The Public Engagement (PE) Department in SMRU-BHF was officially formed in 2018. We aim to connect SMRU-BHF and communities, by providing quality healthcare services along with humanitarian assistance to the migrant populations along the Thai-Myanmar border, and to support researchers on community engagement in research. Our key responsibilities are to promote and deliver health knowledge, education, and understanding emphasizing on Malaria, Tuberculosis (TB), Maternal and Child Health (MCH), vaccination, and communicable diseases. Through multiple means of engagement to increase, stimulate, and prevent misconceptions on a health basis.
OVERALL OBJECTIVES OF THE PUBLIC ENGAGEMENT DEPARTMENT
At SMRU we promote health knowledge, education, and awareness toward migrant populations, emphasizing malaria, maternal and child health (MCH), tuberculosis (TB), and communicable diseases. Provide translation support across departments. Promote understating of research with communities. Inform and share research findings and outcomes.We established partnership networks, and maintain good relationships and collaborations with local organizations exiting along the Thai-Myanmar border: Thai Public Health, CBOs, and NGOs.Our strength lies in capacity building for team members, community health workers (CHWs), and stakeholders: religious leaders, teachers, and village heads to maximize their abilities to deliver meaningful engagement to target populations.
At SMRU we promote health knowledge, education, and awareness toward migrant populations, emphasizing malaria, maternal and child health (MCH), tuberculosis (TB), and communicable diseases. Provide translation support across departments. Promote understating of research with communities Inform and share research findings and outcomes.We established partnership networks, and maintain good relationships and collaborations with local organizations exiting along the Thai-Myanmar border: Thai Public Health, CBOs, and NGOs.Our strength lies in capacity building for team members, community health workers (CHWs), and stakeholders: religious leaders, teachers, and village heads to maximize their abilities to deliver meaningful engagement to target populations.
The campaign aims to increase communities’ understanding of malaria, as well as stimulate villagers to seek treatment at the nearest health facilities within 24 hours when symptoms appear.
TEENAGE PREGNANCY DIALOGUE DRAMA PERFORMANCE
The campaign aims to raise awareness of adolescent pregnancy and its danger and to determine if dialogue drama performances can raise awareness of adolescent pregnancy.
EXPANDED PROGRAM ON IMMUNIZATION CAMPAIGN
The PE team intends to provide EPI vaccination information to migrant populations and encourage migrants to comprehensively obtain vaccinations at health facilities nearby health facilities.
TUBERCULOSIS (TB) AWARENESS CAMPAIGN
The campaign implementation is delivered to migrant communities, intending to increase community knowledge and understanding of the prevention and danger of TB disease. We aim to gain behaviour change and seek early treatment, and to reduce discrimination in communities on TB and affected families.
TB – HIV DIALOGUE DRAMA PERFORMANCE FOR COMMUNITY AND SOCIAL TRANSFORMATION
SMRU-BHF aims to deliver messages about TB treatment and provide effective treatment for TB patients free of charge. We emphasise important information and messages among the population living on both sides of the Thai-Myanmar border.
DENGUE AWARENESS RAISING CAMPAIGN
The dengue information was provided for migrant communities, expecting them to obtain knowledge and awareness, as well as to gain their preventative practices to reduce dengue infection in their environment.
FILLING THE GAPS AND STRENGTHENING RELATIONSHIPS WITH PARTNERS
MEETING AND DISCUSSION ON MALARIA ELIMINATION IN TWIN VILLAGES ALONG THE THAI-MYANMAR BORDER
METF and PE teams participated in twin villages meetings, discussing and sharing the malaria situation within twin villages, and co-establish malaria elimination statistic plans. This meeting was also attended by Thai public health personnel, local hospital personnel, and others who are involved and responsible for malaria elimination along the Thai-Myanmar border.
SITE VISIT, ENGAGEMENT, MEETING, AND COLLABORATION WITH LOCAL AUTHORITIES AND COMMUNITY LEADERS
Our team maintains close coordination with local authorities and community leaders, this allows us to obtain permission to access targeted areas and support their needs when requested. We engaged with key contact persons and respected elders, village chiefs, employers, and CHWs. Establishing relationships and building trust with these stakeholders allows our team to identify new migrant clusters and support their needs.Through engaging with them, we learned that migrants faced difficulties with traveling to access health services.
Strengthen the capacity of PE team members and Community Health Workers (CHWs)
Capacity Building for PE team members and relevant departments
To support and enable effective and boost confidence among our team members, and colleagues from other departments, we aimed for capacity building on different topics to strengthen our skills to deliver and conduct our activities in the community with confidence and efficiency by using new techniques and methods to optimize engagement practices.
Empowering and Strengthening the Capacity of Community Health Workers (CHWs) and key persons
The PE team emphasizes collaboration with the communities, aiming to build trust and increase their understanding, and knowledge. And to strengthen their capacity and knowledge on various health topics through training for CHWs and relevant key persons.
Engagement for Vulnerable; ensuring no one is behind in health
The project aims to improve healthcare services for vulnerable populations and respond to emergencies and natural disasters in communities in Karen state, Myanmar by providing capacity-building training for key PE team members, stakeholders, and CHWs-MPWs. As well as to establish self-help groups to respond to any emergency health needs and natural disasters in targeted communities.
Maternal and child health
The primary objective of the SMRU MCH program is to reduce the maternal mortality rate (MMR). A large reduction in MMR was obtained since 1986 and the weekly ANC malaria screening. Then there was a further reduction in mortality by providing safe delivery by trained midwives. But more remains to be done since MMR in Myanmar and in the migrant population is still high. Since the Covid pandemic, SMRU has been conducting outreach ANC to allow better access to antenatal care, and approximately 3000 women deliver annually in our clinics. We have numerous studies on the treatment of malaria in pregnancy, as well as the impact of malaria on the mother and the fetus, were conducted. SMRU documented for the first time, the impact of P. vivax malaria in pregnancy as well as the impacts of malaria and the artemisinin derivatives in the first trimester. SMRU is assessing maternal and neonatal health outcomes, including prenatal care, childbirth practices, and postnatal care. It is responsible for writing the obstetrical guidelines for the medical teams on the border. SMRU is also implementing interventions to improve maternal and child health, including vaccination programs and nutritional deficiency as well as birth control measures.
Malaria department
Shoklo Malaria Research Unit (SMRU) malaria program aims to support malaria elimination in Thailand and Myanmar by generating innovative, evidence-based tools for malaria elimination.
Malaria services for migrants (Migrant clinics)Malaria Elimination Task Force (METF)
Myanmar has one of the largest malaria burdens in the Greater Mekong Subregion (GMS). Throughout the GMS, Plasmodium falciparum parasites are increasingly resistant to artemisinin combination therapies. Given the lack of current alternative treatment options, one proposed solution is to eliminate P. falciparum from the region. Because of promising results, several small-scale elimination projects have been piloted in the GMS, including along the Myanmar-Thailand border. Encouraged by the pilot elimination project's success in reducing malaria cases along the Myanmar-Thailand border, the project was scaled up to encompass a large region of Eastern Kayin State, Myanmar. Elimination of Plasmodium vivax imposes multiple challenges including the prevalence of the G6PD deficiency, adherence to the long-course primaquine, and the presence of asymptomatic reservoir among the communities living in the Kayin State. To address these problems METF was initiated in 2014 with Karen Community Based Organizations (CBOs) and SMRU to eliminate artemisinin resistance Plasmodium falciparum and relapsing Plasmodium vivax in Kayin State, Myanmar.
The overall strategies of METF are: Geographic mapping of the communities residing in malaria risk area Community engagement to increase awareness of early case detection and prevention Generalize access to the early diagnosis and treatment Epidemiological surveillance Malaria prevalence surveys using highly sensitive diagnostic tools Targeted accelerated interventions (mass drug administration) Glucose-6-phosphate-deficiency testing and safe radical regimen for P.vivax Vector control interventions Environmental Surveillance and Malaria Risk Assessment
This program has been co-funded by The Global Fund to fight against Malaria, Aids and Tuberculosis The Bill and Melinda Gates Foundation Wellcome
tuberculosis program
We provide patient-centered comprehensive care, diagnosis and treatment services for TB, TB/HIV co-infection, and multi-drug resistant TB (MDR-TB) for displaced, migrant, cross-border populations in Tak province located in Thailand, and Myanmar populations in the Myawaddy district on the eastern Myanmar border. Since late 2020 and the COVID-19 era, we have promoted case finding in the community through mobile outreach screening with portable chest X-rays. We collaborate with local stakeholders for Thai-Myanmar border TB control.
SMRU's Tuberculosis (TB) program began in late 2009. It provides TB screening service, diagnosis, and treatment services with patient-centered comprehensive care for TB, TB/HIV co-infection, and multi-drug resistant TB (MDR-TB). Migrants, displaced, cross-border populations, ethnic minorities, and Myanmar populations can access to SMRU TB centers located on the Thailand-Myanmar border, one center in the Myawaddy district on the eastern Myanmar border and the other in Tak province, Thailand. Since 2013, SMRU has worked in close collaboration with the Mae Tao Clinic and can support significantly migrants and cross-border populations to get diagnosis and treatment services. SMRU has started GeneXpert PCR testing to improve MDR-TB case detection and extended activities on Active Case Detection for specific risk groups (contacts of TB patients, HIV patients, and health workers). SMRU TB clinics have a capacity of 220 rooms, including isolation rooms for MDR-TB patients. On average, 80% of TB patients are treated in residential care - receiving food, medical care, and psycho-social support while 20% of TB patients are followed in their homes under supervised DOT by our team of healthcare workers.SMRU is collaborating with Ethnic Health Organizations serving ethnic minorities in Karen State, local stakeholders in the border area, and the National TB program of both Thailand and Myanmar.
Till the end of 2023, total presumptive TB screenings to 15,354 TB suspects and we have diagnosed 3,740 TB cases (24%). There are 3132 TB cases (84.0 %) receiving anti-TB treatment in the SMRU TB Program with a 16.4% HIV co-infection rate (513 TB/HIV patients) and 5% MDR-TB case detection (203 MDR-TB cases).
Not only providing standard treatment but also enhancing holistic care for physical, mental, and social well-being, patients ensure to complete a long duration of treatment with good adherence. Treatment Success Rate achieved 87.2% in 2019, 90.4% in 2020, 90% in 2021, and 91.4% in 2022 registered TB patients.
Since late 2020 and the COVID-19 era, we have promoted case finding in the community through mobile outreach screening with portable chest X-ray machines. We have strengthened collaboration with local stakeholders and adapted case-finding strategies for Thai-Myanmar border TB control. SMRU integrates community engagement for the mobilization of communities to participate in TB screenings.
TB outreach teams have screened 14,360 migrants and villagers in community outreach screenings in the Phophra, Mae Ramat, and Mae Sot district of Thailand and in the villages along the border of Myawaddy district in Myanmar. These activities could find 123 TB cases in the community from 2021 to 2023.
laboratory services
The central laboratories at SMRU provide diagnostic services and sample management in support to clinical care provided by SMRU in the fields of maternal and child health, malaria, tuberculosis and other infectious diseases.
Research activities led or supported by the laboratories in the same fields can be found in the general research activities section. They include: haematology, microscopy, microbiology, malaria in-vitro, and entomology laboratories.
haematology
The Haematology laboratory was set up in 2010 and supports SMRU clinical and research work through a variety of basic haematology testing (Complete Blood Count, RBC morphology, C-reactive protein, Haemogobin typing, G6PD deficiency tests). In coordination with PE team, the laboratory organises teaching, training and QC for G6PD deficiency and Point-Of-Care testing within SMRU and for external organizations. The laboratory is run by 1 research assistant, 2 laboratory technicians, 1 laboratory assistant, and 1 haematology research scientist.
Microbiology
The SMRU Microbiology department was established in 2006 to provide a diagnostic service for the SMRU patient population and to facilitate research on regionally important non-malaria infectious diseases. Since then it has expanded to include the molecular diagnostics including malaria. This department carries out a wide range of routine, surveillance and research activities in collaboration with the Oxford Tropical Network and other organisations as summarised below.
The department is staffed by one Molecular Microbiologist (department head), one senior laboratory technician, seven laboratory technicians, one senior laboratory assistant, four laboratory assistant and one specimen/equipment manager; with the addition of visiting students and volunteers. It participates in a number of external quality assurance schemes and is an active member of the MORU Tropical Health Network Clinical Microbiology Group, which aims include harmonising standard operating procedures across the network. In March 2020, it was registered as a certified laboratory for COVID-19 testing, awarded by the Department of Medical Science, Ministry of Public Health, Thailand.
Main Activities Diagnosis of infectious diseases using microscopy, culture, serology, molecular and protein profiling methods; Antibiotic sensitivity profiling for treatment and surveillance purposes; Response to the outbreaks using molecular diagnostics, for example Chikungunya and COVID-19; Bacterial/fungal identification using MALDI-TOF MS; Surveillance/diagnostic of the respiratory infections in the populations on the Thailand-Myanmar border; Providing microbiological support for the SMRU Tuberculosis programs, for example microscopic examination (AFB smear) and molecular diagnostic (GeneXpert); Providing microbiological support for SMRU maternal and child health activities, for example routine antenatal urine screening was introduced in 2012 for all pregnant women; Providing knowledge of infectious diseases to the community through Public Engagement team, for example Melioidosis, COVID-19; Providing specimen, equipment, and external lab referral management and obtain the permits to comply with the Pathogens and Animal Toxins Act.
microscopy
There are a total of 22 laboratory technicians working currently at S.M.R.U. They are all local people who have been trained by SMRU at various times since its inception in 1986.There are 16 lab technicians working in 4 clinics spread along the Thai-Myanmar border (from 125 km north of Mae-Sot to 60 km to the south). Their main activity is malaria diagnosis by microscopy (Giemsa stain). They are also able to perform Urine analysis, Stool examination, direct vaginal discharge examination, Haematocrit, Reticulocytes counts, G6PD deficiency rapid fluorescence test and G6PD Biosensor, Bilirubin measurement and Blood transfusion testing. They are also involved in a lot of blood sample processing including centrifugation and storage for various clinical studies.
Five senior lab technicians are working in S.M.R.U central lab in Mae-Ramat. Their main roles are to train and supervise lab technicians in the clinics, manage the staff, perform internal quality control, perform external quality control for various NGOs working in the region, perform second blind readings and third readings for clinical trials, reading malaria smears from malaria surveys, perform quality control on malaria rapid diagnostic tests (R.D.T) used in the field, manage supplies stocks and order, clean and maintain regularly microscopes and other equipment and data entering.
One lab technician is in charge of training and supervising staff (home visitors) performing malaria R.D.T and preparing malaria blood smears in the clinics. He is also involved with M.E.T.F (Malaria elimination Task Force) and exhaustive malaria surveys.
Our laboratories have been certified for registered studies through trainings and external QC by pharmaceutical companies such as G.S.K and Novartis. We follow the regular external quality control organized by the Thai Public Health and all our lab technicians achieved grade 1 in malaria parasites detection and specie identification during a WHO test evaluation in 2014.
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