Abstract
BackgroundA key step to advancing the goal of malaria elimination in Viet Nam by 2030 is focusing limited resources for treatment and prevention to groups most at risk for malaria transmission.MethodsTo better understand risk factors for malaria transmission in central Viet Nam, a survey of 1000 malaria positive cases and 1000 malaria negative controls was conducted. Cases and controls were matched for age and gender and self-presented at commune health stations (CHS) in Binh Phuoc, Dak Nong and Dak Lak Provinces. Diagnoses were confirmed with microscopy, rapid diagnostic test and PCR. Participants were interviewed about 50 potential risk factors for malaria, which included information about occupation, forest visitation, travel, healthcare-seeking behaviour and prior use of anti-malaria interventions. Participants were enrolled by trained government health workers and the samples were analysed in Vietnamese government laboratories. Data were analysed by univariable, block-wise and multivariable logistic regression.ResultsAmong cases, 61.8% had Plasmodium falciparum, 35.2% Plasmodium vivax and 3% mixed species infections. Median (IQR) age was 27 (21–36) years and 91.2% were male. Twenty-five risk factors were associated with being a case and eleven with being a control. Multivariable analysis found that malaria cases correlated with forest workers, recent forest visitation, longer duration of illness, having a recorded fever, number of malaria infections in the past year, having had prior malaria treatment and having previously visited a clinic.ConclusionsThis study demonstrates the benefits of increased statistical power from matched controls in malaria surveillance studies, which allows identification of additional independent risk factors. It also illustrates an example of research partnership between academia and government to collect high quality data relevant to planning malaria elimination activities. Modifiable risk factors and implications of the findings for malaria elimination strategy are presented.
Highlights
A key step to advancing the goal of malaria elimination in Viet Nam by 2030 is focusing limited resources for treatment and prevention to groups most at risk for malaria transmission
A prospective, observational case–control study in health facilities in the two highest incidence provinces, Gia Lai and Binh Phuoc, and neighboring Dak Nong province, in central Viet Nam was done from March 2018 to September 2019
2000 age, gender and study site-matched cases and controls were enrolled at commune health stations (CHS) from February 2018 to March 2019
Summary
A key step to advancing the goal of malaria elimination in Viet Nam by 2030 is focusing limited resources for treatment and prevention to groups most at risk for malaria transmission. A major challenge for malaria elimination programmes (MEPs) in the developing world is access to funds for national programmes. With the decreasing external and domestic funding for malaria programmes in recent years [3] developing countries must necessarily learn to optimize the use of limited resources. Optimizing the use of these resources will require, among other things, targeting of interventions and health services to those groups most at risk of infection, localities of active transmission, and those where malaria is at-risk of being reintroduced
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