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| 2. |
- Cao, Yuanyuan, et al.
(author)
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Improving the surveillance and response system to achieve and maintain malaria elimination : a retrospective analysis in Jiangsu Province, China
- 2022
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In: INFECTIOUS DISEASES OF POVERTY. - : Springer Nature. - 2095-5162 .- 2049-9957. ; 11:1
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Journal article (peer-reviewed)abstract
- Background: Following initiation of China's National Malaria Elimination Action Plan (NMEAP) in 2010, the '1-3-7' approach was developed and rolled out in China to facilitate the malaria elimination programme and accelerate malaria elimination. This study aims to summarize and condense these experiences through a retrospective analysis in Jiangsu Province, which could be adapted and applied in other malaria elimination settings worldwide.Methods: A retrospective analysis of imported malaria cases into China identified through an improved surveillance and response system in Jiangsu Province was carried out for the period of 2001-2020. To improve the malaria surveillance and response system, Centers for Diseases Control and Prevention from the prefectures and counties in Jiangsu province conducted population-level health education to improve healthcare seeking behavior, strengthened capacity of health facilities to improve performance of malaria diagnosis and treatment, and raised the capacity of public health providers to improve implementation of the '1-3-7' approach. Categorical variables were carried out by Chi square tests with Fisher's exact correction.Results: From 2001 to 2020, a total of 9,879 malaria cases were reported in Jiangsu Province. Since 2012, no indigenous malaria cases have been reported in Jiangsu Province. However, in recent years, there has been a substantial increase of imported falciparum malaria cases. Between 2012 and 2020, an estimated 61.57 million individuals have benefited from population-level health education in Jiangsu Province. For healthcare-seeking services among the 2,423 imported malaria cases, 687 (28.4%) and 1,104 (45.6%) cases visited hospitals on the first day and the second day from symptom onset, respectively. A total of 1,502 (61.9%) cases were diagnosed on the first day at medical facilities. Jiangsu Province achieved 100%, 99.4% and 98.3% completion rate in terms of case detection and notification (within one day), case investigation (within three days) and foci response and disposition (within seven days), respectively. The improved surveillance and response system in Jiangsu Province plays an important role in preventing the re-introduction of malaria and maintaining the malaria-free status.Conclusions: Jiangsu Province has maintained its malaria-free status since 2012. The continuous improvement of a surveillance and response system plays an important role in the early detection and rapid response of potential malaria-related outbreaks in Jiangsu, China, and has important lessons for other malaria eliminating settings. Remaining vigilant in the detection of imported malaria cases and maintaining an active surveillance and response system is critical to sustain the success of malaria elimination.
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| 3. |
- Cotter, Chris
(author)
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Assessing the acceptibility and feasibility of reactive drug administration for malaria elimination in a Plasmodium vivax predominant setting: a qualitative study in two provinces in Thailand
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Other publication (other academic/artistic)abstract
- Reactive case detection (RACD) or testing and treatment of close contacts of recent malaria cases, is commonly practiced in settings approaching malaria elimination, but standard diagnostics have limited sensitivity to detect low level infection. Reactive drug administration (RDA), or presumptive treatment without testing, is an alternative approach, but better understanding regarding community acceptability and operational feasibility are needed. This qualitative study is part of a larger randomized-controlled trial evaluating the effectiveness of RDA targeting high-risk villages and forest workers for reducing Plasmodium vivax and P. falciparum malaria in Thailand. Here, we aim to explore the acceptability and feasibility RDA, and to better understand the challenges to its potential future implementation. Qualitative data collection using key informant interviews (KIIs) and focus group discussions (FGDs) were conducted virtually among key public health staff, village health volunteers (VHVs), and community members that implemented or received RDA activities. KIIs and FGDs were audio-recorded and transcribed. Transcriptions were reviewed, coded, and managed manually using Dedoose qualitative data analysis software, then underwent qualitative content analysis to identify key themes. RDA was well accepted by community members and public health staff that implemented it. Community participation was driven by fear of contracting malaria, eagerness to receive protection provided by malaria medicines, and the increased access to health care. Concerns were raised about the safety of taking malaria medicines without having an illness, particularly if underlying health conditions existed. Staff implementing RDA noted its operational feasibility, but highlighted difficulty in traveling to remote areas, and requested additional travel resources and hiring more staff. Other challenges were highlighted including the need for additional training for VHVs on malaria activities and the inability ofHPH staff to conduct RDA due to other health priorities (e.g., Covid-19). More training and practice forVHVs were noted as ways to improve implementation of RDA. To maximize uptake of RDA, local health provider and community education regarding its rational and purpose of RDA are critical. To alleviate safety concerns and ensure participant safety, a rigorous pharmacovigilance program is important. To optimize implementation, an adequate number of trained and resourced staff are needed, particularly for accessing remote and hard-to-reach areas.
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| 4. |
- Cotter, Chris
(author)
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Evaluating and optimizing surveillance and response strategies for malaria elimination in the Asia Pacific region
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Malaria case investigation and reactive case detection (RACD) activities are widely implemented in low transmission settings to identify additional malaria infections and gather surveillance information, but with varying degrees of success. Challenges in conducting RACD include poor diagnostic sensitivity (particularly for low density and asymptomatic infections), knowledge gaps among those conducting RACD, financial and resource constraints, and operational and logistical difficulties. To improve infection detection and better target individuals at highest risk for infection, RACD strategies need to be evaluated and optimized to provide quality and nuanced surveillance information.To support more effective surveillance and response strategies, this PhD project focused on evaluating RACD strategies to improve and optimize malaria surveillance in low transmission settings in the Asia Pacific region. Using a standardized monitoring and evaluation (M&E) tool, case investigation and RACD indicators were assessed, including the knowledge and practices of the staff conducting RACD. This PhD project explored the utility of molecular diagnostics and genotyping and targeted sociobehavorial RACD strategies for increasing infection detection and to understand the relatedness of infections identified during RACD. Also, the acceptability and feasibility of a presumptive treatment-based strategy to reduce malaria (referred to as reactive drug administration (RDA)) was evaluated.Results revealed gaps in case investigation and RACD reporting completeness and timeliness and that staff were not always equipped with the appropriate documentation or have accurate knowledge on how to conduct RACD. Molecular diagnostics used in RACD in Thailand identified an additional 12 (0.6%) infections compared to no RACD-identified infections detected by microscopy. Of the four confirmed infections, only one (25%) was genetically related to the index case. In Indonesia, a sociobehavorial RACD strategy targeting high risk populations and work venues was able to identify 180 individuals for RACD yielding 8 infections compared to only one infection during household-based RACD. Shared risk factors between sociobehavorial RACD individuals and index patients include being male, 30-45 years of age, and occupation of logging or mining. In Thailand, an RDA strategy targeting within and around the household and forest-going co-workers was found to be acceptable by those that participated and feasible to be implemented by the malaria staff.The quality of malaria case investigation and RACD activities and the knowledge of those implementing it can be improved using a standardized M&E tool. The molecular and genotyping findings may be useful for malaria programs in low transmission settings to increase infection detection in persistent malaria foci or among high-risk populations and to characterize local transmission patterns. When the highest risk individuals for malaria can be identified, a strategy like RDA may be useful to target and eliminate malaria to accelerate elimination efforts.
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| 5. |
- Cotter, Chris, et al.
(author)
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Piloting a programme tool to evaluate malaria case investigation and reactive case detection activities : results from 3 settings in the Asia Pacific
- 2017
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In: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 16
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Journal article (peer-reviewed)abstract
- Background: Case investigation and reactive case detection (RACD) activities are widely-used in low transmission settings to determine the suspected origin of infection and identify and treat malaria infections nearby to the index patient household. Case investigation and RACD activities are time and resource intensive, include methodologies that vary across eliminating settings, and have no standardized metrics or tools available to monitor and evaluate them. Methods: In response to this gap, a simple programme tool was developed for monitoring and evaluating (M&E) RACD activities and piloted by national malaria programmes. During the development phase, four modules of the RACD M&E tool were created to assess and evaluate key case investigation and RACD activities and costs. A pilot phase was then carried out by programme implementers between 2013 and 2015, during which malaria surveillance teams in three different settings (China, Indonesia, Thailand) piloted the tool over a period of 3 months each. This study describes summary results of the pilots and feasibility and impact of the tool on programmes. Results: All three study areas implemented the RACD M&E tool modules, and pilot users reported the tool and evaluation process were helpful to identify gaps in RACD programme activities. In the 45 health facilities evaluated, 71.8% (97/135; min 35.3-max 100.0%) of the proper notification and reporting forms and 20.0% (27/135; min 0.0-max 100.0%) of standard operating procedures (SOPs) were available to support malaria elimination activities. The tool highlighted gaps in reporting key data indicators on the completeness for malaria case reporting (98.8%; min 93.3-max 100.0%), case investigations (65.6%; min 61.8-max 78.4%) and RACD activities (70.0%; min 64.7-max 100.0%). Evaluation of the SOPs showed that knowledge and practices of malaria personnel varied within and between study areas. Average monthly costs for conducting case investigation and RACD activities showed variation between study areas (min USD $844.80-max USD $2038.00) for the malaria personnel, commodities, services and other costs required to carry out the activities. Conclusion: The RACD M&E tool was implemented in the three pilot areas, identifying key gaps that led to impacts on programme decision making. Study findings support the need for routine M&E of malaria case reporting, case investigation and RACD activities. Scale-up of the RACD M&E tool in malaria-eliminating settings will contribute to improved programme performance to the high level that is required to reach elimination.
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| 6. |
- Cotter, Chris
(author)
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Sociobehavorial reactive case detection strategies targeting high-risk populations to increase the detection of malaria infections in Aceh Province, Indonesia
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Other publication (other academic/artistic)abstract
- Reactive case detection (RACD), or testing and treatment of close contacts and household members of a recent malaria case, is commonly practiced in settings nearing malaria elimination, but RACD strategies and diagnostics used may not be effective at identifying and targeting the most at risk for malaria. A sociobehavorial RACD approach is an alternative approach that may provide a more effective approach to identify and screen high-risk populations for malaria and detect additional infections compared to a household-based RACD approach. We assessed the utility, and effectiveness of microscopy, LAMP and PCR comparing household-based RACD and sociobehavorial RACD approaches in Aceh Province, Indonesia. Characteristics of the different study populations were analyzed, including prevalence of microscopy and molecular detection. The study enrolled 34 index cases for household-based RACD (HH-RACD) of which 33 were sociobehavorial-RACD (SB-RACD) eligible cases. A total of 847 household members and neighbors were screened in HH-RACD, providing 1 LAMP and PCR positive RACD-identified infection. In SB-RACD 180 individuals were screened and 3 LAMP and PCR positive RACD-identified infections were identified.(p=0.018) Important shared risk factors were identified between SB-RACD screened individuals and index cases. These include: 1) men having a higher likelihood of being an index case and being screened during SB-RACD; 2) being between 30-45 years of age; 3) occupation of logging, mining, or other outdoor labor compared to farming or other; 4) having slept in the forest or family members with forest exposure in the past 60 days; 5) and having a traditional housing type as their main residence. In low transmission settings, targeting of sociobehavorial contacts of malaria index cases when conducting RACD has the potential to yield more RACD-identified infections, particularly when molecular diagnostics are used, making it potentially a more effective screening strategy compared to HH-RACD only.
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| 7. |
- Cotter, Chris
(author)
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Utility and costs of reactive case detection using molecular detection and genotyping in Thailand, a near-elimination setting with predominantly Plasmodium vivax transmission
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Other publication (other academic/artistic)abstract
- In Thailand, progress toward malaria elimination has slowed, largely due to the challenge of residual Plasmodium vivax transmission. Screening and testing for malaria in the vicinity of recent passively-identified index cases, also called reactive case detection (RACD), is commonly used in near-elimination settings, but standard diagnostics such as microscopy miss low-level infections. We assessed the utility, costs, and cost-effectiveness of RACD using loop-mediated isothermal amplification (LAMP) versus standard RACD using microscopy to detect infections in RACD. We also assessed the utility of microsatellite genotyping to determine relatedness of index and RACD-identified infections. Each of 27 microscopy-positive index cases reported through passive surveillance (20 Plasmodium vivax, 5 P. falciparum, and 2 mixed P. falciparum/ P. vivax infections) triggered RACD, whereby 1,973 index case household members or surrounding neighbors received malaria testing. Of these, no infections were detected in RACD by microscopy, but 12 (0.6%) confirmed or probable infections were detected in RACD by molecular testing using LAMP, out of which four infections were confirmed by PCR. Among these four, one (25%) was genetically related to the index case suggesting low levels of local transmission. The average cost per individual screened for RACD using microscopy and RACD using LAMP was $15 and $22, respectively, and the incremental cost effectiveness ratio to detect infections was $1,191 per additional infection detected. In this near elimination setting, RACD using molecular detection and genotyping can make RACD a more effective strategy by identifying additional infections and transmission foci to facilitate a better understanding regarding local patterns of transmission.
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| 8. |
- Cotter, Chris
(author)
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Utility and costs of reactive case detection using molecular detection and genotyping in Thailand, a near-elimination setting with predominantly Plasmodium vivax transmission
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Other publication (other academic/artistic)abstract
- In Thailand, progress toward malaria elimination has slowed, largely due to the challenge of residual Plasmodium vivax transmission. Screening and testing for malaria in the vicinity of recent passively-identified index cases, also called reactive case detection (RACD), is commonly used in near-elimination settings, but standard diagnostics such as microscopy miss low-level infections. We assessed the utility, costs, and cost-effectiveness of RACD using loop-mediated isothermal amplification (LAMP) versus standard RACD using microscopy to detect infections in RACD. We also assessed the utility of microsatellite genotyping to determine relatedness of index and RACD-identified infections. Each of 27 microscopy-positive index cases reported through passive surveillance (20 Plasmodium vivax, 5 P. falciparum, and 2 mixed P. falciparum/ P. vivax infections) triggered RACD, whereby 1,973 index case household members or surrounding neighbors received malaria testing. Of these, no infections were detected in RACD by microscopy, but 12 (0.6%) confirmed or probable infections were detected in RACD by molecular testing using LAMP, out of which four infections were confirmed by PCR. Among these four, one (25%) was genetically related to the index case suggesting low levels of local transmission. The average cost per individual screened for RACD using microscopy and RACD using LAMP was $15 and $22, respectively, and the incremental cost effectiveness ratio to detect infections was $1,191 per additional infection detected. In this near elimination setting, RACD using molecular detection and genotyping can make RACD a more effective strategy by identifying additional infections and transmission foci to facilitate a better understanding regarding local patterns of transmission.
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| 9. |
- Gallalee, Sarah, et al.
(author)
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Forest-goers as a heterogeneous population at high-risk for malaria : a case-control study in Aceh Province, Indonesia
- 2024
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In: Malaria Journal. - : BioMed Central (BMC). - 1475-2875. ; 23:1
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Journal article (peer-reviewed)abstract
- BackgroundA major challenge to malaria elimination is identifying and targeting populations that are harbouring residual infections and contributing to persistent transmission. In many near-elimination settings in Southeast Asia, it is known that forest-goers are at higher risk for malaria infection, but detailed information on their behaviours and exposures is not available.MethodsIn Aceh Province, Indonesia, a near-elimination setting where a growing proportion of malaria is due to Plasmodium knowlesi, a case–control study was conducted to identify risk factors for symptomatic malaria, characteristics of forest-goers, and key intervention points. From April 2017 to September 2018, cases and controls were recruited and enrolled in a 1:3 ratio. Cases had confirmed malaria infection by rapid diagnostic test or microscopy detected at a health facility (HF). Gender-matched controls were recruited from passive case detection among individuals with suspected malaria who tested negative at a health facility (HF controls), and community-matched controls were recruited among those testing negative during active case detection. Multivariable logistic regression (unconditional for HF controls and conditional for community controls) was used to identify risk factors for symptomatic malaria infection.ResultsThere were 45 cases, of which 27 were P. knowlesi, 17 were Plasmodium vivax, and one was not determined. For controls, 509 and 599 participants were recruited from health facilities and the community, respectively. Forest exposures were associated with high odds of malaria; in particular, working and sleeping in the forest (HF controls: adjusted odds ratio (aOR) 21.66, 95% CI 5.09–92.26; community controls: aOR 16.78, 95% CI 2.19–128.7) and having a second residence in the forest (aOR 6.29, 95% CI 2.29–17.31 and 13.53, 95% CI 2.10–87.12). Male forest-goers were a diverse population employed in a variety of occupations including logging, farming, and mining, sleeping in settings, such as huts, tents, and barracks, and working in a wide range of group sizes. Reported use of protective measures, such as nets, hammock nets, mosquito coils, and repellents was low among forest-goers and interventions at forest residences were absent.ConclusionsSecond residences in the forest and gaps in use of protective measures point to key malaria interventions to improve coverage in forest-going populations at risk for P. knowlesi and P. vivax in Aceh, Indonesia. Intensified strategies tailored to specific sub-populations will be essential to achieve elimination.
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| 10. |
- Lin, Kangming, et al.
(author)
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Evaluation of an Innovative Point-of-Care Rapid Diagnostic Test for the Identification of Imported Malaria Parasites in China
- 2023
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In: Tropical Medicine and Infectious Disease. - : MDPI. - 2414-6366. ; 8:6
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Journal article (peer-reviewed)abstract
- Background: China was certified malaria-free by the World Health Organization on 30 June 2021. However, due to imported malaria, maintaining a malaria-free status in China is an ongoing challenge. There are critical gaps in the detection of imported malaria through the currently available tools, especially for non-falciparum malaria. In the study, a novel point-of-care Rapid Diagnostic Test designed for the detection of imported malaria infections was evaluated in the field. Methods: Suspected imported malaria cases reported from Guangxi and Anhui Provinces of China during 2018-2019 were enrolled to evaluate the novel RDTs. Diagnostic performance of the novel RDTs was evaluated based on its sensitivity, specificity, positive and negative predictive values, and Cohen's kappa coefficient, using polymerase chain reaction as the gold standard. The Additive and absolute Net Reclassification Index were calculated to compare the diagnostic performance between the novel RDTs and Wondfo RDTs (control group). Results: A total of 602 samples were tested using the novel RDTs. Compared to the results of PCR, the novel RDTs presented sensitivity, specificity, PPV, NPV, and diagnostic accuracy rates of 78.37%, 95.05%, 94.70%, 79.59%, and 86.21%, respectively. Among the positive samples, the novel RDTs found 87.01%, 71.31%, 81.82%, and 61.54% of P. falciparum, P. ovale, P. vivax, and P. malariae, respectively. The ability to detect non-falciparum malaria did not differ significantly between the novel and Wondfo RDTs (control group). However, Wondfo RDTs can detect more P. falciparum cases than the novel RDTs (96.10% vs. 87.01%, p < 0.001). After the introduction of the novel RDTs, the value of the additive and absolute Net Reclassification Index is 1.83% and 1.33%, respectively. Conclusions: The novel RDTs demonstrated the ability to distinguish P. ovale and P. malariae from P. vivax which may help to improve the malaria post-elimination surveillance tools in China.
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