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[Malaria in a changed health care system in Vietnam]
L Bont1, N Schepel, P de Vries
1Academisch Medisch Centrum, afd. Infectieziekten, Tropische Geneeskunde en AIDS, Amsterdam.
Objective:
To determine how and where malaria was diagnosed in a forestry area in South-Vietnam and how it was treated.
Design:
Descriptive.
Setting:
Hieu Liem, Dong Nai province, Vietnam.
Method:
In the government hospital and health posts malaria diagnosis and treatment were free of charge while treatment had to be paid for in four private clinics. A population survey was carried out in the forestry area and outside this area: the people were examined for splenic enlargement and a blood sample was analysed.
Results:
Most patients went to private clinics and it was here that malaria was most frequently diagnosed. In 7.5% of the population in the forest area parasites were found while 1.8% of those living outside the forest appeared to have parasites in the blood. None of the persons with parasitaemia had splenomegaly. Splenomegaly was found in 2.9% of the population, 6.7% in and 0.9% outside the forest area.
Conclusion:
Recent changes in the health sector in Vietnam have liberalized malaria treatment, possibly control. The wide distribution and extensive use of effective drugs like artesunate and mefloquine have probably contributed to reduction of (severe) malaria, but development of resistance to these drugs is to be feared. Control of drug distribution and of prescription practices is urgently needed.