Malaria Surveillance System Research Articles

Evaluating the Implementation of Automated Malaria Rapid Diagnostic Test Readers in Health Facilities in the Democratic Republic of Congo: Process, Challenges, and Lessons Learned.

The WHO's Global Technical Strategy for malaria emphasizes the importance of reliable malaria surveillance systems to track disease burden and measure progress. A key indicator, the test positivity rate (TPR), largely depends on healthcare providers' adherence to rapid diagnostic test (RDT) results and their accurate reporting. To minimize healthcare providers' bias, this study explored the feasibility of using artificial intelligence (AI)-driven Deki Reader devices in the Democratic Republic of Congo. The devices were deployed in 144 health facilities across Haut Katanga, Kasai Central, and Sud Kivu provinces from January to December 2022. Healthcare providers performed malaria diagnostic tests using RDTs and reported the results through the routine system. In addition, they used the Deki Reader device, which automatically read, recorded, and transmitted the AI interpretation into a cloud database. The study compared TPRs from both sources to identify discrepancies. The study revealed the feasibility of using these devices but also identified several logistic and technical challenges. These included delays in device procurement due to COVID-19 pandemic and customs issues, emphasizing the need for better planning and coordination in future rollouts. Device malfunctions and the reliance on stable internet connectivity highlighted the importance of robust support systems and contingency plans. This study demonstrated both the benefits and challenges of implementing such digital health technologies in primary health facilities. Key considerations for successful deployment include careful planning, adequate training and supervision, and taking into account local infrastructure, especially internet connectivity.

Simulated Malaria Online Tool: an instrument for evaluating healthcare providers' practices and contributing to the evidence base for certifying malaria elimination and preventing its re-establishment

BackgroundHealthcare providers (HCPs) practice and correct management of suspected malaria (CMSM) are central components of malaria elimination and prevention of re-establishment (POR) in countries in the elimination phase. However, knowledge of malaria surveillance systems and HCPs practices often wanes in countries aiming to eliminate malaria due to the low numbers of cases. The study aimed to implement a valid Simulated Malaria Online Tool (SMOT) for assessment HCP performance in CMSM and POR in a malaria-free area.MethodsHCPs were evaluated using SMOT tool based on four criteria including presenting a suspected malaria case for detection of HCPs’ failures in recognition (a), diagnosis (b), appropriate treatment (c), and urgent reporting (d); and compared with simulated patients (SP). Multiple logistic regression analysis was carried out to estimate adjusted odds ratios (ORs) for the risk of HCPs failures.ResultsThe overall failure proportion was 237 (83%), and the majority of failures were in recognition (a). There was no significant difference between the SMOT and SP based on all failure criteria (P > 0.05). The private clinic (93%) and the public specialized clinic (70%) had the highest and lowest failure proportions. After passing the recognition stage (a), the overall failure proportions decreased to 47.8% and 25.0% for total HCPs and infectious disease specialists, respectively. In the final analysis, private sector (AOR = 4.36: 1.25–15.2), not-specialist providers (AOR = 2.84: 1.29–6.25) and HCPs with ≥ 5 years’ experience (AOR = 2.03: 1.01–6.25) increased the risk of failure.ConclusionFindings confirmed the implementation of SMOT tool in settings where malaria transmission is low or interrupted. The tool is able to identify sub-groups of providers needing strengthening, and contributes to the prevention of malaria re-establishment.

Readiness of malaria elimination in community and health facility of Mannaung Township, Rakhine State, Myanmar in 2022: a mixed-methods study

Background: Myanmar aims to eliminate Plasmodium falciparum malaria by 2025 and all human strains by 2030. In 2018, three townships including Mannaung township in Rakhine State were chosen for elimination pilot projects. The readiness assessment of community health-seeking behaviour and healthcare services of a malaria surveillance system for malaria elimination was conducted in Mannaung township. Methods: In December 2022, a mixed-methods survey interviewed 400 villagers regarding health-seeking behaviour and in-depth interviews (IDI) with Healthcare Providers (HCPs) from eight Health Centers and three hospitals for healthcare services of surveillance systems for malaria elimination. Results: Of 400 households, 154 (38.5%) had at least one family member contracting fever in the last 3 months. Among the 686 members contacted, 220 (32.1%) had a fever within the 3 months. Of these reported fever, 70 respondents (31.8%) were tested with RDT of which 51 (72.9%) were tested within 24 hours. Three main themes emerged from qualitative data analysis: experience of malaria prevention and control activities, malaria case-based response activities and suggestions to improve malaria surveillance. Although most of the HCPs expressed their understanding of testing criteria for malaria elimination, some had a knowledge gap in malaria elimination response activities. The HCPs received malaria elimination training in 2019, but they suggested providing malaria elimination-related training annually. Conclusions: The readiness assessment revealed delayed health-seeking behaviour in malaria thus awareness raising within the community should be provided. The HCPs need to enhance their ability to conduct surveillance activities for malaria elimination.

Mapping malaria transmission foci in Northeast Thailand from 2011 to 2021: approaching elimination in a hypoendemic area

BackgroundThailand is approaching local elimination of malaria in the eastern provinces. It has successfully reduced the number of cases over the past decade, but there are persistent transmission hot spots in and around forests. This study aimed to use data from the malaria surveillance system to describe the spatiotemporal trends of malaria in Northeast Thailand and fine-scale patterns in locally transmitted cases between 2011 and 2021.MethodsCase data was stratified based on likely location of infection and parasite species. Annual Parasite Index per 1000 population (API) was calculated for different categories. Time series decomposition was performed to identify trends and seasonal patterns. Statistically significant clusters of high (hot spots) and low (cold spots) API were identified using the Getis-Ord Gi* statistic. The stability of those hot spots and the absolute change in the proportion of API density from baseline were compared by case type.ResultsThe total number of confirmed cases experienced a non-linear decline by 96.6%, from 1061 in 2011 to 36 in 2021. There has been a decline in both Plasmodium vivax and Plasmodium falciparum case numbers, with only four confirmed P. falciparum cases over the last two years—a 98.89% drop from 180 in 2011. API was generally higher in Si Sa Ket province, which had peaks every 2–3 years. There was a large outbreak in Ubon Ratchathani in 2014–2016 which had a high proportion of P. falciparum reported. The proportion of cases classified increased over the study period, and the proportion of cases classed as indigenous to the village of residence increased from 0.2% to 33.3%. There were stable hot spots of indigenous and imported cases in the south of Si Sa Ket and southeast of Ubon Ratchathani. Plasmodium vivax hot spots were observed into recent years, while those of P. falciparum decreased to zero in Ubon in 2020 and emerged in the eastern part in 2021, the same year that P. falciparum hot spots in Si Sa Ket reached zero.ConclusionsThere has been a large, non-linear decline in the number of malaria cases reported and an increasing proportion of cases are classed as indigenous to the patient’s village of residence. Stable hot spots of ongoing transmission in the forested border areas were identified, with transmission likely persisting because of remote location and high-risk forest-going behaviours. Future efforts should include cross-border collaboration and continued targeting of high-risk behaviours to reduce the risk of imported cases seeding local transmission.

Malaria epidemiology, surveillance and response for elimination in Lao PDR

BackgroundLao PDR has made significant progress in malaria control. The National Strategic Plans outline ambitious targets, aiming for the elimination of Plasmodium falciparum and P. vivax malaria from all northern provinces by 2025 and national elimination by 2030. This article presents an overview of malaria epidemiology, surveillance, and response systems in Lao PDR, emphasizing experiences and achievements in transmission reduction.MethodsData on surveillance, monitoring and evaluation systems, human resources, infrastructure, and community malaria knowledge during 2010–2020 were systematically gathered from the national program and relevant documents. The collected information was synthesized, and discussions on challenges and future prospects were provided.ResultsMalaria control and elimination activities in Lao PDR were implemented at various levels, with a focus on health facility catchment areas. There has been significant progress in reducing malaria transmission throughout the country. Targeted interventions, such as case management, vector control, and community engagement, using stratification of control interventions by catchment areas have contributed to the decline in malaria cases. In elimination areas, active surveillance strategies, including case and foci investigation, are implemented to identify and stop transmission. The surveillance system has facilitated timely detection and response to malaria cases, enabling these targeted interventions in higher-risk areas.ConclusionsThe malaria surveillance and response system in Lao PDR has played a crucial role in reducing transmission and advancing the country towards elimination. Challenges such as importation, drug resistance, and sustaining support require ongoing efforts. Further strengthening surveillance, improving access to services, and addressing transmission determinants are key areas of focus to achieve malaria elimination and enhance population health in Lao PDR.

IJCM_234A: Malaria Surveillance System Assessment in Jashpur district, Chhattisgarh State, India, January - March 2023

Background: Globally in 2021, 247 million malaria cases were reported from 84 malaria endemic countries. India is committed to eliminate malaria by year 2030. India reported >160,000 malaria cases in 2021 and 2022; 65% cases from four states-West Bengal, Chhattisgarh, Orrisa and Jharkhand. Objectives: We assessed malaria surveillance system in Jashpur district to describe epidemiology of reported malaria cases, for its strengths and weaknesses and to provide evidence-based recommendations. Methodology: We analyzed surveillance data for the year 2022. We assessed timeliness and completeness attributes of the system using US CDC guidelines for evaluating the surveillance system of the five randomly selected reporting units (RUs) for January-March 2023. We reviewed surveillance data reporting portal, hospital records and interviewed key informants. We analyzed data using MS Excel and calculated frequencies and proportion Results: Jashpur reported 269 cases in 2022; 51% female, 58% among tribal community, 89% above 15 years and 90% were of plasmodium falciparum. The maximum number of cases were reported during July to November with peak in the month of August. The annual parasite index (API) per 1000 population was 0.3 for the district, however two blocks had API of >0.5. All the five RUs submitted monthly reports timely. Of the ten reporting formats reviewed, 48% critical blank fields were not filled. Conclusion: Malaria surveillance system in Jashpur detected cases largely among tribal community, identified high burden blocks with good timeliness but require improvement in complete information. We recommended district to focus preventive public health measures in high burden blocks and orient the laboratory technicians for complete data entry in line list of cases.

Study protocol: improving response to malaria in the Amazon through identification of inter-community networks and human mobility in border regions of Ecuador, Peru and Brazil

IntroductionUnderstanding human mobility’s role in malaria transmission is critical to successful control and elimination. However, common approaches to measuring mobility are ill-equipped for remote regions such as the Amazon. This...

Evaluation of the malaria case surveillance system in KwaZulu-Natal Province, South Africa, 2022: a focus on DHIS2

BackgroundSouth Africa set a target to eliminate malaria by 2023, with KwaZulu-Natal (KZN) Province the malaria-endemic province closest to achieving this goal. Objective two of the National Malaria Elimination Strategic Plan (NMESP) focused on strengthening surveillance systems to support the country’s elimination efforts. Regular evaluations of the malaria surveillance systems against the targets of the NMESP objective are crucial in improving their performance and impact. This study aimed to assess whether the malaria surveillance system in KwaZulu-Natal Province meets the NMESP surveillance objective and goals.MethodsA mixed-methods cross-sectional study design was used to evaluate the malaria surveillance system, focusing on the District Health Information System 2 (DHIS2). The study assessed the data quality, timeliness, simplicity, and acceptability of the system. Key personnel from KZN’s Provincial malaria control programme were interviewed using self-administered questionnaires to evaluate their perception of the system's simplicity and acceptability. Malaria case data from January 2016 to December 2020 were extracted from the DHIS2 and evaluated for data quality and timeliness.ResultsThe survey respondents generally found the DHIS2-based surveillance system acceptable (79%, 11/14) and easy to use (71%, 10/14), stating that they could readily find, extract, and share data (64%, 9/14). Overall data quality was good (88.9%), although some variables needed for case classification had low completeness and data availability. However, case notifications were not timely, with only 61% (2 622/4 329) of cases notified within 24 h of diagnosis. During the 5-year study period, the DHIS2 captured 4 333 malaria cases. The majority of cases (81%, 3 489/4 330) were categorized as imported, and predominately in males (67%, 2 914/4 333).ConclusionWhile the malaria surveillance system in KZN Province largely met the NMESP surveillance strategic goals, it failed to achieve the overarching surveillance objective of 100% notification of cases within 24 h of diagnosis. The majority of reported cases in KZN Province were classified as imported, emphasizing the importance of complete data for accurate case classification. Engaging with healthcare professionals responsible for case notification and disseminating aggregated data back to them is needed to encourage and improve notification timeliness.

Improving the Quality and Use of Malaria Surveillance Data: Results from Evaluating an Integrated Malaria Information Storage System at the Health Facility Level in Selected Districts in Mozambique.

Mozambique addressed critical malaria surveillance system challenges by rolling out an integrated malaria information storage system (iMISS) at the district level in February 2021. The iMISS integrates malaria data from existing systems across thematic program areas to improve data availability and use. In seven districts, the platform was extended to health facilities (HFs), allowing HFs to access iMISS and use tablets to submit monthly malaria reports to a central database, eliminating the need for paper-based reporting to districts. A structured evaluation of the iMISS rollout to HFs was carried out in February-July 2021. The four evaluation areas were data quality (reporting rate, timeliness, and fidelity) of monthly malaria reports electronically submitted to the iMISS, adoption of the iMISS for data-informed decision-making, system maintenance, and acceptability of the iMISS among target users. All 94 HFs in the seven targeted districts were assessed. Over the 6-month period, 86.1% of reported cases on the iMISS were consistent with cases recorded in paper-based reports, allowing for up to 10% discrepancy. In addition, 69.0% of expected monthly district meetings were held, and information from iMISS was discussed during 58.6% of these meetings. Maintenance issues, mostly related to tablet access and internet connectivity, were experienced by 74.5% of HFs; 33.7% of issues were resolved within 1 month. The iMISS and electronic submission of malaria reports were well accepted by HF- and district-level users. Continued political commitment and timely execution of issue management workflows are crucial to ensure trust in the new platform and facilitate higher levels of data use.

Situational Analysis of Malaria Incidence Under Integrated Malaria Service in Hotspot Township - Minbya Township, Rakhine State, Myanmar, 2017-2020.

Malaria is a significant public health concern and tropical disease, particularly affecting Myanmar within the Greater Mekong Subregion. The annual parasite index (API) exceeds 1 per 10,000 population in the northern seven townships of Rakhine State, with Minbya Township designated as a high-burden area for malaria by the World Health Organization (WHO) Myanmar and the National Malaria Control Programme (NMCP). Since 2017, the Malaria reduction intensification plan has been in place in this township to combat the high disease transmission rates. This study aims to assess the malaria epidemiology in Minbya Township from 2017 to 2020 under the intensification plan for elimination, as well as to evaluate the effectiveness of the integrated strategy in reducing cases in hotspot areas. The study utilized a surveillance study design to collect secondary data from the Malaria surveillance system (MSS) and the epidemiologic monitoring dashboard of Minbya Township, Maruk-U District, located in Rakhine State. Since 2017, the Malaria prevention and control (P&C) Program in Minbya Township has successfully decreased malaria morbidity, eliminated malaria-related deaths, and bolstered malaria testing capabilities through the participation of village health volunteers (VHVs). Approximately 87% of malaria prevention and control services are executed by the township's malaria elimination and disease control programs, with additional support from stakeholders. The API dropped from 13 in 2017 to 2.5 in 2020, with Plasmodium vivax being the most prevalent malaria species, accounting for 55% of cases. The study suggests that early diagnosis and promotion of artemisinin-based combination treatment (ACT), along with strategic planning including expanding active case detection in rural health centers and implementing a community-based integrated healthcare approach, are effective and efficient strategies for malaria elimination.

Assessment of the efficiency of the routine epidemiological surveillance system for malaria at the Tambacounda Health District, Senegal.

as part of the fight against malaria, epidemiological surveillance (ES) is one of the key pillars of the global technical strategy 2016-2030 to combat this disease. However, in the south-east of Senegal, where malaria poses a major public health problem, epidemiological surveillance has until recently been very neglected. To help reduce malaria-related morbidity and mortality in Senegal, an evaluation of the routine malaria ES system was conducted in the Tambacounda Health District in 2021. we conducted a cross-sectional, descriptive survey of 27 health structures in Tambacounda district from 20th February to 1st March 2022. overall, the routine ES system in the district was acceptable according to its users, with satisfactory tool filling time in 96.3% of the structures in our study, a cumulative completeness of reports at 92% despite a 77% promptness. The data collected at the services delivery points (SDP) level allowed a representativeness of the ES system in 100% of health facilities. The ES system was also rated as simple by 74.1% of SDP managers even though only 55.6% of them were trained. However, the stability of the system was low because 55.6% of SDP had staff to ensure the continuity of ES service despite the availability of management tools (100%) and the telephone network (96.3%). The same was true for the usefulness of the ES because only 25.9% of SDP managers analyzed their produced data. The reported ES and malaria morbidity data were not adequate. On the other hand, the ES system was reactive with a speed of transmission of information at 96.3% and a possibility of rapid diagnosis and management of cases at 100%. the routine malaria ES system at the level of health facilities in Tambacounda District was acceptable, simple, flexible, representative, and responsive. However, an increase in qualified staff at the health posts, capacity strengthening of the ES staff and regular supervision of SDP are needed essentials to make the district's malaria surveillance system more efficient.

Malaria in a vulnerable population living in quilombo remnant communities in the Brazilian Amazon: a cross-sectional study from 2005-2020.

Quilombo remnant communities are areas officially recognized by the Brazilian government as historical communities founded by formerly enslaved individuals. These communities are mostly located in the endemic areas of malaria in the Brazilian Amazon. We retrospectively described the prevalence of malaria among individuals living in 32 recognized quilombo remnant communities in the Baiao and Oriximina municipalities located in the Para State. The number of malaria cases and the Annual Parasitic Incidence (API) recorded by the Brazilian malaria surveillance system (SIVEP-Malaria) from January 2005 to December 2020 were analyzed. We found that all communities registered at least one case over the 16-year period, the most frequent parasitic species being Plasmodium vivax (76.1%). During this period, 0.44% (4,470/1,008,714) of the malaria cases registered in Para State were reported in these quilombo remnant communities, with frequencies of 10.9% (856/7,859) in Baiao municipality and 39.1% (3,614/9,238) in Oriximina municipality, showing that individuals living in these rural communities are exposed to malaria. These data indicate that effective surveillance requires improved measures to identify malaria transmission among vulnerable populations living in quilombo remnant communities in the Brazilian Amazon.

The contribution of active case detection to malaria elimination in Thailand

IntroductionThailand’s malaria surveillance system complements passive case detection with active case detection (ACD), comprising proactive ACD (PACD) methods and reactive ACD (RACD) methods that target community members near index cases....

Absence of Asymptomatic Malaria Reservoirs in an Area with a Previous History of Local Malaria Transmission: A Successful Experience in Line with the Malaria Elimination Program in Iran.

Asymptomatic malaria is a major challenge to be addressed in the implementation of the malaria elimination program. The main goal of the malaria surveillance system in the elimination phase is to identify reliably all the positive cases of malaria reliably (symptomatic and asymptomatic) in the shortest possible time. This study focused on the monitoring of asymptomatic malaria reservoirs in areas where local transmission had been previously established. It was a case-study approach that was conducted in the Anarestan area. A total of 246 residents and immigrants living in the area at the age range of 4-60 years old were randomly selected to be tested for malaria by microscope, RDT, and nested-PCR techniques. The inclusion criterion for participants to be entered into the study was the absence of specific symptoms of malaria. Moreover, participants who have been taking antimalarials for the last month were excluded from the study. The results indicated no positive cases of asymptomatic malaria among the participants tested by all methods. The results of this study have shown that, without concerns for asymptomatic parasitic patients, a malaria elimination program has been successfully implemented within the studies area. In addition, the findings emphasized the existence of a strong malaria surveillance system in this area.

Evaluation of the malaria surveillance system – Adaklu District, Volta Region, Ghana, 2019

ObjectivesWe evaluated the malaria surveillance system in Adaklu District of the Volta Region of Ghana to determine if the system was meeting its objectives and assessed its usefulness and attributes. Study designDescriptive cross-sectional design was used in evaluating the surveillance system. MethodsWe interviewed stakeholders using a semi-structured questionnaire on case detection and reporting. We assessed the system attributes using the Centers for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems. We extracted and reviewed malaria surveillance data from the District Health Management Information System 2. Summary statistics and direct content analysis were performed on quantitative and qualitative data respectively. ResultsOf the 80,441 suspected malaria cases recorded in Adaklu District from 2014 to 2018, 47,917 (59.6%) cases were confirmed. The system was meeting its objective of detecting malaria cases and monitoring trends in the population however, the system missed an epidemic in August 2016. Data generated from the surveillance system is used by the NMCP to aid in the distribution of logistics such as LLINs, RDT test kits, and track malaria control progress in the district. Staff at all levels were able to detect, confirm, treat and report malaria. All sub-districts/health facilities reported to the district and reports were all accurate and timely. The predictive value positive was 62.9%. ConclusionsThe malaria surveillance system in Adaklu District was useful and meeting its set objective of monitoring trends of malaria in the population. It was simple, flexible, acceptable and representative; however, the system was not detecting epidemics. The District Health Management Team should set alert and epidemic thresholds to help detect promptly epidemics of malaria in the district.

Imported malaria from land bordering countries in China: A challenge in preventing the reestablishment of malaria transmission

ObjectiveNo indigenous malaria cases have been reported since 2017 in China, but a large number of imported cases are still reported every year, including those from the land bordering countries. To characterize their epidemiological profiles will provide evidence for the development of appropriate strategies to effectively address the challenges of border malaria in the post-elimination phase. MethodsIndividual-level data of imported malaria cases from the land bordering countries were collected from 2017 to 2021 in China via the web-based surveillance systems, and analyzed by SPSS, ArcGIS and WPS software, to explore their epidemiological profiles. ResultsA total of 1170 malaria cases imported into China from six of the fourteen land bordering countries were reported between 2017 and 2021 with a decline trend. Overall, cases were widely distributed in 31–97 counties from 11 to 21 provinces but mainly in Yunnan. Moreover, these imported cases were mainly infected with P. vivax (94.8%), and a total of 68 recurrent cases were reported in 6–14 counties from 4 to 8 provinces. In addition, nearly 57.1% of the total reported cases could seek healthcare within 2 days of getting sick, and 71.3% of the reported cases could be confirmed as malaria on the day they sought medical care. ConclusionsChina still needs to attach great importance to the risk and challenge of the imported malaria from bordering countries particularly from Myanmar in preventing reestablishment of malaria transmission in the post-elimination phase. It is necessary not only to strengthen collaboration and cooperation with the bordering countries, but also coordinate multiple departments at home to improve malaria surveillance and response system and prevent the reestablishment of malaria transmission in China.

Analysis of Malaria Situation in Jask County During the Implementation of the Elimination Programme in 2010-2020

Background: Currently, Iran has entered the malaria elimination phase, and no malaria cases have been observed in this country during the last two consecutive years. Continuous monitoring and analysis of the malaria situation are necessary to achieve the elimination goals set to be achieved in 2025. This study aimed to determine the malaria situation analysis during the implementation of the elimination programme in Jask county, one of the most important malaria foci in Iran. Methods: This descriptive-analytical study was conducted in Jask county of Hormozgan province in the southeast of Iran from 2010 to 2020. Data were collected from the national malaria surveillance system and special forms that were completed by malaria focal points in Jask county. Data were analyzed using SPSS 21 software and descriptive statistics. Results: A total of 347 confirmed malaria cases were recorded, and the total number of cases was found to decrease from 114 cases in 2010 to 11 in 2020. The mean age of the patients was 23.4±19.6 years, and most cases (74.06%) belonged to 15-year-old or older people. Plasmodium vivax was the most prevalent species (83.86%). Based on the results, males were more infected (81.84%) than females, and the majority of the patients were from rural areas (86.4%). Conclusion: Malaria incidence has significantly decreased during the past eleven years in Jask county. The considerable drop in the incidence of malaria may be related to the implementation of comprehensive malaria control measures and intensive entomological and parasitological monitoring.

Private Sector Contributions to National Malaria Surveillance Systems in Elimination Settings: Lessons Learned from Cambodia, Lao PDR, Myanmar, and Vietnam.

Comprehensive malaria case surveillance is necessary to achieve and sustain malaria elimination. In the Greater Mekong Subregion (GMS), the private sector plays a substantial role in malaria treatment. Yet, none of the six GMS countries collects complete case data from private sector points-of-care. Between 2016 and 2019, the GMS Elimination of Malaria through Surveillance program supported national malaria programs in Cambodia, Lao PDR, Myanmar, and Vietnam to execute elimination strategies by engaging the private sector in malaria case management, generating private sector case data, and integrating these data into national surveillance systems. The project enrolled 21,903 private sector outlets, covering between 52% and 80% of the private sector in targeted geographies, which were trained and equipped to perform rapid diagnostic tests (RDTs) and report malaria case data. By 2019, the private providers enrolled in the program reported a total of 3,521,586 suspected cases and 96,400 confirmed malaria cases into national surveillance systems, representing 16% of the total reported caseload by these countries (Cambodia, 25%; Lao PDR, 5%; Myanmar, 12%; Vietnam, 8%). Results demonstrated that with comprehensive support, such as training, provision of free or subsidized RDTs, first-line treatments, and routine supportive supervision, private providers can provide quality malaria case management and achieve high reporting rates.

An Evaluation of Malaria Surveillance System in Punjab, India, 2020.

India accounted for 6% of global burden of malaria with 95% population residing in malaria endemic areas. However, Punjab is in the malaria elimination phase with annual parasite incidence (API) <1/1000 population. We evaluated malaria surveillance system in Punjab using CDC's updated guidelines for evaluating public health surveillance systems to provide recommendations for strengthening the existing system and to overcome the challenges in the path of malaria free Punjab. We chose two districts of Punjab, Amritsar (lowest API) and Mansa (highest API), interviewed stakeholders, and performed a retrospective desk review. We evaluated the overall usefulness of the system and assessed seven attributes at state, district, health facility, and village level during July-August 2020. In Punjab, there was progressive decline in the malaria cases from 2,955 cases in 2009 to 1,140 in 2019 and no malaria deaths since 2011. Regarding various attributes, overall score for flexibility was good (85.9%); average for simplicity (77%), acceptability (74%), data quality (74%), and timeliness (70%); and poor for representativeness (59%) and stability (57%). Malaria surveillance system was useful in analyzing the trends of morbidity and mortality and for generating data to drive policy decisions. To improve stability, representativeness, and acceptability, surveillance staff should not be engaged in supplemental work, and reports from private sector must be ensured. Supportive supervision and regular trainings should be carried out regarding reporting formats, guidelines, and timely epidemiological investigations to improve timeliness, data quality, and simplicity.

The public health response to an outbreak of border-spill malaria along China-Myanmar border.

Malaria importation can be caused by cross-border movement either of both people and anopheline mosquitoes. However, there still lacks robust evidence of imported malaria caused by Plasmodium spp. infected anopheles along international border areas (border-spill malaria). The objectives of this study were to confirm whether an outbreak of Plasmodium vivax malaria is border-spill malaria and assess the effects of China's public health response along China-Myanmar border. Epidemiological, parasitological and entomological investigations were conducted to investigate the outbreak of border-spill malaria. Meanwhile, comprehensive interventions were carried out to prevent further transmission and reintroduction of malaria. Rapid diagnostic testing, microscopy and polymerase chain reaction were performed and the infections were confirmed as P. vivax. A total of 22 (9.21%) of 239 workers contracted P. vivax during the outbreak. Multivariate logistic regression analysis identified that the distance of worker shelters in China within 300 meters to the internally displaced person (IDP) camps in Myanmar was a risk factors associated with malaria infection (adjusted odds ratio 7.5920; 95% confidence interval, 2.6079-22.1013; P = 0.0002). After comprehensive interventions, malaria transmission was successfully interpreted and prevented at the project site till the completion of project on 14 January 2020, and recurrence of P. vivax malaria was not detected by the end of 2020. This study provided robust evidence of border-spill malaria along China-Myanmar border. Malaria parasite reservoir and distance travelled by female anopheline mosquitoes are two determinants for border-spill malaria. The public health response to the outbreak indicates that the malaria surveillance and response system works well in preventing reintroduction of malaria. However, prevention of border-spill malaria is still a major challenge in the Yunnan border area, China.