Abstract
BackgroundIn the past decade substantial reduction in malaria morbidity and mortality has been observed through well-implemented case management and vector control strategies. India has also achieved a significant reduction in malaria burden in 2018 and has committed to eliminate malaria by 2030. The Mandla Malaria Elimination Demonstration Project (MEDP) was started in 2017 in 1233 villages of District Mandla to demonstrate malaria elimination in a tribal district with hard-to-reach areas was possible using active and passive surveillance, case management, vector control, and targeted information, education and communication campaigns. An operational plan was developed to strengthen the existing surveillance and malaria elimination systems, through fortnightly active case detection to ensure that all cases including those that are introduced into the communities are rapidly identified and treated promptly. The plan also focused on the reduction of human-mosquito contact through the use of Long-Lasting Insecticial Nets (LLINs) and Indoor Residual Spray (IRS). The operational plan was modified in view of the present COVID-19 pandemic by creating systems of assistance for the local administration for COVID-related work while ensuring the operational integrity of malaria elimination efforts.ResultsThe use of MEDP study design and operational plan, with its built-in management control systems, has yielded significant (91%) reduction of indigenous cases of malaria during the period from June 2017 to May 2020. The malaria positivity rate was 0.33% in 2017–18, 0.13% in 2018–19, and 0.06% in 2019–20. Mass screening revealed 0.18% malaria positivity in September–October 2018, followed by 0.06% in June 2019, and 0.03% in December 2019, and these were mostly asymptomatic cases in the community. The project has been able to sustain the gains of the past three years during the ongoing COVID-19 pandemic.ConclusionThis paper provides the study design and the operational plan for malaria elimination in a high-burden district of Central India, which presented difficulties of hard to reach areas, forest malaria, and complex epidemiology of urban and rural malaria. The lessons learned could be used for malaria elimination efforts in rest of the country and other parts of South Asia with comparable demography and epidemiology.
Highlights
In the past decade substantial reduction in malaria morbidity and mortality has been observed through well-implemented case management and vector control strategies
In the South-East Asia Region (SEAR), progress in malaria control has been noted over the past decade, with the incidence rate falling from 17 cases of the disease per 1,000 population at risk in 2010 to 5 cases in 2018 (a 70% decrease) [2]
The project has completed 33 months of its field operations and the results are presented in the series of eleven Malaria Elimination Demonstration Project (MEDP) companion papers that present findings on gaps in human resources, development and usage of mobile app for disease surveillance, workforce management and supply chain management, proper utilization of vector control tools (IRS and Long-Lasting Insecticial Nets (LLINs)), development of context specific Institutional Ethical Clearance (IEC) campaigns for behaviour change, and reduction of malaria cases over the past 33 months
Summary
In the past decade substantial reduction in malaria morbidity and mortality has been observed through well-implemented case management and vector control strategies. India has achieved a significant reduction in malaria burden in 2018 and has committed to eliminate malaria by 2030. An operational plan was developed to strengthen the existing surveillance and malaria elimination systems, through fortnightly active case detection to ensure that all cases including those that are introduced into the communities are rapidly identified and treated promptly. Sri Lanka has been malaria free for the past 4 years and China has reported zero indigenous cases for the past 2 years. India has reported a 28% reduction in malaria cases from last year [2], reaffirming that the effectiveness of the existing tools and principles of malaria elimination
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