Space–Time Clustering Characteristics of Malaria in Bhutan at the End Stages of Elimination

Malaria in Bhutan has fallen significantly over the last decade. As Bhutan attempts to eliminate malaria in 2022, this study aimed to characterize the space–time clustering of malaria from 2010 to 2019. Malaria data were obtained from the Bhutan Vector-Borne Disease Control Program data repository. Spatial and space–time cluster analyses of Plasmodium falciparum and Plasmodium vivax cases were conducted at the sub-district level from 2010 to 2019 using Kulldorff’s space–time scan statistic. A total of 768 confirmed malaria cases, including 454 (59%) P. vivax cases, were reported in Bhutan during the study period. Significant temporal clusters of cases caused by both species were identified between April and September. The most likely spatial clusters were detected in the central part of Bhutan throughout the study period. The most likely space–time cluster was in Sarpang District and neighboring districts between January 2010 to June 2012 for cases of infection with both species. The most likely cluster for P. falciparum infection had a radius of 50.4 km and included 26 sub-districts with a relative risk (RR) of 32.7. The most likely cluster for P. vivax infection had a radius of 33.6 km with 11 sub-districts and RR of 27.7. Three secondary space–time clusters were detected in other parts of Bhutan. Spatial and space–time cluster analysis identified high-risk areas and periods for both P. vivax and P. falciparum malaria. Both malaria types showed significant spatial and spatiotemporal variations. Operational research to understand the drivers of residual transmission in hotspot sub-districts will help to overcome the final challenges of malaria elimination in Bhutan.

Detection of Weligama Coconut Leaf Wilt Disease Phytoplasma by Real-Time Polymerase Chain Reaction

Weligama Coconut Leaf Wilt Disease (WCLWD) is a non-lethal, but debilitating phytoplasma disease found in coconut palms in Sri Lanka which is confined to the Southern Province of the country, well-away from the major coconut growing area. If it spreads to the major coconut growing area, it might severely damage the coconut industry in Sri Lanka. Government commenced a disease control program to eradicate the disease and, more importantly to prevent spreading of the disease to major coconut growing areas. The major constraint in this program is the lack of an accurate and reliable method for identifying affected palms. Visual symptoms are used to identify the affected palms for removal, yet growers are not always convinced of the method of resisting palm removal. This poses a serious threat to the implementation of the disease control program. Although a Nested-PCR-based disease diagnosis was established earlier, the detection rate and reliability need further improvements. Therefore, an urgent necessity for a more reliable disease detection method has arisen. In the current study, a Real-Time Polymerase Chain Reaction (qPCR) powered by a pair of primers and a probe designed from the published partial sequences of the WCLWD phytoplasma was validated with 202 coconut samples and a detection rate of above 95% was achieved. This newly established detection system was highly reliable and a way forward for controlling the WCLWD disease in Sri Lanka.

Analisys of the Implementation of Non-Communicable Disease Control Programs in Posbindu PTM Puskesmas Rokan IV Koto I Districs Rokan Hulu

The implementation of the Non-Communicable Disease Control Program carried out in Posbindu PTM is a concrete manifestation of community participation in implementing early detection, monitoring and early follow-up of Non-Communicable Disease risk factors independently and continuously. Rokan IV Koto I Community Health Center has implemented PTM control in an integrated manner but the scope of Non-Communicable Disease prevention and eradication efforts is still low at 53,9%. The purpose of the study was to determine the implementation of the control program for non-communicable diseases in Posbindu PTM Rokan IV Koto I Community Health Center seen from input indicators and processes of the Non-Communicable Disease Control Program. This type of research is qualitative. 8 informants consisted of midwives midwives in charge of posbindu, mobilizing midwives, monitoring midwives, counselor doctors, recording cadres, Head of Sub-Division of Administration, community leaders, BPJS. The tringulation used is source tringulation, methods and data. The results of the study show that inputs (human resources, incentives, facilities and facilities) have been done well even though the use of Posbindu PTM facilities and equipment is not yet available in every village. The process (identification of potential PTM problems, implementation of activities and program innovations, recording and reporting, early risk follow-up and referral of PTM) has gone well. BASMI PELAKOR 1 innovation was able to increase the coverage of community visits to Posbindu PTM to 57,4% which previously had been in 2018 at 53,92%. Suggestion for Community Health Center to facilitate the formation of partnerships in each village through CSR (Corporate Social Responsibility) to buy their own tools, deliberation with the community to determine the Posbindu PTM schedule that is mutually agreed upon, involve community participation in implementing BASMI PELAKOR. Keywords : Implementaon of PTM Control Program, Input of PTM program implementaon. PTM program implementaon process.