Abstract

BackgroundA high-resolution surveillance-response system has been developed within a geographic information system (GIS) to support malaria elimination in the Pacific. This paper examines the application of a GIS-based spatial decision support system (SDSS) to automatically locate and map the distribution of confirmed malaria cases, rapidly classify active transmission foci, and guide targeted responses in elimination zones.MethodsCustomized SDSS-based surveillance-response systems were developed in the three elimination provinces of Isabel and Temotu, Solomon Islands and Tafea, Vanuatu. Confirmed malaria cases were reported to provincial malaria offices upon diagnosis and updated into the respective SDSS as part of routine operations throughout 2011. Cases were automatically mapped by household within the SDSS using existing geographical reconnaissance (GR) data. GIS queries were integrated into the SDSS-framework to automatically classify and map transmission foci based on the spatiotemporal distribution of cases, highlight current areas of interest (AOI) regions to conduct foci-specific targeted response, and extract supporting household and population data. GIS simulations were run to detect AOIs triggered throughout 2011 in each elimination province and conduct a sensitivity analysis to calculate the proportion of positive cases, households and population highlighted in AOI regions of a varying geographic radius.ResultsA total of 183 confirmed cases were reported and mapped using the SDSS throughout 2011 and used to describe transmission within a target population of 90,354. Automatic AOI regions were also generated within each provincial SDSS identifying geographic areas to conduct response. 82.5% of confirmed cases were automatically geo-referenced and mapped at the household level, with 100% of remaining cases geo-referenced at a village level. Data from the AOI analysis indicated different stages of progress in each province, highlighting operational implications with regards to strategies for implementing surveillance-response in consideration of the spatiotemporal nature of cases as well as logistical and financial constraints of the respective programmes.ConclusionsGeospatial systems developed to guide Pacific Island malaria elimination demonstrate the application of a high resolution SDSS-based approach to support key elements of surveillance-response including understanding epidemiological variation within target areas, implementing appropriate foci-specific targeted response, and consideration of logistical constraints and costs.

Highlights

  • A high-resolution surveillance-response system has been developed within a geographic information system (GIS) to support malaria elimination in the Pacific

  • Approval for this study was provided by the Ministries of Health (MoH) in each country, who formally requested in-country technical support to assist in the development and implementation of a practical and easy-to-use SDSSbased malaria surveillance system to support progressive malaria elimination

  • Data collection activities and spatial decision support system (SDSS)-based surveillance operations were conducted by provincial vector borne diseases control programme (VBDCP) surveillance, monitoring and evaluation (SM&E) officers as part of their routine activities, with technical assistance provided by the Pacific Malaria Initiative Support Centre (PacMISC) and World Health Organization (WHO)

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Summary

Introduction

A high-resolution surveillance-response system has been developed within a geographic information system (GIS) to support malaria elimination in the Pacific. This paper examines the application of a GIS-based spatial decision support system (SDSS) to automatically locate and map the distribution of confirmed malaria cases, rapidly classify active transmission foci, and guide targeted responses in elimination zones. As efforts to combat the global burden of malaria continue, there is a renewed focus on the need to strengthen surveillance throughout all phases of intensified malaria control and elimination [1,2,3,4,5,6,7] This renewed emphasis on surveillance and its ultimate role in identifying and rapidly tackling remaining transmission reservoirs by adequate integrated response package is highlighted by the World Health Organization (WHO) Global Malaria Programme “T3: Test. As transmission declines and locally acquired cases approach zero, sound vigilance becomes essential to monitor outbreak and importation risk [18,19]

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