Malaria elimination in India requires additional surveillance mechanisms

2021 ◽  
Author(s):  
Manju Rahi ◽  
Payal Das ◽  
Amit Sharma
Keyword(s):  
Real Time ◽  
Malaria Elimination ◽  
Surveillance Data ◽  
Surveillance Systems ◽  
Malaria Surveillance ◽  
Aggregated Data ◽  
Malaria Burden ◽  
The Core ◽  
Reporting Systems ◽  
Geographic Regions

Abstract Malaria surveillance is weak in high malaria burden countries. Surveillance is considered as one of the core interventions for malaria elimination. Impressive reductions in malaria-associated morbidity and mortality have been achieved across the globe, but sustained efforts need to be bolstered up to achieve malaria elimination in endemic countries like India. Poor surveillance data become a hindrance in assessing the progress achieved towards malaria elimination and in channelizing focused interventions to the hotspots. A major obstacle in strengthening India’s reporting systems is that the surveillance data are captured in a fragmented manner by multiple players, in silos, and is distributed across geographic regions. In addition, the data are not reported in near real-time. Furthermore, multiplicity of malaria data resources limits interoperability between them. Here, we deliberate on the acute need of updating India’s surveillance systems from the use of aggregated data to near real-time case-based surveillance. This will help in identifying the drivers of malaria transmission in any locale and therefore will facilitate formulation of appropriate interventional responses rapidly.

scholarly journals Strengthening surveillance systems for malaria elimination: a global landscaping of system performance, 2015–2017

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Christopher Lourenço ◽  
Andrew J. Tatem ◽  
Peter M. Atkinson ◽  
Justin M. Cohen ◽  
Deepa Pindolia ◽  
...  
Keyword(s):  
Malaria Elimination ◽  
Surveillance System ◽  
Health Sector ◽  
Surveillance Data ◽  
World Health ◽  
Surveillance Systems ◽  
Malaria Surveillance ◽  
Remote Communities ◽  
Median Percentage ◽  
Health Organization

Abstract Background Surveillance is a core component of an effective system to support malaria elimination. Poor surveillance data will prevent countries from monitoring progress towards elimination and targeting interventions to the last remaining at-risk places. An evaluation of the performance of surveillance systems in 16 countries was conducted to identify key gaps which could be addressed to build effective systems for malaria elimination. Methods A standardized surveillance system landscaping was conducted between 2015 and 2017 in collaboration with governmental malaria programmes. Malaria surveillance guidelines from the World Health Organization and other technical bodies were used to identify the characteristics of an optimal surveillance system, against which systems of study countries were compared. Data collection was conducted through review of existing material and datasets, and interviews with key stakeholders, and the outcomes were summarized descriptively. Additionally, the cumulative fraction of incident infections reported through surveillance systems was estimated using surveillance data, government records, survey data, and other scientific sources. Results The landscaping identified common gaps across countries related to the lack of surveillance coverage in remote communities or in the private sector, the lack of adequate health information architecture to capture high quality case-based data, poor integration of data from other sources such as intervention information, poor visualization of generated information, and its lack of availability for making programmatic decisions. The median percentage of symptomatic cases captured by the surveillance systems in the 16 countries was estimated to be 37%, mostly driven by the lack of treatment-seeking in the public health sector (64%) or, in countries with large private sectors, the lack of integration of this sector within the surveillance system. Conclusions The landscaping analysis undertaken provides a clear framework through which to identify multiple gaps in current malaria surveillance systems. While perfect systems are not required to eliminate malaria, closing the gaps identified will allow countries to deploy resources more efficiently, track progress, and accelerate towards malaria elimination. Since the landscaping undertaken here, several countries have addressed some of the identified gaps by improving coverage of surveillance, integrating case data with other information, and strengthening visualization and use of data.

Surveillance-based estimation of the malaria disease burden in a low endemic state of Punjab, India, targeted for malaria elimination

2021 ◽  
Author(s):  
Jaspreet Kaur ◽  
Taruna Kaura ◽  
Ayush Sharma ◽  
Ashish Kumar ◽  
M K Pangotra ◽  
...  
Keyword(s):  
Malaria Elimination ◽  
Control Strategies ◽  
The State ◽  
Primary Data ◽  
Effective Control ◽  
Malaria Surveillance ◽  
Weighted Estimates ◽  
Malaria Burden ◽  
Routine Surveillance ◽  
Malaria Trends

Abstract Background The state of Punjab in India qualifies for malaria elimination because the number of cases reported through routine surveillance is in decline. However, surveillance system prevalence mainly provides malaria trends. Therefore, a prospective epidemiological study was designed to estimate the malaria burden in the state. Methods District-wise annual parasite incidence (API) was used for identification of three strata, representing high, moderate and low API zones. A total of 0.9 million people from nine districts was under malaria surveillance for 1 y. The weighted estimates of API for the three regions was calculated and combined to give an estimate of API for the total population of the state. Results Based upon the primary data generated, malaria cases from high, moderate and low malaria-endemic areas were estimated to be 3727, 904 and 106, respectively. Further, the total number of malaria cases in the state was estimated to be 4737 (95% CI 4006 to 5469) cases per annum. Conclusion Actual burden of malaria in the state of Punjab, India, is about seven to eight times higher than that reported by routine surveillance activities. However, the state still qualifies for malaria elimination but needs vigorous efforts to strengthen the active surveillance and reporting system along with implementation of effective control strategies to achieve malaria elimination.

scholarly journals Accounting for healthcare-seeking behaviours and testing practices in real-time influenza forecasts

2018 ◽  
Author(s):  
Robert Moss ◽  
Alexander E Zarebski ◽  
Sandra J Carlson ◽  
James M McCaw
Keyword(s):  
Real Time ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surveillance Data ◽  
Surveillance Systems ◽  
Healthcare Seeking ◽  
Public Health Decision ◽  
Predictive Skill ◽  
Health Decision ◽  
Substantial Change

AbstractFor diseases such as influenza, where the majority of infected persons experience mild (if any) symptoms, surveillance systems are sensitive to changes in healthcare-seeking and clinical decision-making behaviours. This presents a challenge when trying to interpret surveillance data in near-real-time (e.g., in order to provide public health decision-support). Australia experienced a particularly large and severe influenza season in 2017, perhaps in part due to (a) mild cases being more likely to seek healthcare; and (b) clinicians being more likely to collect specimens for RT-PCR influenza tests. In this study we used weekly Flutracking surveillance data to estimate the probability that a person with influenza-like illness (ILI) would seek healthcare and have a specimen collected. We then used this estimated probability to calibrate near-real-time seasonal influenza forecasts at each week of the 2017 season, to see whether predictive skill could be improved. While the number of self-reported influenza tests in the weekly surveys are typically very low, we were able to detect a substantial change in healthcare seeking behaviour and clinician testing behaviour prior to the high epidemic peak. Adjusting for these changes in behaviour in the forecasting framework improved predictive skill. Our analysis demonstrates a unique value of community-level surveillance systems, such as Flutracking, when interpreting traditional surveillance data.

scholarly journals Updates on malaria epidemiology and profile in Cabo Verde from 2010 to 2019: The goal of Elimination

2020 ◽  
Author(s):  
Adilson José DePINA ◽  
Gillian Stresman ◽  
Helga Sofia Baptista Barros ◽  
António Lima Moreira ◽  
Abdoulaye Kane Dia ◽  
...  
Keyword(s):  
Malaria Elimination ◽  
High Mobility ◽  
Malaria Surveillance ◽  
Individual Level ◽  
Cabo Verde ◽  
Malaria Burden ◽  
Malaria Epidemiology ◽  
The Past ◽  
Epidemic Period ◽  
Imported Cases

Abstract Background: Located in West Africa, Cabo Verde is an archipelago consisting of nine inhabited islands. Malaria has been endemic since the settlement of the islands during the 16th century and is poised to achieve malaria elimination in January 2021. The aim of this research is to characterise the trends in malaria cases from 2010 to 2019 in Cabo Verde as the country transitions from endemic transmission to elimination and prevention of reintroduction phases. Methods: All confirmed malaria cases reported to the Ministry of Health between 2010 and 2019 were extracted from the passive malaria surveillance system. Individual-level data available included age, sex, municipality of residence, and the self-reported countries visited if travelled within the past 30 days, therby classified as imported. Trends in reported cases were visualised and multivariable logistic regression used to assess risk factors associated with a malaria case being imported and differences over time.Results: A total of 814 incident malaria cases were reported in the country between 2010 and 2019, the majority of which were Plasmodium falciparum. Overall, prior to 2017, when the epidemic occurred, 58.08% (95% CI: 53.56-64.59) of infections were classified as imported, whereas during the post-epidemic period, 93.33% (95% CI: 86.97-99.70) were imported. The last locally acquired case was reported in January 2018. Imported malaria cases were more likely to be 25-40 years old (AOR: 15.14, 95% CI: 5.86-39.15) compared to those under 15 years of age and more likely during the post-epidemic period (AOR: 56.12; 95% CI: 13.97-225.49) and most likely to be reported on Sao Vicente Island (AOR=4256.9, 95% CI=260-6.96e+4) compared to Boa Vista. Conclusions: Cabo Verde has made substantial gains in reducing malaria burden in the country over the past decade and are poised to achieve elimination in 2021. However, the high mobility between the islands and continental Africa, where malaria is still highly endemic, means there is a constant risk of malaria reintroduction. Characterisation of imported cases provides useful insight for program and enables better evidence-based decision-making to ensure malaria elimination can be sustained.

scholarly journals Accounting for Healthcare-Seeking Behaviours and Testing Practices in Real-Time Influenza Forecasts

2019 ◽  
Vol 4 (1) ◽  
pp. 12 ◽  
Author(s):  
Robert Moss ◽  
Alexander Zarebski ◽  
Sandra Carlson ◽  
James McCaw
Keyword(s):  
Real Time ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surveillance Data ◽  
Community Level ◽  
Surveillance Systems ◽  
Healthcare Seeking ◽  
Public Health Decision ◽  
Predictive Skill ◽  
Health Decision

For diseases such as influenza, where the majority of infected persons experience mild (if any) symptoms, surveillance systems are sensitive to changes in healthcare-seeking and clinical decision-making behaviours. This presents a challenge when trying to interpret surveillance data in near-real-time (e.g., to provide public health decision-support). Australia experienced a particularly large and severe influenza season in 2017, perhaps in part due to: (a) mild cases being more likely to seek healthcare; and (b) clinicians being more likely to collect specimens for reverse transcription polymerase chain reaction (RT-PCR) influenza tests. In this study, we used weekly Flutracking surveillance data to estimate the probability that a person with influenza-like illness (ILI) would seek healthcare and have a specimen collected. We then used this estimated probability to calibrate near-real-time seasonal influenza forecasts at each week of the 2017 season, to see whether predictive skill could be improved. While the number of self-reported influenza tests in the weekly surveys are typically very low, we were able to detect a substantial change in healthcare seeking behaviour and clinician testing behaviour prior to the high epidemic peak. Adjusting for these changes in behaviour in the forecasting framework improved predictive skill. Our analysis demonstrates a unique value of community-level surveillance systems, such as Flutracking, when interpreting traditional surveillance data. These methods are also applicable beyond the Australian context, as similar community-level surveillance systems operate in other countries.

scholarly journals Sustainability of a mobile phone application-based data reporting system in Myanmar’s malaria elimination program: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Win Han Oo ◽  
Kaung Myat Thu ◽  
Julia C. Cutts ◽  
Win Htike ◽  
Kyawt Mon Win ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Mobile Phones ◽  
Malaria Elimination ◽  
User Satisfaction ◽  
Parallel Systems ◽  
Cost Effective ◽  
Surveillance Systems ◽  
Malaria Surveillance ◽  
System Integrity ◽  
Case Based

Abstract Background Strengthening surveillance systems to collect near-real-time case-based data plays a fundamental role in achieving malaria elimination in the Greater Mekong Subregion (GMS). With the advanced and widespread use of digital technology, mHealth is increasingly taking a prominent role in malaria surveillance systems in GMS countries, including Myanmar. In Myanmar’s malaria elimination program, an mHealth system called Malaria Case-based Reporting (MCBR) has been applied for case-based reporting of malaria data by integrated community malaria volunteers (ICMVs). However, the sustainability of such mHealth systems in the context of existing malaria elimination programs in Myanmar is unknown. Methods Focus group discussions were conducted with ICMVs and semi-structured in-depth interviews were conducted with malaria program stakeholders from Myanmar’s Ministry of Health and Sports and its malaria program implementing partners. Thematic (deductive followed by inductive) analysis was undertaken using a qualitative descriptive approach. Results Technological and financial constraints such as inadequate internet access, software errors, and insufficient financial resources to support mobile phone-related costs have hampered users’ access to MCBR. Poor system integrity, unpredictable reporting outcomes, inadequate human resources for system management, and inefficient user support undermined the perceived quality of the system and user satisfaction, and hence its sustainability. Furthermore, multiple parallel systems with functions overlapping those of MCBR were in use. Conclusions Despite its effectiveness and efficiency in malaria surveillance, the sustainability of nationwide implementation of MCBR is uncertain. To make it sustainable, stakeholders should deploy a dedicated human workforce with the necessary technical and technological capacities; secure sustainable, long-term funding for implementation of MCBR; find an alternative cost-effective plan for ensuring sustainable system access by ICMVs, such as using volunteer-owned mobile phones for reporting rather than supporting new mobile phones to them; and find a solution to the burden of multiple parallel systems. Trial registration Not applicable.

scholarly journals Two parallel reporting systems for malaria surveillance in Pakistan, 2013–17: is exact burden reflected?

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1986
Author(s):  
Hammad Habib ◽  
Razia Fatima ◽  
Abdul Baseer Achakzai ◽  
Ahmad Wali ◽  
Aashifa Yaqoob ◽  
...  
Keyword(s):  
Information System ◽  
Disease Surveillance ◽  
Health Information System ◽  
Cross Sectional Study ◽  
Surveillance Systems ◽  
Malaria Surveillance ◽  
District Health ◽  
Cross Sectional ◽  
Reporting Systems ◽  
Reported Data

Background: Pakistan is facing challenges regarding the availability of reliable data for malaria surveillance. These include lack of coordination between different reporting systems and fragmented information system. This study aimed to compare the reporting of malaria surveillance systems in Pakistan. Methods: There are two parallel reporting systems for malaria surveillance in Pakistan, the District Health Information System (DHIS) and Malaria Information System (MIS). DHIS reports on all morbidity at health facility level, while MIS is only used for malaria surveillance in the donor supported districts. A cross sectional study was conducted between July-September 2018 by using the retrospective records of DHIS and MIS data reported to the Directorate of Malaria Control (DOMC) Islamabad during 2013-17. Descriptive and inferential analysis was performed to compare the coverage, outcome and impact indicators. Results: During 2013-17, all districts (n=145, 100%) across Pakistan reported on the DHIS. The MIS reporting coverage has gradually increased from 21 (14.5%) to 72 (49.7%) districts. Reported number of suspected screened and confirmed malaria cases were compared. MIS reported twice the number of suspects screened for malaria (100.5%) and confirmed malaria cases (124.4%) as compared to the DHIS. The difference in the reported average annual blood examination rate (ABER) was 3.8, test positivity rate (TPR) was -0.9 and the annual parasite incidence (API) was 4.9/1000 population over five years between two systems. DHIS reported only half the ABER and API as compared to MIS. Conclusion: There is huge under-reporting of suspected and confirmed malaria cases in the DHIS as compared to MIS. Urgent attention is needed to address this, as it is vital to have uniform reporting of true disease burden across the country. An integrated disease surveillance system, improved data validation systems, and use of the online DHIS-2 are potential options for better integrity and coherence of reported data.

An Observational Study Using English Syndromic Surveillance Data Collected During the 2012 London Olympics – What did Syndromic Surveillance Show and What Can We Learn for Future Mass-gathering Events?

2016 ◽  
Vol 31 (6) ◽  
pp. 628-634 ◽  
Author(s):  
Dan Todkill ◽  
Helen E. Hughes ◽  
Alex J. Elliot ◽  
Roger A. Morbey ◽  
Obaghe Edeghere ◽  
...  
Keyword(s):  
Public Health ◽  
Observational Study ◽  
Real Time ◽  
Syndromic Surveillance ◽  
Olympic Games ◽  
Surveillance Data ◽  
Surveillance Systems ◽  
Mass Gathering ◽  
Opening Ceremony ◽  
London 2012

AbstractIntroductionIn preparation for the London 2012 Olympic Games, existing syndromic surveillance systems operating in England were expanded to include daily general practitioner (GP) out-of-hours (OOH) contacts and emergency department (ED) attendances at sentinel sites (the GP OOH and ED syndromic surveillance systems: GPOOHS and EDSSS).Hypothesis/ProblemThe further development of syndromic surveillance systems in time for the London 2012 Olympic Games provided a unique opportunity to investigate the impact of a large mass-gathering event on public health and health services as monitored in near real-time by syndromic surveillance of GP OOH contacts and ED attendances. This can, in turn, aid the planning of future events.MethodsThe EDSSS and GPOOHS data for London and England from July 13 to August 26, 2012, and a similar period in 2013, were divided into three distinct time periods: pre-Olympic period (July 13-26, 2012); Olympic period (July 27 to August 12); and post-Olympic period (August 13-26, 2012). Time series of selected syndromic indicators in 2012 and 2013 were plotted, compared, and risk assessed by members of the Real-time Syndromic Surveillance Team (ReSST) in Public Health England (PHE). Student’s t test was used to test any identified changes in pattern of attendance.ResultsVery few differences were found between years or between the weeks which preceded and followed the Olympics. One significant exception was noted: a statistically significant increase (P value = .0003) in attendances for “chemicals, poisons, and overdoses, including alcohol” and “acute alcohol intoxication” were observed in London EDs coinciding with the timing of the Olympic opening ceremony (9:00 pm July 27, 2012 to 01:00 am July 28, 2012).ConclusionsSyndromic surveillance was able to provide near to real-time monitoring and could identify hourly changes in patterns of presentation during the London 2012 Olympic Games. Reassurance can be provided to planners of future mass-gathering events that there was no discernible impact in overall attendances to sentinel EDs or GP OOH services in the host country. The increase in attendances for alcohol-related causes during the opening ceremony, however, may provide an opportunity for future public health interventions.TodkillD, HughesHE, ElliotAJ, MorbeyRA, EdeghereO, HarcourtS, HughesT, EndericksT, McCloskeyB, CatchpoleM, IbbotsonS, SmithG. An observational study using English syndromic surveillance data collected during the 2012 London Olympics – what did syndromic surveillance show and what can we learn for future mass-gathering events?Prehosp Disaster Med. 2016;31(6):628–634.

scholarly journals Updates on malaria epidemiology and profile in Cabo Verde from 2010 to 2019: The goal of Elimination

2020 ◽  
Author(s):  
Adilson José DePINA ◽  
Gillian Stresman ◽  
Helga Sofia Baptista Barros ◽  
António Lima Moreira ◽  
Abdoulaye Kane Dia ◽  
...  
Keyword(s):  
Malaria Elimination ◽  
High Mobility ◽  
Malaria Surveillance ◽  
Individual Level ◽  
Cabo Verde ◽  
Malaria Burden ◽  
Malaria Epidemiology ◽  
The Past ◽  
Epidemic Period ◽  
Imported Cases

Abstract Background: Located in West Africa, Cabo Verde is an archipelago consisting of nine inhabited islands. Malaria has been endemic since the settlement of the islands during the 16th century and is poised to achieve malaria elimination in January 2021. The aim of this research is to characterise the trends in malaria cases from 2010 to 2019 in Cabo Verde as the country transitions from endemic transmission to elimination and prevention of reintroduction phases.Methods: All confirmed malaria cases reported to the Ministry of Health between 2010 and 2019 were extracted from the passive malaria surveillance system. Individual-level data available included age, sex, municipality of residence, and the self-reported countries visited if travelled within the past 30 days, therby classified as imported. Trends in reported cases were visualised and multivariable logistic regression used to assess risk factors associated with a malaria case being imported and differences over time.Results: A total of 814 incident malaria cases were reported in the country between 2010 and 2019, the majority of which were Plasmodium falciparum. Overall, prior to 2017, when the epidemic occurred, 58.1% (95% CI: 53.6-64.6) of infections were classified as imported, whereas during the post-epidemic period, 93.3% (95% CI: 86.9-99.7) were imported. The last locally acquired case was reported in January 2018. Imported malaria cases were more likely to be 25-40 years old (AOR: 15.1, 95% CI: 5.9-39.2) compared to those under 15 years of age and more likely during the post-epidemic period (AOR: 56.1; 95% CI: 13.9-225.5) and most likely to be reported on São Vicente Island (AOR=4256.9, 95% CI=260-6.9e+4) compared to Boavista.Conclusions: Cabo Verde has made substantial gains in reducing malaria burden in the country over the past decade and are poised to achieve elimination in 2021. However, the high mobility between the islands and continental Africa, where malaria is still highly endemic, means there is a constant risk of malaria reintroduction. Characterisation of imported cases provides useful insight for program and enables better evidence-based decision-making to ensure malaria elimination can be sustained.

scholarly journals Sustainability of a Mobile Phone Application-Based Data Reporting System in Myanmar’s Malaria Elimination Program: A Qualitative Study

2021 ◽  
Author(s):  
Win Han Oo ◽  
Kaung Myat Thu ◽  
Julia Cutts ◽  
Win Htike ◽  
Kyawt Mon Win ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Mobile Phones ◽  
Malaria Elimination ◽  
User Satisfaction ◽  
Parallel Systems ◽  
Cost Effective ◽  
Surveillance Systems ◽  
Malaria Surveillance ◽  
System Integrity ◽  
Case Based

Abstract Background Strengthening surveillance systems to collect near-real-time case-based data plays a fundamental role in achieving malaria elimination in the Greater Mekong Subregion (GMS). With the advanced and widespread use of digital technology, mHealth is increasingly taking a prominent role in malaria surveillance systems in GMS countries, including Myanmar. In Myanmar’s malaria elimination program, an mHealth system called Malaria Case-based Reporting (MCBR) has been applied for case-based reporting of malaria data by integrated community malaria volunteers (ICMVs). However, the sustainability of such mHealth systems in the context of existing malaria elimination programs in Myanmar is unknown. Methods Focus group discussions were conducted with ICMVs and semi-structured in-depth interviews were conducted with malaria program stakeholders from Myanmar’s Ministry of Health and Sports and its malaria program implementing partners. Thematic (deductive followed by inductive) analysis was undertaken using a qualitative descriptive approach. Results Technological and financial constraints such as inadequate internet access, software errors, and insufficient financial resources to support mobile phone-related costs have hampered users’ access to MCBR. Poor system integrity, unpredictable reporting outcomes, inadequate human resources for system management, and inefficient user support undermined the perceived quality of the system and user satisfaction, and hence its sustainability. Furthermore, multiple parallel systems with functions overlapping those of MCBR were in use. Conclusions Despite its effectiveness and efficiency in malaria surveillance, the sustainability of nationwide implementation of MCBR is uncertain. To make it sustainable, stakeholders should deploy a dedicated human workforce with the necessary technical and technological capacities; secure sustainable, long-term funding for implementation of MCBR; find an alternative cost-effective plan for ensuring sustainable system access by ICMVs, such as using volunteer-owned mobile phones for reporting rather than supporting new mobile phones to them; and find a solution to the burden of multiple parallel systems. Trial registration: Not applicable

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