Abstract
BackgroundRepeat national household surveys suggest highly variable malaria transmission and increasing coverage of high-impact malaria interventions throughout Zambia. Many areas of very low malaria transmission, especially across southern and central regions, are driving efforts towards sub-national elimination.Case descriptionReactive case detection (RCD) is conducted in Southern Province and urban areas of Lusaka in connection with confirmed incident malaria cases presenting to a community health worker (CHW) or clinic and suspected of being the result of local transmission. CHWs travel to the household of the incident malaria case and screen individuals living in adjacent houses in urban Lusaka and within 140 m in Southern Province for malaria infection using a rapid diagnostic test, treating those testing positive with artemether–lumefantrine.DiscussionReactive case detection improves access to health care and increases the capacity for the health system to identify malaria infections. The system is useful for targeting malaria interventions, and was instrumental for guiding focal indoor residual spraying in Lusaka during the 2014/2015 spray season. Variations to maximize impact of the current RCD protocol are being considered, including the use of anti-malarials with a longer lasting, post-treatment prophylaxis.ConclusionThe RCD system in Zambia is one example of a malaria elimination surveillance system which has increased access to health care within rural communities while leveraging community members to build malaria surveillance capacity.
Highlights
Repeat national household surveys suggest highly variable malaria transmission and increasing cover‐ age of high-impact malaria interventions throughout Zambia
The potential sensitivity of any passive surveillance system is limited by the treatment-seeking behaviour of the population [7], increasing the availability of service providers capable of diagnosing, treating and reporting on local malaria infections is a first step towards improving the surveillance system
Trends in malaria measured through the surveillance system in 2014 In 2014, the 20 health centres participating in the Lusaka District Reactive case detection (RCD) system detected 3688 confirmed incident malaria cases, of which 3080 (83.5 %) reported recent travel history and were excluded from further RCD activities
Summary
The RCD system presented aims to further Zambia toward malaria elimination by: (a) prompting CHWs to perform case investigations in areas affected with recent confirmed malaria, expanding access to health care and (b) improving the malaria surveillance network to maximize the number of diagnosed and documented incident malaria cases to guide intervention decisions. For example, utilizes the Malaria Information System (MIS), a stand-alone system developed in MS Access with communication from two additional alert systems for malaria positive and resistance data [20] This system provides SMS alert messages to various levels of the Cambodia MOH, an aspect which the Zambia system has not included. Parasite prevalence identified during RCD may be a better indicator for the prevalence of locally-acquired malaria infections than incidence, and mapping test positivity from responses can indicate where foci of residual transmission remain, directing interventions in a targeted manner. Development and approval of a once a day regimen would likely improve compliance, among individuals with asymptomatic malaria infections [26]
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