Defining malaria risks among forest workers in Aceh, Indonesia: A formative assessment

Abstract Background. Following a dramatic decline of malaria cases in Aceh province, geographically-based reactive case detection (RACD) was recently evaluated as a tool to improve surveillance with the goal of malaria elimination. While RACD detected few cases in households surrounding index cases, engaging in forest work was identified as a risk factor for malaria and infections from Plasmodium knowlesi—a non-human primate malaria parasite—were more common than expected. This qualitative formative assessment was conducted to improve understanding of malaria risk from forest work and identify strategies for targeted surveillance among forest workers, including adapting reactive case detection.Methods. Between June and August, 2016, five focus groups and 18 in-depth interviews with forest workers and key informants were conducted in each of four subdistricts in Aceh Besar and Aceh Jaya districts. Themes included: types of forest activities, mobility of workers, interactions with non-human primates, malaria prevention and treatment-seeking behaviors, and willingness to participate in malaria surveys at forest work sites and using peer-referral.Results. Reported forest activities included mining, logging, and agriculture in the deep forest and along the forest fringe. Forest workers, particularly miners and loggers, described often spending weeks to months at work sites in makeshift housing, rarely utilizing mosquito prevention and, upon fever, self-medicating and seeking care from traditional healers or pharmacies rather than health facilities. Non-human primates are frequently observed near work sites, and most forest work locations are within a day’s journey of health clinics. Employers and workers expressed interest in undertaking malaria testing and in participating in survey recruitment by peer-referral and at work sites.Conclusions. Diverse groups of forest workers in Aceh are potentially exposed to malaria through forest work. Passive surveillance and household-based screening may under-estimate malaria burden due to extended stays in the forest and health-seeking behaviors. Adapting active surveillance to specifically target forest workers through work-site screening and/or peer-referral appears promising for addressing currently undetected infections.

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Defining malaria risks among forest workers in Aceh, Indonesia: a formative assessment

Malaria Journal ◽

10.1186/s12936-020-03511-2 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Lenny L. Ekawati ◽

Kelly C. Johnson ◽

Jerry O. Jacobson ◽

Carmen A. Cueto ◽

Iska Zarlinda ◽

...

Keyword(s):

Formative Assessment ◽

Plasmodium Knowlesi ◽

Malaria Prevention ◽

Traditional Healers ◽

Case Detection ◽

Willingness To Participate ◽

Health Seeking ◽

Reactive Case Detection ◽

Malaria Burden ◽

Forest Activities

Abstract Background Following a dramatic decline of malaria cases in Aceh province, geographically-based reactive case detection (RACD) was recently evaluated as a tool to improve surveillance with the goal of malaria elimination. While RACD detected few cases in households surrounding index cases, engaging in forest work was identified as a risk factor for malaria and infections from Plasmodium knowlesi—a non-human primate malaria parasite—were more common than expected. This qualitative formative assessment was conducted to improve understanding of malaria risk from forest work and identify strategies for targeted surveillance among forest workers, including adapting reactive case detection. Methods Between June and August, 2016, five focus groups and 18 in-depth interviews with forest workers and key informants were conducted in each of four subdistricts in Aceh Besar and Aceh Jaya districts. Themes included: types of forest activities, mobility of workers, interactions with non-human primates, malaria prevention and treatment-seeking behaviours, and willingness to participate in malaria surveys at forest work sites and using peer-referral. Results Reported forest activities included mining, logging, and agriculture in the deep forest and along the forest fringe. Forest workers, particularly miners and loggers, described often spending weeks to months at work sites in makeshift housing, rarely utilizing mosquito prevention and, upon fever, self-medicating and seeking care from traditional healers or pharmacies rather than health facilities. Non-human primates are frequently observed near work sites, and most forest work locations are within a day’s journey of health clinics. Employers and workers expressed interest in undertaking malaria testing and in participating in survey recruitment by peer-referral and at work sites. Conclusions Diverse groups of forest workers in Aceh are potentially exposed to malaria through forest work. Passive surveillance and household-based screening may under-estimate malaria burden due to extended stays in the forest and health-seeking behaviours. Adapting active surveillance to specifically target forest workers through work-site screening and/or peer-referral appears promising for addressing currently undetected infections.

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Defining malaria risks among forest workers in Aceh, Indonesia: a formative assessment

10.21203/rs.3.rs-37048/v4 ◽

2020 ◽

Author(s):

Lenny Lia Ekawati ◽

Kelly C. Johnson ◽

Jerry O. Jacobson ◽

Carmen A. Cueto ◽

Iska Zarlinda ◽

...

Keyword(s):

Formative Assessment ◽

Plasmodium Knowlesi ◽

Malaria Prevention ◽

Traditional Healers ◽

Detection Methods ◽

Case Detection ◽

Willingness To Participate ◽

Health Seeking ◽

Reactive Case Detection ◽

Forest Activities

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Defining malaria risks among forest workers in Aceh, Indonesia: A formative assessment

10.21203/rs.3.rs-37048/v2 ◽

2020 ◽

Author(s):

Lenny Lia Ekawati ◽

Kelly C. Johnson ◽

Jerry O. Jacobson ◽

Carmen A. Cueto ◽

Iska Zarlinda ◽

...

Keyword(s):

Formative Assessment ◽

Plasmodium Knowlesi ◽

Malaria Prevention ◽

Traditional Healers ◽

Willingness To Participate ◽

Health Seeking ◽

Malaria Burden ◽

Aceh Province ◽

Deep Forest ◽

Forest Activities

Abstract Background . Following a dramatic decline of malaria cases in Aceh province, geographically-based reactive case detection (RACD) was recently evaluated as a tool to improve surveillance with the goal of malaria elimination. While RACD detected few cases in households surrounding index cases, engaging in forest work was identified as a risk factor for malaria and infections from Plasmodium knowlesi —a non-human primate malaria parasite—were more common than expected. This qualitative formative assessment was conducted to improve understanding of malaria risk from forest work and identify strategies for targeted surveillance among forest workers. Methods. Between June and August, 2016, five focus groups and 18 in-depth interviews with forest workers and key informants were conducted in each of four subdistricts in Aceh Besar and Aceh Jaya districts. Themes included: types of forest activities, mobility of workers, interactions with non-human primates, malaria prevention and treatment-seeking behaviors, and willingness to participate in malaria surveys at forest work sites and using peer-referral. Results. Reported forest activities included mining, logging, and agriculture in the deep forest and along the forest fringe. Forest workers, particularly miners and loggers, described often spending weeks to months at work sites in makeshift housing, rarely utilizing mosquito prevention and, upon fever, self-medicating and seeking care from traditional healers or pharmacies rather than health facilities. Non-human primates are frequently observed near work sites, and most forest work locations are within a day’s journey of health clinics. Employers and workers expressed interest in undertaking malaria testing and in participating in survey recruitment by peer-referral and at work sites. Conclusions. Diverse groups of forest workers in Aceh are potentially exposed to malaria through forest work. Passive surveillance and household-based screening may under-estimate malaria burden due to extended stays in the forest and health-seeking behaviors. Active surveillance specifically targeting forest workers through work-site screening and/or peer-referral appears promising for addressing undetected infections.

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Defining Malaria Risks Among Forest Workers in Aceh, Indonesia: A Formative Assessment

10.21203/rs.3.rs-37048/v1 ◽

2020 ◽

Author(s):

Lenny Lia Ekawati ◽

Kelly C. Johnson ◽

Jerry O. Jacobson ◽

Carmen A. Cueto ◽

Iska Zarlinda ◽

...

Keyword(s):

Formative Assessment ◽

Plasmodium Knowlesi ◽

Malaria Prevention ◽

Traditional Healers ◽

Willingness To Participate ◽

Health Seeking ◽

Malaria Burden ◽

Aceh Province ◽

Deep Forest ◽

Forest Activities

Abstract Background. Following a dramatic decline of malaria cases in Aceh province, geographically-based reactive case detection (RACD) was recently evaluated as a tool to improve surveillance with the goal of malaria elimination. While RACD detected few cases in households surrounding index cases, engaging in forest work was identified as a risk factor for malaria and infections from Plasmodium knowlesi—a primate malaria parasite—were more common than expected. This qualitative formative assessment was conducted to improve understanding of malaria risk from forest work and identify strategies for targeted surveillance among forest workers. Methods. Between June and August, 2016, five focus groups and 18 in-depth interviews with forest workers and key informants were conducted in each of four subdistricts in Aceh Besar and Aceh Jaya districts. Themes included: types of forest activities, mobility of workers, interactions with non-human primates, malaria prevention and treatment-seeking behaviors, and willingness to participate in malaria surveys at forest work sites and using peer-referral. Results. Reported forest activities included mining, logging, and agriculture in the deep forest and along the forest fringe. Forest workers, particularly miners and loggers, described often spending weeks to months at work sites in makeshift housing, rarely utilizing mosquito prevention and, upon fever, self-medicating and seeking care from traditional healers or pharmacies rather than health facilities. Non-human primates are frequently observed near work sites, and most forest work locations are within a day’s journey of health clinics. Employers and workers expressed interest in undertaking malaria testing and in participating in survey recruitment by peer-referral and at work sites. Conclusions. Diverse groups of forest workers in Aceh are potentially exposed to malaria through forest work. Passive surveillance and household-based screening may under-estimate malaria burden due to extended stays in the forest and health-seeking behaviors. Active surveillance specifically targeting forest workers through work-site screening and/or peer-referral appears promising for addressing undetected infections.

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Clustering of malaria in households in the Greater Mekong Subregion: operational implications for reactive case detection

Malaria Journal ◽

10.1186/s12936-021-03879-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Mavuto Mukaka ◽

Pimnara Peerawaranun ◽

Daniel M. Parker ◽

Ladda Kajeechiwa ◽

Francois H. Nosten ◽

...

Keyword(s):

Limit Of Detection ◽

Large Mass ◽

Case Detection ◽

Reactive Case Detection ◽

Malaria Burden ◽

Control Programmes ◽

Positive Treatment ◽

Asymptomatic Infections ◽

Greater Mekong Subregion ◽

Index Cases

Abstract Background Malaria reactive case detection is the testing and, if positive, treatment of close contacts of index cases. It is included in national malaria control programmes of countries in the Greater Mekong Subregion to accelerate malaria elimination. Yet the value of reactive case detection in the control and elimination of malaria remains controversial because of the low yield, limited evidence for impact, and high demands on resources. Methods Data from the epidemiological assessments of large mass drug administration (MDA) studies in Myanmar, Vietnam, Cambodia and Laos were analysed to explore malaria infection clustering in households. The proportion of malaria positive cases among contacts screened in a hypothetical reactive case detection programme was then determined. The parasite density thresholds for rapid diagnostic test (RDT) detection was assumed to be > 50/µL (50,000/mL), for dried-blood-spot (DBS) based PCR > 5/µL (5000/mL), and for ultrasensitive PCR (uPCR) with a validated limit of detection at 0.0022/µL (22/mL). Results At baseline, before MDA, 1223 Plasmodium infections were detected by uPCR in 693 households. There was clustering of Plasmodium infections. In 637 households with asymptomatic infections 44% (278/637) had more than one member with Plasmodium infections. In the 132 households with symptomatic infections, 65% (86/132) had more than one member with Plasmodium infections. At baseline 4% of households had more than one Plasmodium falciparum infection, but three months after MDA no household had more than one P. falciparum infected member. Reactive case detection using DBS PCR would have detected ten additional cases in six households, and an RDT screen would have detected five additional cases in three households among the 169 households with at least one RDT positive case. This translates to 19 and 9 additional cases identified per 1000 people screened, respectively. Overall, assuming all febrile RDT positive patients would seek treatment and provoke reactive case detection using RDTs, then 1047 of 1052 (99.5%) Plasmodium infections in these communities would have remained undetected. Conclusion Reactive case detection in the Greater Mekong subregion is predicted to have a negligible impact on the malaria burden, but it has substantial costs in terms of human and financial resources.

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Malaria infection prevalence and sensitivity of reactive case detection in Zanzibar

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2020.06.017 ◽

2020 ◽

Vol 97 ◽

pp. 337-346 ◽

Cited By ~ 1

Author(s):

Logan Stuck ◽

Bakar S. Fakih ◽

Abdul-wahid H. Al-mafazy ◽

Natalie E. Hofmann ◽

Aurel Holzschuh ◽

...

Keyword(s):

Malaria Infection ◽

Infection Prevalence ◽

Case Detection ◽

Reactive Case Detection

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Case investigation and reactive case detection for malaria elimination in northern Senegal

Malaria Journal ◽

10.1186/1475-2875-12-331 ◽

2013 ◽

Vol 12 (1) ◽

Cited By ~ 46

Author(s):

Megan Littrell ◽

Gnagna Dieng Sow ◽

Algaye Ngom ◽

Mady Ba ◽

Balla Mbacke Mboup ◽

...

Keyword(s):

Malaria Elimination ◽

Case Detection ◽

Reactive Case Detection ◽

Case Investigation

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Adding proactive and reactive case detection into the integrated community case management system to optimise diagnosis and treatment of malaria in a high transmission setting of Cameroon: an observational quality improvement study

BMJ Open ◽

10.1136/bmjopen-2018-026678 ◽

2019 ◽

Vol 9 (6) ◽

pp. e026678 ◽

Cited By ~ 2

Author(s):

Cavin Epie Bekolo ◽

Thomas D’Arcy Williams

Keyword(s):

Quality Improvement ◽

Case Management ◽

Diagnostic Testing ◽

Sub Saharan Africa ◽

Secondary Outcome ◽

Case Detection ◽

Community Case Management ◽

Reactive Case Detection ◽

Integrated Community Case Management ◽

Index Cases

ObjectiveIntegrated community case management (iCCM) of childhood illness is a powerful intervention to reduce mortality. Yet, only 29% and 59% of children with fever in sub-Saharan Africa had access to malaria testing and treatment between 2015 and 2017. We report how iCCM+ based on incorporating active case detection of malaria into iCCM could help improve testing and treatment.DesignA community-led observational quality improvement study.SettingThe rural community of Bare-Bakem in Cameroon.ParticipantsChildren and adults with fever between April and June 2018.InterventionA modified iCCM programme (iCCM+) comprising a proactive screening of febrile children <5 years old for malaria using rapid diagnostic testing to identify index cases and a reactive screening triggered by these index cases to detect secondary cases in the community.Primary and secondary outcome measuresThe proportion of additional malaria cases detected by iCCM+ over iCCM.ResultsWe screened 501 febrile patients of whomPlasmodiuminfection was confirmed in 425 (84.8%) cases. Of these cases, 102 (24.0%) were index cases identified in the community during routine iCCM activity and 36 (8.5%) cases detected passively in health facilities; 38 (8.9%) were index cases identified proactively in schools and 249 (58.6%) were additional cases detected by reactive case detection—computing to a total of 287 (67.5%) additional cases found by iCCM+ over iCCM. The likelihood of finding additional cases increased with increasing family size (adjusted odd ratio (aOR)=1.2, 95% CI: 1.1 to 1.3) and with increasing age (aOR=1.7, 95% CI: 1.5 to 1.9).ConclusionMost symptomatic cases of malaria remain undetected in the community despite the introduction of CCM of malaria. iCCM+ can be adopted to diagnose and treat more of these undiagnosed cases especially when targeted to schools, older children and larger households.

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