant: Dr. Philippe CAVAILLER
Staff members:
Dr. Moritoshi IWAGAMI, Dr. Sengdeuane
KEOMALAPHET, Dr. Phoyphaylinh PRASAYASITH, Ms. Pheovaly SOUNDALA, and Ms. Sonesimmaly SANNIKONE
Finance and administration:
Dr. Antoine des GRAVIERS and Ms. Phouvanhnamalee VILAYSOUK
Background
Military sector in Lao People’s Democratic Republic (Lao PDR) covers certain portion of Lao population including their family. The Lao Ministry of Defense has a medical institute in Vientiane capital and several hospitals across the country. However, unfortunately, the Lao Ministry of Defense has limited supports from donors to improve their capacity and facilities since most of the donors hesitate to support military sector. On the other hand, several studies reported that soldiers are high risk population for malaria because they patrol and stay in the forests where malaria and other vector-borne diseases are highly prevalent [1,2]. Moreover, our previous study found household clustering of asymptomatic malaria infections which means malaria is transmitted by Anopheles mosquito within a family [3]. These resuMilitary sector in Lao People’s Democratic Republic (Lao PDR) covers certain portion of Lao population including their family. The Lao Ministry of Defense has a medical institute in Vientiane capital and several hospitals across the country. However, unfortunately, the Lao Ministry of Defense has limited supports from donors to improve their capacity and facilities since most of the donors hesitate to support military sector. On the other hand, several studies reported that soldiers are high risk population for malaria because they patrol and stay in the forests where malaria and other vector-borne diseases are highly prevalent [1,2]. Moreover, our previous study found household clustering of asymptomatic malaria infections which means malaria is transmitted by Anopheles mosquito within a family [3]. These results suggested that even though malaria is not frequently transmitted in a village nowadays, malaria can be introduced by their family members who work and stay in the forests.lts suggeMilitary sector in Lao People’s Democratic Republic (Lao PDR) covers certain portion of Lao population including their family. The Lao Ministry of Defense has a medical institute in Vientiane capital and several hospitals across the country. However, unfortunately, the Lao Ministry of Defense has limited supports from donors to improve their capacity and facilities since most of the donors hesitate to support military sector. On the other hand, several studies reported that soldiers are high risk population for malaria because they patrol and stay in the forests where malaria and other vector-borne diseases are highly prevalent [1,2]. Moreover, our previous study found household clustering of asymptomatic malaria infections which means malaria is transmitted by Anopheles mosquito within a family [3]. These results suggested that even though malaria is not frequently transmitted in a village nowadays, malaria can be introduced by their family members who work and stay in the forests.sted that even though malaria is not frequently transmitted in a village nowadays, malaria can be introduced by their family members who work and stay in the forests.
Objective of the Arboshield project is to strengthen the capacity of the medical sector in the Ministry of Defense and some of the selected civilian hospitals in the Ministry of Health, Lao PDR in the areas of vector-borne diseases, especially surveillance, outbreak detection/ response, diagnosis, treatment, prevention, as well as biosafety and security through training and improving their facilities. The roles of the Lao-Japan Parasitology lab in this project are giving a training course on malaria for the trainees from military sector and civil sector, and quality assessment of malaria diagnosis in the Lao Institute for Disease Prevention and six military provincial hospitals (Xieng Khouang, Luang Prabang, Vang Vieng, Vientiane Capital, Savannakhet, and Champasak), which participate in the Arboshield project.
Results of quality assessment for malaria diagnosis
Blood samples collected from malaria suspected patients in the military hospitals were transported to IPL, and diagnosed by malaria rapid diagnostic test (RDT) and nested PCR. The summary of malaria diagnosis conducted by IPL was shown in Table 1 and 2. In 2019, a total of 320 samples is examined. Four samples were tested positive by RDT (1 P. falciparum and 3 P. vivax) in 103 Hospital in Vientiane Capital and 106 Hospital in Champasak, whereas eight samples were tested positive by PCR (1 P. falciparum and 7 P. vivax) in 103 Hospital in Vientiane Capital, 101 Hospital in Xiangkhouang and 106 Hospital in Champasak. In 2020, a total of 23 samples is examined (as of 5th November 2020) (Table 2). Only three samples were tested positive by RDT (2 P. falciparum and 1 P. vivax) in 101 Hospital in Xiang Khouang and 109 Hospital in Savannakhet. These results showed that sensitivity of the PCR is 2 times higher than that of the RDT. Thus, high-sensitive diagnostic method like PCR is necessary for accurate diagnosis for malaria case management and control in Lao PDR. It is noted that the number of malaria cases or suspected cases in the military hospitals decreased drastically in 2020 (n=23) compared with 2019 (n=320). It would be a good sign of improvement of malaria prevention and control among the military sector in Lao PDR.
Malaria screening survey for Lao military personnel in Savannakhet province in 2019
The Lao military base in Seno, Savannakhet province conducted a malaria screening survey in 2019. A total of 593 military personnel who had no signs and symptoms of malaria participated in this survey. All the participants were tested negative by malaria RDT. Dried blood samples were collected from the military personnel on filter paper (FTATM Classic Card, GE Healthcare Life Sciences, WhatmanTM, UK) for PCR analysis. As of 3rd November, 2020, genomic DNA was extracted from the 400 filter papers by using QIAamp DNA Mini Kit (QIAGEN, Germany). Malaria screening nested PCR was performed for 351 samples and only two samples were PCR positive for P. vivax. This PCR analysis was performed by the Arboshield trainee (one year), Dr. Phouniloud HONGVANGTHONG under the guidance of the staffs in the Lao-Japan Parasitology Lab as an onthe- job training. The remaining samples will be examined.
Financial support
This project is financially supported by The Defense Threat Reduction Agency (DTRA), USA.
References
1. Iwagami M, Keomalaphet S, Khattignavong P, Soundala P, Lorphachan L, Matsumoto-Takahashi E, Strobel M, Reinharz D, Phommasansack M, Hongvanthong B, Brey PT, Kano S. The detection of cryptic Plasmodium infection among villagers in Attapeu province, Lao PDR. PLoS Neglected Tropical Diseases, 11(12): e0006148, 2017.
2. Vilay P, Nonaka D, Senamonty P, Lao M, Iwagami M, Kobayashi J, Hernandez PM, Phrasisombath K, Kounnavong S, Hongvanthong B, Brey PT, Kano S. Malaria prevalence, knowledge, perception, preventive and treatment behavior among military in Champasak and Attapeu provinces, Lao PDR: a mixed methods study. Tropical Medicine and Health, 47:11, 2019.
3. Pongvongsa T, Nonaka D, Iwagami M, Nakatsu M, Phongmany P, Nishimoto F, Kobayashi J, Hongvanthong B, Brey PT, Moji K, Mita T, Kano S. Household clustering of asymptomatic malaria infections in Xepon district, Savannakhet province, Lao PDR. Malaria Journal, 15(1): 508, 2016.
