scholarly journals Performance of passive case detection for malaria surveillance: results from nine countries in Mesoamerica and the Dominican Republic

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Diego Rios-Zertuche ◽  
Keith H. Carter ◽  
Katie Panhorst Harris ◽  
Max Thom ◽  
Maria Paola Zúñiga-Brenes ◽  
...  
Keyword(s):  
Dominican Republic ◽  
Malaria Elimination ◽  
Health Facilities ◽  
Suspected Case ◽  
Case Detection ◽  
Malaria Surveillance ◽  
Detection Rates ◽  
Travel History ◽  
Passive Case Detection ◽  
Malaria Test

Abstract Background In malaria elimination settings, available metrics for malaria surveillance have been insufficient to measure the performance of passive case detection adequately. An indicator for malaria suspected cases with malaria test (MSCT) is proposed to measure the rate of testing on persons presenting to health facilities who satisfy the definition of a suspected malaria case. This metric does not rely on prior knowledge of fever prevalence, seasonality, or external denominators, and can be used to compare detection rates in suspected cases within and between countries, including across settings with different levels of transmission. Methods To compute the MSCT, an operational definition for suspected malaria cases was established, including clinical and epidemiological criteria. In general, suspected cases included: (1) persons with fever detected in areas with active malaria transmission; (2) persons with fever identified in areas with no active transmission and travel history to, or residence in areas with active transmission (either national or international); and (3) persons presenting with fever, chills and sweating from any area. Data was collected from 9 countries: Belize, Colombia (in areas with active transmission), Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, and Panama (September–March 2020). A sample of eligible medical records for 2018 was selected from a sample of health facilities in each country. An algorithm was constructed to assess if a malaria test was ordered or performed for cases that met the suspected case definition. Results A sample of 5873 suspected malaria cases was obtained from 239 health facilities. Except for Nicaragua and Colombia, malaria tests were requested in less than 10% of all cases. More cases were tested in areas with active transmission than areas without cases. Travel history was not systematically recorded in any country. Conclusions A statistically comparable, replicable, and standardized metric was proposed to measure suspected malaria cases with a test (microscopy or rapid diagnostic test) that enables assessing the performance of passive case detection. Cross-country findings have important implications for malaria and infectious disease surveillance, which should be promptly addressed as countries progress towards malaria elimination. Local and easy-to-implement tools could be implemented to assess and improve passive case detection.

scholarly journals A comparative analysis of the outcome of malaria case surveillance strategies in Sri Lanka in the prevention of re-establishment phase

2021 ◽  
Author(s):  
W. M. Kumudunayana T. de A. W Gunasekera ◽  
Risintha Premaratne ◽  
Deepika Fernando ◽  
Muzrif Munaz ◽  
M. G. Y. Piyasena ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Case Reports ◽  
Individual Case ◽  
Case Detection ◽  
Malaria Surveillance ◽  
Blood Smears ◽  
Passive Case Detection ◽  
Routine Basis ◽  
Detection Strategies ◽  
Very High

Abstract Background Sri Lanka sustained its malaria-free status by implementing, among other interventions, three core case detection strategies namely Passive Case Detection (PCD), Reactive Case Detection (RACD) and Proactive Case Detection (PACD). The outcomes of these strategies were analysed in terms of their effectiveness in detecting malaria infections for the period from 2017-2019. Methods Comparisons were made between the surveillance methods and between years, based on data obtained from the national malaria database and individual case reports of malaria patients. The number of blood smears examined microscopically was used as the measure of the volume of tests conducted. The yield from each case detection method was calculated as the proportion of blood smears which were positive for malaria. Within RACD and PACD, the yield of sub categories of travel cohorts and spatial cohorts was ascertained for 2019. Results A total of 158 malaria cases were reported in 2017-2019. During this period between 666,325-725,149 blood smears were examined annually. PCD detected 95.6%, with a yield of 16.1 cases per 100,000 blood smears examined. RACD and PACD produced a yield of 11.2 and 0.3, respectively. The yield of screening the sub category of travel cohorts was very high for RACD and PACD being 806.5 and 44.9 malaria cases per 100,000 smears, respectively. Despite over half of the blood smears examined being obtained by screening spatial cohorts within RACD and PACD, the yield of both was zero over all three years. Conclusions The PCD arm of case surveillance is the most effective and, therefore, has to continue and be further strengthened as the mainstay of malaria surveillance. Focus on travel cohorts within RACD and PACD should be even greater. Screening of spatial cohorts, on a routine basis and solely because people are resident in previously malarious areas, may be wasteful, except in situations where the risk of local transmission is very high, or is imminent. These findings may apply more broadly to most countries in the post-elimination phase.

scholarly journals A comparative analysis of the outcome of malaria case surveillance strategies in Sri Lanka in the prevention of re‐establishment phase

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
W. M. Kumudunayana T. de A. W. Gunasekera ◽  
Risintha Premaratne ◽  
Deepika Fernando ◽  
Muzrif Munaz ◽  
M. G. Y. Piyasena ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Case Reports ◽  
Individual Case ◽  
Case Detection ◽  
Malaria Surveillance ◽  
Blood Smears ◽  
Passive Case Detection ◽  
Routine Basis ◽  
Detection Strategies ◽  
Very High

Abstract Background Sri Lanka sustained its malaria-free status by implementing, among other interventions, three core case detection strategies namely Passive Case Detection (PCD), Reactive Case Detection (RACD) and Proactive Case Detection (PACD). The outcomes of these strategies were analysed in terms of their effectiveness in detecting malaria infections for the period from 2017 to 2019. Methods Comparisons were made between the surveillance methods and between years, based on data obtained from the national malaria database and individual case reports of malaria patients. The number of blood smears examined microscopically was used as the measure of the volume of tests conducted. The yield from each case detection method was calculated as the proportion of blood smears which were positive for malaria. Within RACD and PACD, the yield of sub categories of travel cohorts and spatial cohorts was ascertained for 2019. Results A total of 158 malaria cases were reported in 2017–2019. During this period between 666,325 and 725,149 blood smears were examined annually. PCD detected 95.6 %, with a yield of 16.1 cases per 100,000 blood smears examined. RACD and PACD produced a yield of 11.2 and 0.3, respectively. The yield of screening the sub category of travel cohorts was very high for RACD and PACD being 806.5 and 44.9 malaria cases per 100,000 smears, respectively. Despite over half of the blood smears examined being obtained by screening spatial cohorts within RACD and PACD, the yield of both was zero over all three years. Conclusions The PCD arm of case surveillance is the most effective and, therefore, has to continue and be further strengthened as the mainstay of malaria surveillance. Focus on travel cohorts within RACD and PACD should be even greater. Screening of spatial cohorts, on a routine basis and solely because people are resident in previously malarious areas, may be wasteful, except in situations where the risk of local transmission is very high, or is imminent. These findings may apply more broadly to most countries in the post-elimination phase.

scholarly journals Malaria in Eswatini, 2012–2019: a case study of the elimination effort

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Theresia Estomih Nkya ◽  
Ulrike Fillinger ◽  
Makhoselive Dlamini ◽  
Onyango P. Sangoro ◽  
Rose Marubu ◽  
...  
Keyword(s):  
Malaria Elimination ◽  
Indoor Residual Spraying ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Malaria Vectors ◽  
Entomological Surveillance ◽  
Malaria Surveillance ◽  
Control Approach ◽  
Entry Points

AbstractEswatini was the first country in sub-Saharan Africa to pass a National Malaria Elimination Policy in 2011, and later set a target for elimination by the year 2020. This case study aimed to review the malaria surveillance data of Eswatini collected over 8 years between 2012 and 2019 to evaluate the country’s efforts that targeted malaria elimination by 2020. Coverage of indoor residual spraying (IRS) for vector control and data on malaria cases were provided by the National Malaria Programme (NMP) of Eswatini. The data included all cases treated for malaria in all health facilities. The data was analysed descriptively. Over the 8 years, a total of 5511 patients reported to the health facilities with malaria symptoms. The case investigation rate through the routine surveillance system increased from 50% in 2012 to 84% in 2019. Incidence per 1000 population at risk fluctuated over the years, but in general increased from 0.70 in 2012 to 1.65 in 2019, with the highest incidence of 3.19 reported in 2017. IRS data showed inconsistency in spraying over the 8 years. Most of the cases were diagnosed by rapid diagnostic test (RDT) kits in government (87.6%), mission (89.1%), private (87%) and company/industry-owned facilities (84.3%), either singly or in combination with microscopy. Eswatini has fallen short of achieving malaria elimination by 2020. Malaria cases are still consistently reported, albeit at low rates, with occasional localized outbreaks. To achieve elimination, it is critical to optimize timely and well-targeted IRS and to consider rational expansion of tools for an integrated malaria control approach in Eswatini by including tools such as larval source management, long-lasting insecticidal nets (LLINs), screening of mosquito house entry points, and chemoprophylaxis. The establishment of rigorous routine entomological surveillance should also be prioritized to determine the local malaria vectors’ ecology, potential species diversity, the role of secondary vectors and insecticide resistance.

scholarly journals A Comparative Analysis of the Outcome of Malaria Case Surveillance Strategies in Sri Lanka in the Prevention of Re-establishment Phase

2020 ◽  
Author(s):  
W. M. Kumudunayana T. de A. W Gunasekera ◽  
Risintha Premaratne ◽  
Deepika Fernando ◽  
Muzrif Munaz ◽  
M. G. Y. Piyasena ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Case Reports ◽  
Individual Case ◽  
Case Detection ◽  
Malaria Surveillance ◽  
Blood Smears ◽  
Passive Case Detection ◽  
Routine Basis ◽  
Detection Strategies ◽  
Very High

Abstract BackgroundSri Lanka sustained its malaria-free status by implementing, among other interventions, three core case detection strategies. The outcomes of these strategies - namely Passive Case Detection (PCD) and, under the overall strategy of Active Case Detection (ACD), Reactive Case Detection (RACD) and Proactive Case Detection (PACD) - were analysed in terms of their effectiveness in detecting malaria infections for the period from 2017-2019.MethodsComparisons were made between the surveillance methods and between years, based on data obtained from the national malaria database and individual case reports of malaria patients. The number of blood smears examined microscopically was used as the measure of the volume of tests conducted. The yield from each case detection method was calculated as the proportion of blood smears which were positive for malaria. Within RACD and PACD, the yield of sub categories of travel cohorts and spatial cohorts was ascertained for 2019.Results A total of 158 malaria cases were reported in 2017-2019, during which between 666,325-725,149 blood smears were examined each year: PCD detected 95.6%, with a yield of 16.1 cases per 100,000 blood smears examined, making it the most effective case detection strategy, while RACD and PACD produced a yield of 11.2 and 0.3 respectively. The yield of screening the sub category of travel cohorts was very high for RACD and PACD being 806.5 and 44.9 malaria cases per 100,000 smears respectively. Despite over half of the blood smears examined being obtained by screening spatial cohorts within RACD and PACD, the yield of both was zero over all three years.Conclusions The PCD arm of case surveillance is the most effective, and therefore, has to continue and be further strengthened as the mainstay in malaria surveillance. Focus on travel cohorts within RACD and PACD should be even greater. Screening of spatial cohorts, on a routine basis and solely because people are resident in previously malarious areas, may be wasteful, except in situations where the risk of local transmission is very high, or is imminent.

scholarly journals Using Mobile Technology to Facilitate Reactive Case Detection of Malaria

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Gordon Cressman ◽  
Michael McKay ◽  
Abdul-wahid Al-Mafazy ◽  
Madhi M. Ramsan ◽  
Abdullah S. Ali ◽  
...  
Keyword(s):  
Mobile Technology ◽  
Malaria Elimination ◽  
Indoor Residual Spraying ◽  
Geographic Area ◽  
Geographical Information ◽  
Bed Nets ◽  
Case Detection ◽  
Malaria Surveillance ◽  
Reactive Case Detection ◽  
Notification System

ObjectiveThis presentation will share findings from more than three years ofusing mobile technology for reactive case detection (RACD) to helpeliminate malaria in a well-defined geographic area. It will reviewthe concepts of RACD, the application of mobile technology, lessonslearned from more than three years of application, and considerationsin applying this technology in other malaria elimination contexts.IntroductionZanzibar is comprised primarily of two large islands with apopulation of 1.3 million. Indoor Residual Spraying (IRS) campaigns,distribution of long-lasting insecticide treated bed nets (LLINs),and use of Rapid Diagnostic Tests (RDTs) have reduced Malariaprevalence from 39% in 2005 to less than 1% in 2011-2012. Asmalaria burden decreases, there is an increasing need to track andfollow up individual cases to contain transmission that could lead toresurgence. One method being used to achieve these aims is reactivecase detection (RACD).RACD is generally understood to be triggered whenever a case isidentified by passive case detection. The response involves visiting thehousehold of the newly reported case and screening family members.Depending on program protocol, it may also involve screeningneighbors within a defined radius. RACD has been used or testedin Cambodia, China, India, Peru, Senegal, Swaziland, Tanzania,and Zambia. RACD can be resource intensive. Several studies raisequestions concerning whether and how RACD can be prioritized andtargeted effectively as case numbers continue to decline.MethodsSince September 2012 Zanzibar Malaria Elimination Programme(ZAMEP) has used RACD to limit onward transmission, reduce thelocal parasite reservoir, and gather data needed improve programeffectiveness. Zanzibar is one of very few malaria eliminationcontexts using a mobile technology system to support RACD.1Thissystem, called the Malaria Case Notification system (MCN) usesmobile software called Coconut Surveillance.Coconut Surveillance is free and open source software designed formalaria elimination. It includes an interactive SMS system for casenotification, a mobile software application designed to guide mobilecase workers through RACD, and an analytics software applicationdesigned for surveillance and response program managers.Data were collected in the Coconut Surveillance database formore than three years, beginning in September 2012. Reports weremonitored in real time and periodically to assess RACD responsetimes against protocol targets, case trends, case locations, and otherdata. Geographical Information System (GIS) software was usedto produce detailed maps of case households. Three independentassessments were conducted of various aspects of the malariasurveillance system.ResultsFrom September 2012 to December 2015, Coconut Surveillancehas helped malaria surveillance officers in Zanzibar respond tomore than 8,617 (84%) reported cases of malaria, complete nearly10,245 household visits, test more than 36,185 household members,and identify and treat 2,032 previously unknown cases. The averagenumber of RACD activities occurring within 48 hours increased from72% in 2013 to 89% in 2015. The number of household membersscreened during RACD also increased from 7,589 in 2013 to 14,987in 2015. Challenges included incomplete registers at health carefacilities, lack of transport, inadequate training for clinicians andsurveillance officers, and insufficient communication to the affectedcommunities.ConclusionsIn Zanzibar twenty malaria surveillance officers equipped withinexpensive Android tablets and motorbikes are keeping malariaprevalence at less than 1%. The effectiveness of the system mightbe enhanced by improving training for clinicians and surveillanceofficers, ensuring the availability of transportation for surveillanceofficers, and improving communications to the affected communities.These results suggest key considerations for applying this and similarsystems in other malaria elimination contexts.

scholarly journals Intensive surveillance, rapid response and border collaboration for malaria elimination: China Yunnan’s ‘‘3 + 1’’strategy

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Jian-Wei Xu ◽  
Zu-Rui Lin ◽  
Yao-Wu Zhou ◽  
Rogan Lee ◽  
Hai-Mo Shen ◽  
...  
Keyword(s):  
Malaria Transmission ◽  
Malaria Elimination ◽  
Health Workers ◽  
Universal Coverage ◽  
Rapid Response ◽  
Evidence Based ◽  
Case Detection ◽  
Malaria Surveillance ◽  
Border Areas ◽  
Township Hospitals

Abstract Background Eliminating malaria and preventing re-establishment of malaria transmission in border areas requires universal coverage of malaria surveillance and a rapid response to any threats (i.e. malaria cues) of re-establishing transmission. Main text Strategy 1: Intensive interventions within 2.5 km-wide perimeter along the border to prevent border-spill malaria. The area within 2.5 km along the international border is the travel radius of anopheline mosquitoes. Comprehensive interventions should include: (1) proactive and passive case detection, (2) intensive vector surveillance, (3) evidence-based vector control, and (4) evidence-based preventative treatment with anti-malarial drugs. Strategy 2: Community-based malaria detection and screening of migrants and travellers in frontier townships. Un-permitted travellers cross borders frequently and present in frontier townships. Maintenance of intensified malaria surveillance should include: (1) passive malaria detection in the township hospitals, (2) seek assistance from villager leaders and health workers to monitor cross border travellers, and refer febrile patients to the township hospitals and (3) the county’s Centre for Disease Control and Prevention maintain regular proactive case detection. Strategy 3: Universal coverage of malaria surveillance to detect malaria cues. Passive detection should be consolidated into the normal health service. Health services personnel should remain vigilant to ensure universal coverage of malaria detection and react promptly to any malaria cues. Strategy + 1: Strong collaborative support with neighbouring countries. Based on the agreement between the two countries, integrated control strategies should be carried out to reduce malaria burden for both countries. There should be a clear focus on the border areas between neighbouring countries. Conclusion The 3 + 1 strategy is an experience summary of border malaria control and elimination, and then contributed to malaria elimination in Yunnan’s border areas, China. Nevertheless, Yunnan still has remaining challenges of re-establishment of malaria transmission in the border areas, and the 3 + 1 strategy should still be carried out.

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 Operational Research to Assess the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Health Facilities in Harare, Zimbabwe

2021 ◽  
Vol 6 (2) ◽  
pp. 94
Author(s):  
Pruthu Thekkur ◽  
Kudakwashe C. Takarinda ◽  
Collins Timire ◽  
Charles Sandy ◽  
Tsitsi Apollo ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Treatment Outcomes ◽  
Real Time ◽  
Treatment Success ◽  
Health Facilities ◽  
Case Detection ◽  
Monthly Data ◽  
Hiv Services ◽  
Tb Treatment ◽  
Set Up

When COVID-19 was declared a pandemic, there was concern that TB and HIV services in Zimbabwe would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in 10 health facilities in Harare to capture trends in TB case detection, TB treatment outcomes and HIV testing and use these data to facilitate corrective action. Aggregate data were collected monthly during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data extracted for the pre-COVID-19 period (March 2019–February 2020). Monthly reports were sent to program directors. During the COVID-19 period, there was a decrease in persons with presumptive pulmonary TB (40.6%), in patients registered for TB treatment (33.7%) and in individuals tested for HIV (62.8%). The HIV testing decline improved in the second 6 months of the COVID-19 period. However, TB case finding deteriorated further, associated with expiry of diagnostic reagents. During the COVID-19 period, TB treatment success decreased from 80.9 to 69.3%, and referral of HIV-positive persons to antiretroviral therapy decreased from 95.7 to 91.7%. Declining trends in TB and HIV case detection and TB treatment outcomes were not fully redressed despite real-time monthly surveillance. More support is needed to transform this useful information into action.

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.

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