scholarly journals Eliminating Plasmodium falciparum malaria: results from tailoring active case detection approaches to remote populations in forested border areas in north-eastern Cambodia

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ann-Sophie Stratil ◽  
Lieven Vernaeve ◽  
Sergio Lopes ◽  
Yves Bourny ◽  
Kylie Mannion ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Falciparum Malaria ◽  
Plasmodium Falciparum Malaria ◽  
Target Population ◽  
Local Communities ◽  
Case Detection ◽  
Active Case Detection ◽  
Active Case ◽  
North Eastern ◽  
Border Areas

Abstract Background Remaining Plasmodium falciparum cases in Cambodia are concentrated in forested border areas and in remote populations who are hard to reach through passive case detection. A key approach to reach these populations is active case detection by mobile malaria workers (MMWs). However, this is operationally challenging because of changing movement patterns of the target population moving into less accessible areas. From January 2018 to December 2020, a tailored package of active case detection approaches was implemented in forested border areas of three provinces in north-eastern Cambodia to reach remote populations and support the elimination of falciparum malaria. Methods Key elements of this project were to tailor approaches to local populations, use responsive monitoring systems, maintain operational flexibility, build strong relationships with local communities, and implement close supervision practices. MMWs were recruited from local communities. Proactive case detection approaches included mobile malaria posts positioned at frequented locations around and within forests, and locally informed outreach activities targeting more remote locations. Reactive case detection was conducted among co-travellers of confirmed cases. Testing for malaria was conducted independent of fever symptoms. Routine monitoring of programmatic data informed tactical adaptations, while supervision exercises ensured service quality. Results Despite operational challenges, service delivery sites were able to maintain consistently high testing rates throughout the implementation period, with each of 45 sites testing a monthly average of 64 (SD 6) people in 2020. In 2020, project MMWs detected only 32 P. falciparum cases. Over the project period, the P. falciparum/P. vivax ratio steadily inversed. Including data from neighbouring health centres and village malaria workers, 45% (80,988/180,732) of all people tested and 39% (1280/3243) of P. falciparum cases detected in the area can be attributed to project MMWs. Remaining challenges of the last elimination phase include maintaining intensified elimination efforts, addressing the issue of detecting low parasitaemia cases and shifting focus to P. vivax malaria. Conclusions Reaching remote populations through active case detection should remain a key strategy to eliminate P. falciparum malaria. This case study presented a successful approach combining tailored proactive and reactive strategies that could be transferred to similar settings in other areas of the Greater Mekong Subregion.

scholarly journals Eliminating Plasmodium falciparum malaria: Results from tailoring active case detection approaches to remote populations in forested border areas in north-eastern Cambodia

2021 ◽  
Author(s):  
Ann-Sophie Stratil ◽  
Lieven Vernaeve ◽  
Sergio Lopes ◽  
Yves Bourny ◽  
Kylie Mannion ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Plasmodium Falciparum Malaria ◽  
Target Population ◽  
Local Communities ◽  
Case Detection ◽  
Active Case Detection ◽  
Active Case ◽  
North Eastern ◽  
Passive Case Detection ◽  
Border Areas

Abstract Background: Remaining Plasmodium falciparum cases in Cambodia are concentrated in forested border areas and in remote populations who are hard to reach through passive case detection. A key approach to reach these populations is active case detection by mobile malaria workers (MMWs). However, this is operationally challenging because of changing movement patterns of the target population moving into less accessible areas. From January 2018 to December 2020, a tailored package of active case detection approaches was implemented in forested border areas of three provinces in north-eastern Cambodia to reach remote populations and support the elimination of P. falciparum malaria.Approach: Key elements of this project were to tailor approaches to local populations, use responsive monitoring systems, maintain operational flexibility, build strong relationships with local communities, and implement close supervision practices. MMWs were recruited from local communities. Proactive case detection approaches included mobile malaria posts positioned at frequented locations around and within forests, and locally informed outreach activities targeting more remote locations. Reactive case detection was conducted among co-travellers of confirmed cases. Testing for malaria was conducted independent of fever symptoms. Routine monitoring of programmatic data informed tactical adaptations, while supervision exercises ensured service quality. Results: Despite operational challenges, service delivery sites were able to maintain consistently high testing rates throughout the implementation period, with each site testing a monthly average of 64 (standard deviation 6) people in 2020. Over the project period, the P. falciparum/P. vivax ratio steadily inversed. In 2020, MMWs detected only 32 P. falciparum cases. Including data from neighbouring health facilities and village malaria workers, 45% (80,988/180,732) of all people tested and 39% (1,280/3,243) of P. falciparum cases detected in the area can be attributed to project MMWs.Remaining challenges: Maintaining intensified elimination efforts, addressing the issue of detecting low parasitemia cases and shifting focus to P. vivax malaria challenge the last phase of malaria elimination.Conclusions: Reaching remote populations through active case detection should remain a key strategy to eliminate P. falciparum malaria. We have presented a successful approach combining tailored proactive and reactive strategies that could be transferred to similar settings in other areas of the Greater Mekong Subregion.

scholarly journals Eliminating Plasmodium Falciparum Malaria: Results From Tailoring Active Case Detection Approaches to Remote Populations in Forested Border Areas in North-eastern Cambodia

2020 ◽  
Author(s):  
Ann-Sophie Stratil ◽  
Lieven Vernaeve ◽  
Sergio Lopes ◽  
Yves Bourny ◽  
Kylie Mannion ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Plasmodium Falciparum Malaria ◽  
Target Population ◽  
Local Communities ◽  
Case Detection ◽  
Active Case Detection ◽  
Active Case ◽  
North Eastern ◽  
Passive Case Detection ◽  
Border Areas

Abstract Background: Remaining Plasmodium falciparum cases in Cambodia are concentrated in forested border areas and in remote populations who are hard to reach through passive case detection. A key approach to reach these populations is active case detection by mobile malaria workers (MMWs). However, this is operationally challenging because of changing movement patterns of the target population moving into less accessible areas. From 2018 to 2020, a tailored package of active case detection approaches was implemented in forested border areas of three provinces in north-eastern Cambodia to reach remote populations and support the elimination of P. falciparum malaria.Approach: Key elements of this project were to tailor approaches to local populations, use responsive monitoring systems, maintain operational flexibility, build strong relationships with local communities, and implement close supervision practices. MMWs were recruited from local communities. Proactive case detection approaches included mobile malaria posts positioned at frequented locations around and within forests, and locally informed outreach activities targeting more remote locations. Reactive case detection was conducted among co-travellers of confirmed cases. Tests were conducted independent of fever symptoms. Routine monitoring informed tactical adaptations, while supervision exercises ensured service quality. Results: Despite operational challenges, between January 2018 and June 2020, service delivery sites were able to maintain consistently high testing rates, with each site testing a monthly average of > 60 people in 2020. Over the project period, the P. falciparum/ P. vivax ratio has steadily inversed. In 2020, MMWs detected only 22 P. falciparum cases with constant testing rates. Including data from neighbouring health facilities and village malaria workers, 52% of all people tested and 40% of P. falciparum cases detected in the area can be attributed to MMWs.Remaining challenges: Maintaining intensified elimination efforts, addressing the issue of detecting low parasitemia cases and shifting focus to P. vivax malaria challenge the last phase of malaria elimination.Conclusions: Reaching remote populations through active case detection should remain a key strategy to eliminate P. falciparum malaria. We have presented a successful approach combining tailored proactive and reactive strategies that could be transferred to similar settings in other areas of the Greater Mekong Subregion.

scholarly journals Eliminating Plasmodium falciparum malaria: results from tailoring active case detection approaches to remote populations in forested border areas in north-eastern Cambodia

2021 ◽  
Author(s):  
Ann-Sophie Stratil ◽  
Lieven Vernaeve ◽  
Sergio Lopes ◽  
Yves Bourny ◽  
Kylie Mannion ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Target Population ◽  
Local Communities ◽  
Case Detection ◽  
Active Case Detection ◽  
Active Case ◽  
North Eastern ◽  
Passive Case Detection ◽  
Implementation Period ◽  
Border Areas

Abstract Background Remaining Plasmodium falciparum cases in Cambodia are concentrated in forested border areas and in remote populations who are hard to reach through passive case detection. A key approach to reach these populations is active case detection by mobile malaria workers (MMWs). However, this is operationally challenging because of changing movement patterns of the target population moving into less accessible areas. From January 2018 to December 2020, a tailored package of active case detection approaches was implemented in forested border areas of three provinces in north-eastern Cambodia to reach remote populations and support the elimination of P. falciparum malaria.Methods Key elements of this project were to tailor approaches to local populations, use responsive monitoring systems, maintain operational flexibility, build strong relationships with local communities, and implement close supervision practices. MMWs were recruited from local communities. Proactive case detection approaches included mobile malaria posts positioned at frequented locations around and within forests, and locally informed outreach activities targeting more remote locations. Reactive case detection was conducted among co-travellers of confirmed cases. Testing for malaria was conducted independent of fever symptoms. Routine monitoring of programmatic data informed tactical adaptations, while supervision exercises ensured service quality. Results Despite operational challenges, service delivery sites were able to maintain consistently high testing rates throughout the implementation period, with each of 45 (standard deviation, SD 1) sites testing a monthly average of 64 (SD 6) people in 2020. In 2020, MMWs detected only 32 P. falciparum cases. Over the project period, the P. falciparum/P. vivax ratio steadily inversed. Including data from neighbouring health centres and village malaria workers, 45% (80,988/180,732) of all people tested and 39% (1,280/3,243) of P. falciparum cases detected in the area can be attributed to project MMWs.Remaining challenges: maintaining intensified elimination efforts, addressing the issue of detecting low parasitaemia cases and shifting focus to P. vivax malaria challenge the last phase of malaria elimination.Conclusions Reaching remote populations through active case detection should remain a key strategy to eliminate P. falciparum malaria. This case study presented a successful approach combining tailored proactive and reactive strategies that could be transferred to similar settings in other areas of the Greater Mekong Subregion.

scholarly journals TRADITIONAL TREATMENT OF UNCOMPLICATED CASES OF FALCIPARUM MALARIA WITH PIPER BETLE (TRADITIONAL MEDICATION), AS OPPOSED TO TREATMENT WITH CHLOROQUINE

2013 ◽  
Vol 2 (1) ◽  
Author(s):  
Lilian Andries ◽  
Sunny Wangko ◽  
Benedictus S. Lampus
Keyword(s):  
Falciparum Malaria ◽  
New Drugs ◽  
Piper Betle ◽  
Case Detection ◽  
Traditional Treatment ◽  
Active Case Detection ◽  
Active Case ◽  
North Sulawesi ◽  
Kaplan Meier ◽  
Significant Difference

Abstrak: Di Indonesia, penyakit malaria masih merupakan masalah kesehatan, malahan pada akhir tahun 2004 dan awal tahun 2005 terjadi KLB (Kejadian Luar Biasa) dengan beberapa kematian di beberapa daerah di Indonesia, termasuk Propinsi Sulawesi Utara. Terdapat berbagai kendala dalam penggunaan obat malaria seperti resistensi parasit malaria, obat baru yang mahal, serta belum tersedianya vaksin yang sesuai. Pengobatan dengan ramuan sirih (Piper betle, Linn.), daun mayana (Coleus Arthopurpureus), kuning telur, madu, dan wiski lokal “cap tikus” telah digunakan secara turun temurun olpengobatan tradisional, eh pengobat tradisional asal Propinsi Sulawesi Utara. Dilakukan Active Case Detection (ACD) dan uji efektifitas mengikuti kajian uji klinik. Efektifitas ramuan sirih dibandingkan dengan klorokuin dalam menghilangkan parasit malaria darah tepi. Analisis dilakukan terhadap 70 kasus yang positif parasit malaria falsiparum berusia 10-60 tahun dimana 35 kasus diberi perlakuan dengan ramuan sirih dan 35 kasus lainnya obat klorokuin (dosis standar WHO). Hasil ACD didapatkan prevalensi sebesar 8% (0-23,4%) pada 22 kelurahan. Ramuan ini efektif menghilangkan parasit malaria sebesar 91,4% pada akhir minggu pertama, sedangkan klorokuin 88,6%. Pada akhir minggu ke-4 didapatkan 3 kasus yang diberikan klorokuin masih tetap positif terhadap parasit malaria, sedangkan dengan ramuan sirih semuanya negatif. Analisis dengan tes logrank (Kaplan-Meier) tidak menunjukkan perbedaan bermakna. Kata kunci: obat tradisional, piper betle, klorokuin, parasit malaria.   Abstract: Malaria is still a health problem in Indonesia. Even at the end of 2004 and the beginning of 2005, outbreaks took place in some areas of Indonesia, including the province of North Sulawesi. There are several obstacles to the use of malaria drugs including resistance of the parasite, unaffordable new drugs, and no available vaccines. Traditional malaria treatment which was a mixture of piper betle (Piper betle, Linn.), mayana leaves (Coleus arthopurpure-us), egg yolk, honey, and local whiskey “cap tikus” has been used for generations by traditional healers in North Sulawesi. The study was designed to ascertain the efficacy of the traditional treatment compared to that of chloroquine to eliminate parasitemia. Seventy cases of uncomplicated falciparum malaria found through active case detection were given either the traditional treatment or chloroquine. The traditional treatment was effective in 91.4% of cases, compared to 88.6% in the cases of chloroquine, in eliminating parasitemia by the end of the first week. By the end of the fourth week, all cases given the traditional treatment were negative of para-sitemia, while three cases given chloroquine were still positive. Analysis using the logrank test (Kaplan-Meier) showed no significant difference between piper betle extract and chloroquine. Keywords: traditional medicine, piper betle, chloroquine, malaria parasite.

scholarly journals Getting to zero: micro-foci of malaria in the Solomon Islands requires stratified control

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tanya L. Russell ◽  
Lynn Grignard ◽  
Alan Apairamo ◽  
Nathan Kama ◽  
Albino Bobogare ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Solomon Islands ◽  
Transmission Risk ◽  
Radical Cure ◽  
Case Detection ◽  
Cross Sectional Survey ◽  
Blood Samples ◽  
Active Case Detection ◽  
Targeted Interventions ◽  
Active Case

Abstract Background The Solomon Islands has made significant progress in the control of malaria through vector control, access and use of improved diagnostics and therapeutic drugs. As transmission is reduced there is a need to understand variations in transmission risk at the provincial and village levels to stratify control methods. Methods A cross-sectional survey of malaria in humans was conducted in the Solomon Islands during April 2018. Nineteen villages across 4 provinces were included. The presence of Plasmodium species parasites in blood samples was detected using PCR. Results Blood samples were analysed from 1,914 participants. The prevalence of DNA of Plasmodium falciparum was 1.2 % (n = 23) and for Plasmodium vivax was 1.5 % (n = 28). 22 % (n = 5/23) of P. falciparum DNA positive participants were febrile and 17 % of P. vivax DNA positive participants (n = 5/28). The prevalence of both P. falciparum and P. vivax was extremely spatially heterogeneous. For P. falciparum, in particular, only 2 small foci of transmission were identified among 19 villages. Plasmodium falciparum infections were uniformly distributed across age groups. Insecticide-treated bed net use the night prior to the survey was reported by 63 % of participants and significantly differed by province. Conclusions Malaria transmission across the Solomon Islands has become increasingly fragmented, affecting fewer villages and provinces. The majority of infections were afebrile suggesting the need for strong active case detection with radical cure with primaquine for P. vivax. Village-level stratification of targeted interventions based on passive and active case detection data could support the progress towards a more cost-effective and successful elimination programme.

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