Using Mobile Technology to Facilitate Reactive Case  Detection of Malaria

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.

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An overview of malaria elimination efforts in South Kalimantan from 2010 to 2018

International Journal of Public Health Science (IJPHS) ◽

10.11591/ijphs.v10i1.20617 ◽

2021 ◽

Vol 10 (1) ◽

pp. 97

Author(s):

Muhammad Rasyid Ridha ◽

Deni Fakhrizal ◽

Syarif Hidayat ◽

Evi Liani

Keyword(s):

Information System ◽

Combination Therapy ◽

Malaria Elimination ◽

Artemisinin Combination Therapy ◽

Secondary Data ◽

Descriptive Study ◽

Bed Nets ◽

Malaria Surveillance ◽

Treatment Use ◽

Total Participation

Malaria elimination in Kalimantan is targeted to be completed by 2020. This study aimed to analyze efforts to eliminate malaria in South Kalimantan from 2010-2018. This research is a descriptive study of the population of South Kalimantan who is at risk of suffering from malaria. This study used a total participation technique involving all cases of malaria recorded in the malaria surveillance information system (SISMAL) 2010-2018 for South Kalimantan. The data used are secondary data obtained from the South Kalimantan Provincial Health Office in 2010-2018, namely the number of suspected malaria cases, confirmation and inspection, treatment use data, bed nets distribution, village stratification and annual parasite incidence (API) in each district. The results showed that there was the trend of malaria elimination efforts in South Kalimantan was increased from 89% of suspected patients in 2010 to 100% in 2018, and trend of API decreased from 1.5‰ in 2010 to 0.21‰ in 2018. So, with the provision of artemisinin combination therapy (ACT), from 78% in 2010 increased to 100% in 2018. All regencies/cities in South Kalimantan showed API number <1‰ in 2018. Stratification of high case incidence (HCI) villages/sub-district in 2018 decreased compared to 2010, from 211 villages to 19 villages, while malaria-free stratification from 0 in 2010 to 1,761 villages. Malaria elimination efforts in South Kalimantan showed a significant increase and it is expected that 2020 South Kalimantan will be free of malaria.

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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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Effectiveness of reactive case detection for malaria elimination in three archetypical transmission settings: a modelling study

Malaria Journal ◽

10.1186/s12936-017-1903-z ◽

2017 ◽

Vol 16 (1) ◽

Cited By ~ 25

Author(s):

Jaline Gerardin ◽

Caitlin A. Bever ◽

Daniel Bridenbecker ◽

Busiku Hamainza ◽

Kafula Silumbe ◽

...

Keyword(s):

Malaria Elimination ◽

Case Detection ◽

Reactive Case Detection ◽

Modelling Study

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A framework for evaluating the costs of malaria elimination interventions: an application to reactive case detection in Southern Province of Zambia, 2014

Malaria Journal ◽

10.1186/s12936-016-1457-5 ◽

2016 ◽

Vol 15 (1) ◽

Cited By ~ 6

Author(s):

Bruce A. Larson ◽

Thandiwe Ngoma ◽

Kafula Silumbe ◽

Marie-Reine I. Rutagwera ◽

Busiku Hamainza ◽

...

Keyword(s):

Malaria Elimination ◽

Case Detection ◽

Reactive Case Detection ◽

Southern Province

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Digitized smart surveillance in malaria elimination programme in Mangaluru city, Karnataka, India - a detailed account of operationalization in post-digitization years

10.1101/2020.07.06.20147405 ◽

2020 ◽

Author(s):

B Shantharam Baliga ◽

Shrikala Baliga ◽

Animesh Jain ◽

Naveen Kulal ◽

Manu Kumar ◽

...

Keyword(s):

Active Surveillance ◽

Malaria Elimination ◽

Secondary Data ◽

Control Measures ◽

Detailed Account ◽

Geographical Information ◽

Malaria Surveillance ◽

Smart Surveillance ◽

Complete Treatment ◽

Elimination Programme

Background An indigenously developed digital handheld Android-based geographical information system (GIS)-tagged tablets (TABs) device has been deployed in Mangaluru city, Karnataka, India for smart surveillance in malaria elimination programme from October 2014. Here a detailed account is enumerated in the post-digitization years. The study was aimed to assess the effectiveness of the digitized surveillance system under the ongoing health system in Mangaluru city. Methods A software developed for digitization of malaria surveillance was continued in the post-digitization years (PDY). The same digitization year (DY) protocol was followed in the post-digitization periods also. Secondary data from the malaria control software, total nunber of cases, active surveillance, malaria indices, and feedback from stakeholders were looked at and analyzed. Results Digital surveillance was sustained and the performance improved in the 5th year with participation of all stakeholders. Malaria indices significantly reduced to about 65% in the digitization years compared with digitization year (p<0.001). Slide positivity rate (SPR) decreased from 10.36 (DY) to 4.3 (PDY4). Annual parasite incidence (API) decreased from 16.17 (DY) to 5.4 (PDY4). There was a tempo-spatial correlation between closure of cases on 14th day and incidence of malaria. There was a negative correlation between contact smears and incidence of malaria (r = -0.907). Good impact was recorded in the pre-monsoon months (~85%) and low impact in July and August months (~40%). Conclusion Software helped to improve incidence-centric active surveillance, complete treatment with documentation of elimination of parasite, targeted vector control measures. The learnings and analytical output from the data helped to modify strategies for local control of both disease and the vector.

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Malaria Elimination in Unguja Island Zanzibar: Individual Risk Factors for Continued Transmission.

10.21203/rs.3.rs-365085/v1 ◽

2021 ◽

Author(s):

Issa Ally Garimo ◽

Dinah Gasarasi ◽

Rogath Kishimba ◽

Abdulla Ali ◽

Wahida Hasan Shirazi ◽

...

Keyword(s):

Risk Factors ◽

Malaria Elimination ◽

Malaria Infection ◽

Conditional Logistic Regression ◽

Bed Nets ◽

Individual Risk ◽

Malaria Surveillance ◽

Conditional Logistic Regression Model ◽

Individual Risk Factors ◽

Malaria Interventions

Abstract Introduction: To achieve malaria elimination, understanding of the individual risk factors for malaria infection is critical to inform strategic planning and implementation. To address this, a community-based individual risk-factor study was conducted in Unguja Island Zanzibar.Methods: A matched case control study with a sample size of 103 cases and 309 controls was conducted in Unguja Island. Malaria cases from health facilities were reported via Unstructured Supplementary Service Data (USSD) mobile phones to a central database, after which an SMS alert was sent to the District Malaria Surveillance Officer’s (DMSO) mobile phone. DMSO followed up index cases up to household level and performed malaria test on all household members using rapid diagnostic tests (mRDT). Family members tested negative were considered as controls. Both cases and controls were interviewed with the same questionnaire. Data were analyzed using Epi-info version 3.5.1 using conditional logistic regression model. Results: The findings revealed that chance of malaria infection was higher among individuals who travelled outside Zanzibar [AOR = 60.47, 95% CI 15.73 - 232.44], who spend their time in outdoor activities during the night [AOR = 8.53, 95% CI 1.96 - 37.11], whose rooms were not sprayed with indoor residual spray (IRS) [AOR= 29.60, 95% CI 2.68 - 326.49] and those who did not have a bed net [AOR=16.25, 95% CI 3.32 - 79.50].Conclusion: Travel outside Zanzibar, outdoors activities during the night, lack of access to malaria interventions (IRS or bed nets) were the risk factors for malaria infection in Unguja. Ministry of Health should set a mechanism of encouraging people who travel to malaria endemic areas to attend the nearby health facility for malaria screening. Sensitizing people on using protective gear during the night and ensuring good coverage of malaria interventions would reduce the risk of malaria in Unguja Zanzibar.

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Risk Factors Associated with Malaria Infection Identified through Reactive Case Detection in Zanzibar, 2012-2019

10.21203/rs.3.rs-936591/v1 ◽

2021 ◽

Author(s):

Humphrey Raphael Mkali ◽

Erik J. Reaves ◽

Shabbir M. Lalji ◽

Abdul-wahid Al-mafazy ◽

Joseph J. Joseph ◽

...

Keyword(s):

Risk Factors ◽

Malaria Infection ◽

Universal Access ◽

Indoor Residual Spraying ◽

P Value ◽

Case Detection ◽

Reactive Case Detection ◽

Factors Associated ◽

Llin Use ◽

History Of

Abstract BackgroundOver the past two decades, Zanzibar substantially reduced malaria burden. As malaria decreases, sustainable improvements in prevention and control interventions may increasingly depend on accurate knowledge of malaria risk factors to further target interventions. This study aimed to investigate the risk factors associated with malaria infection in Zanzibar. MethodsWe analyzed surveillance data from Zanzibar’s Malaria Case Notification system collected between August 2012 and December 2019. This system collects data from all malaria cases passively detected and reported by public and private health facilities, from household-based follow-up and reactive case detection activities linked to those primary cases. All members of households of the passively detected malaria cases were screened for malaria using a malaria rapid diagnostic test (mRDT); individuals with a positive mRDT result were treated with artemisinin-based combination therapy. Univariate and multivariate logistic regression analyses were done to investigate the association between mRDT positivity among the household members and explanatory factors (i.e., age, sex, history of fever, history of travel, rainfall, long-lasting insecticidal net [LLIN] density, LLIN use, household indoor residual spraying [IRS], and household location) with adjustment for seasonality ResultsThe findings show that younger age (p-value for trend<0.001), history of fever in the last two weeks (odds ratio [OR]=32.0; 95% CI: 29.1-35.3), history of travel outside Zanzibar in the last 30 days (OR=2.3; 95% CI: 2.1-2.6) and living in Unguja (OR=1.2; 95% CI: 1.1-1.3) were independently associated with increased odds of mRDT positivity. In contrast, male sex (OR=0.8; 95% CI: 0.7-0.9), having higher household LLIN density (p-value for trend<0.001), sleeping under an LLIN the previous night (OR=0.8; 95% CI: 0.7-0.9), and living in a household that received IRS in the last 12 months (OR=0.9; 95% CI: 0.8-0.9) were independently associated with reduced odds of mRDT positivity. A significant effect modification of combining IRS and LLIN was also noted (OR=0.7; 95% CI:0.6-0.8).ConclusionsThe findings suggest that vector control remains an important malaria prevention intervention: they underscore the need to maintain universal access to LLINs, the persistent promotion of LLIN use, and application of IRS. Additionally, enhanced behavioral change and preventive strategies targeting children aged 5-14 years and travelers are needed.

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Digitized smart surveillance in malaria elimination programme in Mangaluru city, Karnataka, India ― a detailed account of operationalization in post-digitization years

10.21203/rs.3.rs-48811/v1 ◽

2020 ◽

Author(s):

Susanta Kumar Ghosh ◽

B. Shantharam Baliga ◽

Shrikala Baliga ◽

Animesh Jain ◽

Naveen Kulal ◽

...

Keyword(s):

Active Surveillance ◽

Malaria Elimination ◽

Secondary Data ◽

Control Measures ◽

Detailed Account ◽

Geographical Information ◽

Malaria Surveillance ◽

Smart Surveillance ◽

Complete Treatment ◽

Elimination Programme

Abstract Background An indigenously developed digital handheld Android-based geographical information system (GIS)-tagged tablets (TABs) device has been deployed in Mangaluru city, Karnataka, India for smart surveillance in malaria elimination programme from October 2014. Here a detailed account is enumerated in the post-digitization years. The study was aimed to assess the effectiveness of the digitized surveillance system under the ongoing health system in Mangaluru city. Methods A software developed for digitization of malaria surveillance was continued in the post-digitization years (PDY). The same digitization year (DY) protocol was followed in the post-digitization periods also. Secondary data from the malaria control software, total nunber of cases, active surveillance, malaria indices, and feedback from stakeholders were looked at and analyzed. Results Digital surveillance was sustained and the performance improved in the 5 th year with participation of all stakeholders. Malaria indices significantly reduced to about 65% in the digitization years compared with digitization year ( p <0.001). Slide positivity rate (SPR) decreased from 10.36 (DY) to 4.3 (PDY4). Annual parasite incidence (API) decreased from 16.17 (DY) to 5.4 (PDY4). There was a tempo-spatial correlation between closure of cases on 14 th day and incidence of malaria. There was a negative correlation between contact smears and incidence of malaria ( r = - 0.907). Good impact was recorded in the pre-monsoon months (~85%) and low impact in July and August months (~40%).Conclusion Software helped to improve incidence-centric active surveillance, complete treatment with documentation of elimination of parasite, targeted vector control measures. The learnings and analytical output from the data helped to modify strategies for local control of both disease and the vector.

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

Malaria Journal ◽

10.1186/s12936-021-03645-x ◽

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.

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