Annual Blood Examination Rate Research Articles

Assessment of the quality of malaria surveillance and laboratory services for diagnosis in three districts of Gujarat state, India

ObjectivesSurveillance is the backbone for the control of malaria and its elimination. In the state of Gujarat, situated in the western region of India, some of the districts reported a high annual blood examination rate (ABER) for malaria. Therefore, a study was conducted to identify the underlying reasons for the increase in the ABER for malaria.MethodsPlanned investigations were carried out in three of the state districts, scrutinizing records of malaria forms and other epidemiological data collected during health worker surveillance, assessment of laboratory services, and rapid fever surveys.ResultsThe rate of fever ranged from 8 to 57% in the primary health centers that were surveyed. Analysis of epidemiological data revealed that malaria parasite positivity was more from passive than active surveillance. Increased ABER was accounted for by multiple factors, including blood slides collected during the mass survey and contact smears, which were included in the ABER and not mentioned separately. Blood slides prepared for the migrant population were included in the ABER, but the migrant population was not counted while calculating the ABER.ConclusionThe ABER in villages surveyed varied from 1.6 to 78%, which is mainly due to indiscriminate preparation of blood slides, i.e., without fever symptoms. Addressing the key gaps identified in data recording may aid in channeling the limited resources efficiently, thereby progressing toward malaria elimination. Adequate surveillance activities, along with systematic data recording, will enable timely, informed decision-making for the effective allocation of resources, ultimately supporting malaria elimination efforts in the state.

Evaluation of Outbreak Preparedness to Prevent the Reintroduction of Malaria in Ramanagara District: A Descriptive Epidemiological Study.

Background Malaria is a vector-borne disease transmitted by female anopheline mosquitoes. It is also a multidimensional disease influenced by social factors such as poor environmental conditions and awareness gaps. India has witnessed a substantial reduction in malaria cases and has declared three regions as malaria-free, with Karnataka being one of the states. However, Karnataka witnesses significant population movement and migration, which influences the spread of malaria. Ramanagara, a district in Karnataka, reported zero indigenous cases over the past three years. Hence, we selected this district to evaluate outbreak preparedness to prevent the reintroduction of malaria. This choice underscores the district's significance as a valuable model for preventing the reintroduction of malaria. Methodology Baseline survey data on malaria cases and vector survey data were evaluated for the period spanning 2018 to 2022. The data were gathered from both the regional office and the Ramanagara district health office. In addition to the documenting system, because there was no regular submission of Form-P and Form-L of the Integrated Disease Surveillance Project and Integrated Health Information Platform from the private sector, to complete the missing data, across-sectional study was conducted among private sector practitioners and pharmacies in Ramanagara from April 2023 to June 2023. Data was collected via interviews using a malaria surveillance assessment toolkit sourced from the National Centre for Vector Borne Diseases Control and World Health Organization protocols to assess six core areas of malaria elimination. Data collected via interviews were compiled in MS Excel and analyzed using SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA). Results Malaria control measures in the selected district achieved >80% coverage with notable improvements in the National Health Mission-National Vector Borne Disease Control Programme fund utilization, logistics availability, and physical performance over the past five years. The Annual Parasite Index was <1 at 0.0061 in 2018 and 0.0017 in 2022. The annual blood examination rate was consistently >10 from 22.05 in 2018 to 24.36 in 2022. The primary vectors identified were Anopheles culicifacies and Anopheles stephensi. In 2018, there were six cases of Plasmodium vivax and one case of Plasmodium falciparum reported as imported cases. In 2021 and 2022, two cases of P. vivax were reported. Notably, there were no instances of mixed infections or indigenous cases documented from 2018 to 2022 Conclusions Although the level of outbreak preparedness in the region is satisfactory, the effectiveness of vector control measures appears to be lacking. Increased government funding is needed along with comprehensive training and workshops for healthcare workers. Adequate financial resources and enhanced skills among healthcare workers are crucial to reinforce the existing efforts to control vectors and prevent potential outbreaks effectively.

Epidemiological survey, molecular profiling and phylogenetic analysis of cutaneous leishmaniasis in Khyber Pakhtunkhwa, Pakistan.

Cutaneous leishmaniasis (CL), an emerging vector-borne ailment in Khyber Pakhtunkhwa (KPK), Pakistan, exhibits diverse spread patterns and outbreaks. To comprehend its epidemiology and identify parasite species, we conducted an active survey on suspected CL cases (n=8845) in KPK. Microscopy and internal transcribed spacer-1 PCR-restriction fragment length polymorphism (RFLP) molecular techniques detected Leishmania spp. in blood samples. Phylogenetic analysis gauged genetic affinities with other areas. District Bannu displayed the highest CL impact (14.58%), while Swat had the lowest impact (4.33%) among cases. Annual blood examination rate, parasite incidence and slide positivity rate were 4.96 per 1000 people, 0.0233 and 0.047%, respectively. CL infections were prevalent in 1- to 20-y-olds, with males (57.17%) more vulnerable than females (42.82%). Single lesions occurred in 43.73% of patients, while 31.2% people had two lesions, 17.31% had three lesions and 7.74% had more than three lesions. Most had sand-fly exposure but lacked preventive measures like repellents and bed nets. Leishmania tropica was confirmed via RFLP analysis in amplified samples. Phylogenetic analysis unveiled genetic parallels between L. tropica of KPK and isolates from China, Iran, Afghanistan, India, Syria and Morocco. Urgent comprehensive control measures are imperative. Early detection, targeted interventions and raising awareness of CL and sand-fly vectors are vital for reducing the disease's impact. International collaboration and monitoring are crucial to tackle Leishmania spp.'s genetic diversity and curtail its cross-border spread.

Trend of malaria incidences and its association with rainfall in Kalahandi District of Odisha, India.

In Odisha, Kalahandi is one of the most exposed and vulnerable districts to malaria incidences due to its poor socioeconomic condition and extreme climate. The study aimed to explore the temporal characteristics of malaria incidences in Kalahandi and to identify its relationship with rainfall for the period from 2011 to 2018. Out of the total blood films examined, 8.84% were found positive in Kalahandi between 2011 and 2018. Plasmodium falciparum is the most dominant species accounted 88.3% of the total cases. Very high mean annual parasitic index (API) >15 is recorded throughout the study years. The highest incidences are recorded in the monsoon season followed by postmonsoon. The correlation value of the annual blood examination rate with P. falciparum, Plasmodium vivax, and API has shown a very high positive correlation. Rainfall shows a (+) correlation with malaria incidences in the cold (0.47) and hot seasons (0.01) and (-) correlation in the monsoon (-0.54) and postmonsoon season (-0.54).

India may need an additional metric to assess the endemicity of malaria in low surveillance districts.

India's National Framework for malaria elimination is essentially dependent on Annual Parasite Incidence (API). API is the primary criterion for classifying states and districts into different categories: intensified control, pre-elimination, elimination, prevention and re-establishment of malaria. However, API's validity is critically dependent on multiple factors, one such important factor is Annual Blood Examination Rate (ABER) and is often considered as indicator of operational efficiency. Therefore, the present study aimed to determine whether the API is a sufficiently good malaria index to assess malaria endemicity in India. An in-depth analysis of malaria data (2017-19) was done to determine the appropriateness of API as a sole indicator of malaria endemicity. We stratified the Indian districts into three strata based on Annual Blood Examination Rate (ABER): <5, 5.0-5.0, >15, further APIs was compared with Slide Positivity Rates (SPRs) using sign rank test, independently in each stratum. API and SPR were found comparable (p-value 0.323) in stratum 2 only. However, in the case of lower ABER (<5%, strata 1), the API was significantly lower than the SPR, and higher ABER (>15%), the API was found substantially higher than the SPR. Thus, ABER tunes the validity of API and should avoid to use as a single indicator of malaria endemicity. API is an appropriate measure of malaria endemicity in high and moderate transmission areas where surveillance is good (ABER≥5%). However, it is vitally dependent upon surveillance rate and other factors such as population size, the selection of individuals for malaria testing. Therefore, where surveillance is poor (<5%), we propose that API should be complemented with SPR and the number of cases. It will significantly aid the design and deployment of interventions in India.

Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot

BackgroundPanama is one of eight countries in Mesoamerica that aims to eliminate malaria by 2022. Malaria is concentrated in indigenous and remote regions like Guna Yala, a politically autonomous region where access to health services is limited and cases are predominately detected through intermittent active surveillance. To improve routine access to care, a joint effort was made by Guna Yala authorities and the Ministry of Health to pilot a network of community health workers (CHWs) equipped with rapid diagnostic tests and treatment. The impact of this pilot is described.MethodsAccess to care was measured using the proportion of villages targeted by the effort with active CHWs. Epidemiological impact was evaluated through standard surveillance and case management measures. Tests for differences in proportions or rates were used to compare measures prior to (October 2014-September 2016) and during the pilot (October 2016-September 2018).ResultsAn active CHW was placed in 39 (95%) of 41 target communities. During the pilot, CHWs detected 61% of all reported cases from the region. Test positivity in the population tested by CHWs (22%) was higher than in those tested through active surveillance, both before (3.8%) and during the pilot (2.9%). From the pre-pilot to the pilot period, annual blood examination rates decreased (9.8 per 100 vs. 8.0 per 100), test positivity increased (4.2% to 8.5%, Χ2 = 126.3, p < 0.001) and reported incidence increased (4.1 cases per 1000 to 6.9 cases per 1000 [Incidence Rate Ratio = 1.83, 95% CI 1.52, 2.21]). The percent of cases tested on the day of symptom onset increased from 8 to 27% and those treated on the day of their test increased from 26 to 84%.ConclusionsThe CHW network allowed for replacement of routine active surveillance with strong passive case detection leading to more targeted and timely testing and treatment. The higher test positivity among those tested by CHWs compared to active surveillance suggests that they detected cases in a high-risk population that had not previously benefited from access to diagnosis and treatment. Surveillance data acquired through this CHW network can be used to better target active case detection to populations at highest risk.

Trends in malaria indicators after scale-up of community-based malaria management in Afghanistan

BackgroundThe Community-Based Malaria Management (CBMM) strategy, introduced in 2013 and expanded to all health facilities and health posts in Afghanistan by 2016, aimed to deliver rapid diagnostic testing and more timely treatment to all communities nationwide. In this study, trends for several malaria outcome indicators were compared before and after the expansion of the CBMM strategy, using cross-sectional analysis of surveillance data.MethodsGeneralized estimating equation (GEE) models with a Poisson distribution were used to assess trends of three key outcomes before (2012–2015) and after (2016–2019) CBMM expansion. These outcomes were annual malaria incidence rate (both all and confirmed malaria incidence), malaria death rate, and malaria test positivity rate. Additional variables assessed included annual blood examination rates (ABER) and malaria confirmation rate.ResultsAverage malaria incidence rates decreased from 13.1 before CBMM expansion to 10.0 per 1000 persons per year after CBMM expansion (P < 0.001). The time period after CBMM was expanded witnessed a 339% increase in confirmed malaria incidence as compared to the period before (IRR 3.39, 95% CI 2.18, 5.27; P < 0.001). In the period since the expansion of CBMM (2016–2019), overall malaria incidence rate declined by 19% each year (IRR 0.81, 95% CI 0.71,0.92; P = 0.001) and the malaria death rate declined by 85% each year (IRR 0.15, 95% CI 0.12, 0.20; P < 0.001). In comparing the before period to the after period, the ABER increased from 2.3 to 3.5 per 100 person/year, the malaria test positivity rate increased from 12.2 to 20.5%, and the confirmation rate increased from 21% before to 71% after CBMM.ConclusionsAfghanistan’s CBMM expansion to introduce rapid diagnostic tests and provide more timely treatment for malaria through all levels of care temporally correlates with significant improvement in multiple indicators of malaria control.

Spatiotemporal distribution of malaria prevalence in the district Anuppur, central India

Background: In the current study, 2013±16 medical data were examined to evaluate intervention effects on malaria prevalence in central India. Spatiotemporal variation in the distribution of malaria types (PV, PF, and PV-PF) was also investigated and geographical distribution of malaria prevalence in central India first time.Methods: The data was collected from the primary health centers, sub health centers, community health centers, and district hospital. The data was used for the calculation of annual blood examination rate, annual parasite incidence, blood slide positive rate, blood slide falciparum rate, % PF, % PV, and % PV-PF types of malaria. The rate of malaria was transformed ( ) for carrying out statistical analyses. ANOVA models were considered for analysis of the data. The minimum deviation informatics statistic has been used to compare the spatiotemporal distribution of malaria types. The spatiotemporal distribution maps of malaria prevalence and mosquito breeding sites were generated using the geographic component software ArcGIS 10.3.Results: The results display that space was an important significant factor for malaria prevalence. Kotma, one of the blocks of the study region displayed varying geographic patterns of dominance. The analysis for the presence of malaria types indicated that space was an important source of variation for the rate of malaria due to Plasmodium falciparum. The distributional patterns of the malaria types, as observed in the empirical data were tested using the MDIS statistic and findings indicate that the distributions of malaria types for the spatial points, namely Pushparajgarh, Kotma, and Anuppur were not the same over the selected time points. The geographical maps mainly displayed the active mosquito breeding sites in river areas and handpump areas namely Karpa, Laidara, Khamraudh, Rajendragram, Sivarichndas, Basaniha, Soniyamar, Kiragi. The maps also displayed 46% high risk, 34% moderate risk, and 20% low-risk area.Conclusions: The prevalence of malaria in this tribal-dominated area shows that was governed by mosquitogenic factors and their transmission.

Molecular characterization and genetic diversity of cutaneous leishmaniasis from North Eastern Pakistan

The genetic diversity of Leishmania spp. in North Eastern Pakistan remains undetermined despite increased cases of cutaneous leishmaniasis (CL). This study was designed to decipher the molecular characterization and genetic diversity of Leishmania spp. in North Eastern Pakistan. Out of 13761 CL suspected cases, 567 cases were microscopically positive and confirmed as Leishmania spp. by internal transcribed spacer (ITS) gene amplification through the PCR- RFLP technique. Further, isolates were directly sequenced to conduct phylogenetic analysis for genetic diversity. Among suspected CL cases, Mirpur showed the highest proportion of CL infection with 4.85% (118/2431) of the cases, while the Neelum district showed the lowest percentage at 3.29% (9/273). The slide positivity rate, annual blood examination rate, and annual parasite incidence rate were 3.84, 0.27, and 0.01% respectively, and the incidence of CL in the age group 1–20 years old was higher in males (50.92%) than females (25.75%). The RFLP analysis and sequencing confirmed the occurrence of Leishmania tropica, Leishmania major, and Leishmania infantum. Leishmania tropica (p = 0.02) confirmed significantly higher nucleotides variation than L. major (p = 0.05). Current findings confirmed the prior assumption that anthroponotic CL is the primary CL form present in North Eastern Pakistan. Moreover, this is the first report based on molecular identification of L. major, and L. infantum from North Eastern Pakistan. This remarkable heterogeneity in the Leishmania spp. is the leading cause of treatment failure and emergence of new haplotypes. Therefore more extensive investigations are recommended from all geographical regions of North Eastern Pakistan, especially those using a large sample size.

Spatial Clustered Regression Analysis of 2017 Getis Score Indonesian Malaria Prevalence Data

Malaria is a disease that is still endemic to Indonesia. In the national scale, morbidity rate related to malaria continued to decline from 2009 to 2017. Eastern areas of Indonesia (namely Papua, West Papua, and East Nusa Tenggara) still have high endemic levels of malaria, while western areas (Islands Sumatera and Java) mostly have low endemic levels or even free of malaria. This indicates that malaria has a clustering pattern. This research used the Annual Parasite Incidence (API) data as the dependent variable and Slide Positivity Rate (SPR), Annual Blood Examination Rate (ABER), number of positive cases on children aged 1-14 years, and the number of Plasmodium falciparum cases and Plasmodium vivax cases data as the independent variables. Since they contain spatial autocorrelation, Getis Ord G_i were employed in the clustered regression analysis. Finite Mixture Model was employed as the clustering method. This study resulted in the forming of 3 clusters. Cities/regencies belonging to Cluster-1 were neither hotspots nor coldspots. Elements of Cluster-2 are SPR hotspots. Elements of Cluster-3 are hotspot areas of API, ABER, number of Plasmodium falciparum cases, number of Plasmodium vivax cases, and number of cases on children aged 1-14 years. Cluster-1 consists of 360 cities/regencies located in Islands Kalimantan, Sulawesi, Sumatera, and Java, and North Maluku Province. Cluster-2 consists of 88 cities/regencies, mostly located in provinces South Sumatera, Bengkulu, Lampung, Banten, DKI Jakarta, and West Java. Cluster-3 consists of 66 cities/regencies located in the Papua Island and East Nusa Tenggara Province.

Prevalence and associated factors of malaria in Pushparajgarh block of district Anuppur, Madhya Pradesh, India

Background: The current study aimed to determine the prevalence of malaria and its association with seasonality of malaria and socio-demographic variables in a tribal dominated district Anuppur (Madhya Pradesh).Methods: This cross-sectional study was based on blood films for malaria parasites (BFMP) data obtained from primary health centers, sub-health centers, community health centers and district hospital. This study was also based on household survey for information on malaria awareness and type of treatment preferred for malaria. From 2014-2016, a household survey was conducted regarding the type of treatment available, assessment of the influence of demographic factors, knowledge, awareness and education on malaria occurrence. Odds ratio were used to analyse the association between the gender, age group, season and types of malaria infection.Results: Annual blood examination rate (11.81%) and slide vivax rate (0.66%) was highest in 2016. There was decrease in slide falciparum rate in 2016 (1.52%). Slide positivity rate was 3.78%, 3.73% and 2.74% in the years 2014-16. Annual parasite incidence rate was 3.20%, 3.82% and 3.07% in the years 2014-16. Plasmodium falciparum positivity rate was 78.13%, 78.17% and 54.49% in the study years and was highest among the females and in the age group of 26 years and above. Distinct seasonality was observed correlating with population dynamics of the vector and climatic and socio-demographic conditions.Conclusions: The prevalence of malaria in tribal dominated Pushparajgarh area showed seasonality that was governed by mosquitogenic factors, their transmission and socio-demographic status of the population.

Molecular epidemiological survey of cutaneous leishmaniasis from Azad Jammu and Kashmir, Pakistan.

Cutaneous leishmaniasis (CL) is an emerging neglected tropical disease in Azad Jammu and Kashmir which is an underdeveloped area. Prevalence and parasite species identification are the key factors to control disease in a particular population, which were the objectives of the present study. Due to a lack of previous data, we performed a district-based active CL surveillance in 2018. The data of CL, suspected (n = 20,000) cases were analyzed statistically and identified the parasite species in microscopic positive cases by ITS1-PCR RFLP and also obtained accession numbers MN891719-28 from gene Bank. The phylogenetic tree was constructed using MEGA6 software. Out of 20,000 CL, suspected cases the highest rate of 4.02% (135/3360) of CL in Mirpur and the lowest 1.58% (8/505) in Neelum was reported. The slide positivity rate, annual parasite incidence rate and annual blood examination rate were 2.27 per 1000 population, 0.08 and 0.34%. The males were more infected 58.12% (297/511) than females 41.88% (214/511) and the age group of 1–20 years were found highly infected 82.78% (423/511) than 21–40 years 13.89% (71/511) and 41–60 years 3.33% (17/511) in the studied population. The patients 56.36% (288/511) had a single lesion whereas 29.35% (150/511) had two, only 10.76% (31/288) and 8% (12/150) were using bed nets. The patients 14.29% (73/511) had three or more lesions were not using bed nets. Only 27.98% (143/511) patients had received treatment, while 72.02% (368/511) didn't. Microscopically positive cases were found to be 2.56% (511/20,000) and ITS1-PCR positive cases were found to be 91.39% (467/511). The RFLP assay confirmed the presence of Leishmania tropica in 467 samples.

Study of the epidemiological behavior of malaria in the Darien Region, Panama. 2015-2017.

Malaria is endemic in Darién and an assessment of the different factors affecting its epidemiology is crucial for the development of adequate strategies of surveillance, prevention, and disease control. The objective of this study was to determine the main characteristics of the epidemiological behavior of malaria in the Darien region. This research was comprised of a retrospective analysis to determine the incidence and malaria distribution in the Darien region from 2015 to 2017. We evaluated malaria indicators, disease distribution, incidence (by age group and sex), diagnostic methods, treatment, and control measures. In addition, we examined the cross-border migration activity and its possible contribution to the maintenance and distribution of malaria. During the period of 2015-2017, we examined 41,141 thick blood smear samples, out of which 501 tested positive for malaria. Plasmodium vivax was responsible for 92.2% of those infections. Males comprised 62.7% of the total diagnosed cases. Meanwhile, a similar percentage, 62.7%, of the total cases were registered in economically active ages. The more frequent symptoms included fever (99.4%) and chills (97.4%), with 53.1% of cases registering between 2,000 and 6,000 parasites/μl of blood. The annual parasitic incidence (API) average was 3.0/1,000 inhabitants, while the slide positivity rate (SPR) was 1.2% and the annual blood examination rate (ABER) 22.5%. In Darién there is a constant internal and cross-border migration movement between Panama and Colombia. Malaria control measures consisted of the active and passive search of suspected cases and of the application of vector control measures. This study provides an additional perspective on malaria epidemiology in Darién. Additional efforts are required to intensify malaria surveillance and to achieve an effective control, eventually moving closer to the objective of malaria elimination. At the same time, there is a need for more eco-epidemiological, entomological and migratory studies to determine how these factors contribute to the patterns of maintenance and dissemination of malaria.

Occurrence and seasonal variation of human Plasmodium infection in Punjab Province, Pakistan

BackgroundMalaria is the fifth leading cause of death worldwide. Pakistan is considered as a moderate malaria-endemic country but still, 177 million individuals are at risk of malaria. Roughly 60% of Pakistan’s population, live in malaria-endemic regions. The present study is based upon the survey of various health care centers in 10 major cities of Northern and Southern Punjab to find out the malarial infection patterns in 2015. The diagnosis, seasonal variations, age and gender-wise distribution of Plasmodium spp. circulating in the study area were also included in the objectives.MethodsThe malaria-suspected patients ‘16075’ were enrolled for malaria diagnosis using microscopy, out of which 925 were malaria positive which were processed for molecular analysis using nested PCR. The 18S rRNA genes of Plasmodium species were amplified, sequenced, blast and the phylogenetic tree was constructed based on sequences using online integrated tool MEGA7.ResultsThe 364 cases recruited from Northern Punjab with the highest incidence in Rawalpindi (25.5%) and lowest in Chakwal (15.9%). From Southern Punjab 561 cases were enlisted Rajanpur (21.4%) maximum and lowest from Multan and Rahim Yar Khan (18%). The slide positivity rate, annual parasite incidence, and annual blood examination rates were 5.7 per 1000 population, 0.1, and 0.2% respectively. The only P. vivax (66.7%), P. falciparum (23.7%) and mixed infection by these two species (9.6%) were diagnosed. The same trend (P. vivax > P. falciparum > mixed infection) in species identification %age was confirmed from molecular analysis. However, the occurrence of malaria was higher in Southern Punjab (5.5%) as compared to the Northern Punjab (4.0%). The overall malaria percentage occurrence of treatment-seeking patients in all recruited cities of Punjab was 4.9%. The age-group of 1–20 and males among genders were more affected by malaria. The comparison of different seasons showed that the malaria infection was at a peak in Summer and post-monsoon.ConclusionThe incidence of malaria was high in the flood infected rural areas of Southern Punjab, Summer, and post-monsoon. The age group (1–20) and gender-wise males were more affected by malaria.

Improved access to early diagnosis and complete treatment of malaria in Odisha, India.

BackgroundIn 2013, the Comprehensive Case Management Programme (CCMP) was initiated to assess the impact of universal access to diagnosis and treatment and improved surveillance on malaria transmission in different settings in Odisha state, India.MethodsPairs of intervention and control sub-districts (blocks), matched on malaria incidence were selected in four districts with different transmission intensities. CCMP activities included training and supervision, ensuring no stock-outs of malaria tests and drugs, analysing verified surveillance data, stratifying areas based on risk factors, and appointing alternative providers to underserved areas. Composite risk scores were calculated for each sub-centre using principal component analysis. Post−pre changes (2013–2015 versus 2011–2012) for annual blood examination rates (ABER) and annual parasite incidence (API) across intervention and control groups were assessed using difference-in-difference (DID) estimates, adjusted for malaria transmission risk.ResultsIn the intervention sub-centres, the mean increase in ABER was 6.41 tests/sub-centre (95%CI 4.69, 8.14; p<0.01) and in API was 9.2 cases diagnosed/sub-centre (95%CI 5.18, 13.21; p<0.01). The control sub-centres reported lower increases in ABER (2.84 [95%CI 0.35, 5.34]; p<0.05) and API (3.68 [95%CI 0.45, 6.90]; p<0.05). The control-adjusted post–pre changes in API showed that 5.52 more cases (95%CI 0.34, 10.70; p<0.05) were diagnosed, and a 3.6 more cases (95%CI 0.58, 6.56; p<0.05) were tested per sub-centre in the intervention versus control areas. Larger differences in post–pre changes in API between intervention and control sub-centres were registered in the higher transmission-risk areas compared with the lower risk areas. All the changes were statistically significant.ConclusionsIntensive intervention activities targeted at improved access to malaria diagnosis and treatment produced a substantial increase in blood examination and case notification, especially in inaccessible, hard-to-reach pockets. CCMP provides insights into how to achieve universal coverage of malaria services through a routine, state-run programme.

Situation of Malaria and Expansion of Key Interventions for Malaria Elimination in Bago Region, Myanmar, 2007-2015

Analysis of malaria trends is important for planning of malaria elimination. Therefore, we reviewed the malaria monthly reports and key interventions for malaria elimination in Bago Region of Myanmar between 2007 and 2015. Secondary data analysis revealed the trends in malaria morbidity, mortality, malaria positive rate (MPR), malaria species, annual parasite incidence (API) and annual blood examination rate (ABER). Key interventions included distribution of insecticide-treated net (ITN), long lasting insecticidal net (LLIN) and case detection. Over the 8-year period, malaria morbidity and mortality rates markedly reduced from 8 to 0.3 per 1,000 population and 1.4 to 0.1 per 100,000 population respectively. During 2010-2015, API and MPR correspondingly reduced. Together with the concomitant increase in ABER and townships with API lower than one per 1,000 population, confirmed cases of P. falciparum malaria markedly decreased from 91.1% in 2007 to 55.4% in 2015. Meanwhile, the ITN/LLIN scaling-up activities resulted in an increase in population coverage from 23.5% in 2011 to 69.3% in 2015. Data from the public sector showed declining trends in malaria morbidity and mortality and low API, increasing the chance of malaria elimination. Still, there is a possibility of residual malaria that may trigger a resurgence, and thus, it is worthwhile to promote surveillance systems, especially in private sector health care establishments.

Two parallel reporting systems for malaria surveillance in Pakistan, 2013–17: is exact burden reflected?

Background: Pakistan is facing challenges regarding the availability of reliable data for malaria surveillance. These include lack of coordination between different reporting systems and fragmented information system. This study aimed to compare the reporting of malaria surveillance systems in Pakistan. Methods: There are two parallel reporting systems for malaria surveillance in Pakistan, the District Health Information System (DHIS) and Malaria Information System (MIS). DHIS reports on all morbidity at health facility level, while MIS is only used for malaria surveillance in the donor supported districts. A cross sectional study was conducted between July-September 2018 by using the retrospective records of DHIS and MIS data reported to the Directorate of Malaria Control (DOMC) Islamabad during 2013-17. Descriptive and inferential analysis was performed to compare the coverage, outcome and impact indicators. Results: During 2013-17, all districts (n=145, 100%) across Pakistan reported on the DHIS. The MIS reporting coverage has gradually increased from 21 (14.5%) to 72 (49.7%) districts. Reported number of suspected screened and confirmed malaria cases were compared. MIS reported twice the number of suspects screened for malaria (100.5%) and confirmed malaria cases (124.4%) as compared to the DHIS. The difference in the reported average annual blood examination rate (ABER) was 3.8, test positivity rate (TPR) was -0.9 and the annual parasite incidence (API) was 4.9/1000 population over five years between two systems. DHIS reported only half the ABER and API as compared to MIS. Conclusion: There is huge under-reporting of suspected and confirmed malaria cases in the DHIS as compared to MIS. Urgent attention is needed to address this, as it is vital to have uniform reporting of true disease burden across the country. An integrated disease surveillance system, improved data validation systems, and use of the online DHIS-2 are potential options for better integrity and coherence of reported data.

GIS based software technology assistance for effective control of malaria in Mangaluru, India

Background: Mangaluru is malaria endemic costal city with Annual Parasitic incidence (API) ranging between 32/1000 population (2006) to 18 (2014). In spite of implementation of control programme and efforts, the disease is far from controlled. Breaking transmission cycle is crucial in controlling malarial disease.A web based android software for surveillance/program implementation was designed and implemented for aiding control of malaria in Mangaluru. An inter professional project of medical and technology architects,Malaria Control System(MCS) is a specialized GIS based software platform for implementation, monitoring and evaluation of malaria control activities. MCSinstantaneously connects people in malaria control with transfer of information towards treatment compliance, surveillance, anti-mosquito measures and evaluation. Web-based application is for hospitals and laboratories to log on and report incidences soon after diagnosis. GIS based data is captured transferred to multipurpose workers (MPW) for house visits within 48 hrs for actions within defined time frame. Methods & Materials: MCS Software was introduced in existing health system in October 2015 and is operational for past 24 months. Real-time digital data was analyzed to study impact during 1st and 2nd year after implementation and compared with that of previous year(PY). Reporting of cases, number of house visits, and closure of cases after confirming parasite clearance, numbers of sources identified/sources closed or eliminated were analyzed to assess implementation of control measures. API, annual blood examination rate (ABER) &; slide positivity rates (SPR) were analyzed and compared to assess disease control. Results: Reporting of cases within 72 hrs from point of diagnosis was 80%. House visits were incidence centric (as against random visits previously) and complete treatment with evidence of parasite clearance was documented in 89 % and 93%(1st & 2ndyr). Breeding was identified in 11,337 visits out of 1, 95,009 visits by MPW (1st year); 10545.visits out of 1,76,398visits(2ndyear) with photo-evidences, followed by elimination in over 92% in both years. Number of cases reported decreased from 12614 (1styr) to 7181 2ndyr). Progressive reduction in API (16/18/8 in previous year/1st/2ndyr); SPR (10.3/8.2/3.7in PY/1st/2ndyr) was documented. Conclusion: By using software technology, instantaneous transfer of information, and networking ensure’s effective implementation of malaria control program to break local transmission cycle.

Use of a public-private partnership in malaria elimination efforts in Sri Lanka; a case study

BackgroundIn special circumstances, establishing public private partnerships for malaria elimination may achieve targets faster than the state sector acting by itself. Following the end of the separatist war in Sri Lanka in 2009, the Anti Malaria Campaign (AMC) of Sri Lanka intensified malaria surveillance jointly with a private sector partner, Tropical and Environmental Diseases and Health Associates Private Limited (TEDHA) with a view to achieving malaria elimination targets by 2014.MethodsThis is a case study on how public private partnerships can be effectively utilized to achieve malaria elimination goals. TEDHA established 50 Malaria Diagnostic Laboratories and 17 entomology surveillance sentinel sites in consultation with the AMC in areas difficult to access by government officials (five districts in two provinces affected by war).ResultsTEDHA screened 994,448 individuals for malaria, of which 243,867 were screened at mobile malaria clinics as compared to 1,102,054 screened by the AMC. Nine malaria positives were diagnosed by TEDHA, while the AMC diagnosed 103 malaria cases in the same districts in parallel. Over 13,000 entomological activity days were completed. Relevant information was shared with AMC and the data recorded in the health information system.ConclusionsA successful public-private partnership model for malaria elimination was initiated at a time when the health system was in disarray in war ravaged areas of Sri Lanka. This ensured a high annual blood examination rate and screening of vulnerable people in receptive areas. These were important for certification of malaria-free status which Sri Lanka eventually received in 2016.

Epidemiological Situation of Malaria in Rakhine State, Myanmar during 2000-2014

Rakhine State is the state with highest number of malaria cases in Myanmar. The objective of the study was to investigate the malaria situation in Rakhine State during 2000-2014. Data on malaria monthly reports from all townships during 2000-2014 were reviewed and analyzed. The malaria morbidity rate in Rakhine State was observed to decrease from 40.0 per 1,000 population in 2000 to 13.5 per 1,000 in 2014. Marked reduction in mortality and case-fatality rates were also observed. Although the morbidity and mortality rates were reduced in all townships, some townships had maintained high malaria positivity rate and low annual blood examination rate. Ten percent of cases in under 5-year children indicated the endemicity and local transmission of malaria. Malaria cases treated by community volunteers were increased from 1.7% in 2011 to 27.9% in 2014. The majority of malaria cases were caused by Plasmodium falciparum. Reduction in malaria morbidity and mortality might be due to early detection and treatment of cases. Efforts to detect and treat cases earlier should be a high priority in townships with high malaria positive rate and low annual blood examination rate in order to reduce the burden of malaria infection in Myanmar.