Abstract
BackgroundAlthough considerable success in reducing the incidence of malaria has been achieved in Brazil in recent years, an increase in the proportion of cases caused by the harder-to-eliminate Plasmodium vivax parasite can be noted. Recurrences in P. vivax malaria cases are due to new mosquito-bite infections, drug resistance or especially from relapses arising from hypnozoites. As such, new innovative surveillance strategies are needed. The aim of this study was to develop an infographic visualization tool to improve individual-level malaria surveillance focused on malaria elimination in the Brazilian Amazon.MethodsAction Research methodology was employed to deal with the complex malaria surveillance problem in the Amazon region. Iterative cycles were used, totalling four cycles with a formal validation of an operational version of the Malaria Trigram tool at the end of the process. Further probabilistic data linkage was carried out so that information on the same patients could be linked, allowing for follow-up analysis since the official system was not planned in such way that includes this purpose.ResultsAn infographic user interface was developed for the Malaria Trigram that incorporates all the visual and descriptive power of the Trigram concept. It is a multidimensional and interactive historical representation of malaria cases per patient over time and provides visual input to decision-makers on recurrences of malaria.ConclusionsThe Malaria Trigram is aimed to help public health professionals and policy makers to recognise and analyse different types of patterns in malaria events, including recurrences and reinfections, based on the current Brazilian health surveillance system, the SIVEP-Malária system, with no additional primary data collection or change in the current process. By using the Malaria Trigram, it is possible to plan and coordinate interventions for malaria elimination that are integrated with other parallel actions in the Brazilian Amazon region, such as vector control management, effective drug and vaccine deployment strategies.
Highlights
Considerable success in reducing the incidence of malaria has been achieved in Brazil in recent years, an increase in the proportion of cases caused by the harder-to-eliminate Plasmodium vivax parasite can be noted
In Brazil, most of malaria cases are restricted to the Amazon region and the transmission has decreased over the past years, it remains high and poses an additional challenge to the goal of elimination [2, 3]
Plasmodium falciparum infections still contribute to a small fraction of cases, Plasmodium vivax infections prevails in the entire region, with almost 90% of total cases [4, 5]
Summary
Considerable success in reducing the incidence of malaria has been achieved in Brazil in recent years, an increase in the proportion of cases caused by the harder-to-eliminate Plasmodium vivax parasite can be noted. In Brazil, most of malaria cases are restricted to the Amazon region (more than 99%) and the transmission has decreased over the past years, it remains high and poses an additional challenge to the goal of elimination [2, 3]. Plasmodium falciparum infections still contribute to a small fraction of cases, Plasmodium vivax infections prevails in the entire region, with almost 90% of total cases [4, 5]. This constitutes a pitfall for malaria elimination since recurrences, common for this species, are prevalent in the region [6]. As transmission decreases, strategies focused on individual data rather than community level data are needed [9]
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