Malaria Surveillance 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.

Assessing the role of the for-profit private healthcare sector in malaria elimination efforts in Bangladesh: a cross-sectional study of challenges and opportunities

BackgroundAmong 13 endemic districts, the Chittagong Hill Tracts bear more than 90% of Bangladesh’s malaria burden. Despite the private sector’s prominence in rural healthcare, its role in malaria management remains underutilized. This study aimed to strategize leveraging the for-profit private sector, such as diagnostic and treatment centers, to bolster national malaria surveillance and control, advancing Bangladesh toward malaria elimination by 2030.MethodsThis mixed-method study commenced with a questionnaire-based cross-sectional survey followed by selected focused group discussions (FGDs) among the participants. Three FGDs were held with the for-profit service providers so that further insights and qualitative viewpoints of them can be utilized in situation analysis. Based on the endemicity and strategic priorities, a comprehensive mapping of private for-profit facilities from the regions comprising 15 sub-districts across 8 chosen districts (7 malaria endemic districts and the rest non-endemic districts) was created. For the non-endemic zone, the sub-districts were selected based on their proximity to an area with high malaria transmission.ResultsAmong the 104 representative participants, majority were male (n = 92, 88.5%), had a diploma in their respective fields (n = 53, 51%) and were involved either in laboratory work (n = 49, 47.1%) or as owners/managers of health centers (n = 41, 39.4%). The selected health facilities were close to the corresponding Upazila Health Complexes (mean distance 2.8 km), but were distantly located from the designated district hospitals (mean distance 48.9 km). The main sources of RDT kits (62.3%) and anti-malarial drugs (63.2%) were local wholesale markets. A large share of the corresponding facilities neither provided malaria treatment services (81.7%) nor worked with the NMEP (93.3%).ConclusionsThis study highlights challenges and recommendations for engaging private for-profit health facilities in Bangladesh’s malaria elimination efforts. The identified challenges include low-quality RDTs, staff shortages, and inadequate capacity building. Recommendations emphasize effective training, stakeholder interaction, and enhanced oversight for successful malaria control efforts.

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.

The impact of the RTS,S malaria vaccine on uncomplicated malaria: evidence from the phase IV study districts, Upper East Region, Ghana, 2020–2022

BackgroundThe RTS,S malaria vaccine has been prequalified for use in endemic settings prioritizing areas with moderate to high disease transmission. The impact of a vaccine at the population level may differ from observations during clinical trial due to programmatic, and individual-related factors, among others. The objective of this study was to assess the impact of the RTS,S malaria vaccine on uncomplicated malaria among children aged 12–59 months in the Phase IV study districts, Upper East Region, Ghana.MethodsA retrospective study was conducted using routine malaria surveillance data for the period 2020–2022. The burden of uncomplicated malaria was compared between the implementing (Kasena Nankana East and West districts) and comparator areas (Builsa North and South districts). The impact of RTS,S malaria vaccine was assessed by estimating the percentage reduction in uncomplicated malaria and incidence averted in the implementing area, accounting for the effect of confounders.ResultsOver 50,000 episodes of uncomplicated malaria among children aged 12–59 months were included in the study. Uncomplicated malaria was reduced by 33% (95%CI 29–36) over the entire study period, but the malaria incidence averted declined from 324/1,000 (95% CI 298–339; p < 0.0001) in 2020 to 287/1000 (95% CI 274–299; p < 0.0001) in 2022.ConclusionThe RTS,S malaria vaccine significantly reduced the burden of uncomplicated malaria among children aged 12–59 months in the implementing area. The sequential marginal declines in malaria incidence averted over the study period might be due to waning of protective immunity and acquisition of natural immunity as children age. Strengthening uptake of the currently recommended vaccines and other malaria control interventions is required to improve public health impact.

Feeding habits and malaria parasite infection of Anopheles mosquitoes in selected agroecological areas of Northwestern Ethiopia

BackgroundSurveillance of the host–anopheline mosquitoes’ interaction is important for assessing malaria transmission risk and guiding vector control. We assume that changes in malaria vector species’ feeding habits, as well as the surrounding environment, have a substantial impact on varied malaria transmission. In this study, we determined the vertebrate host feeding patterns of anopheline mosquitoes to characterize entomologic risk factors for malaria in Jabi Tehnan, Northwestern Ethiopia.MethodsBlood-fed anophelines surveyed during malaria surveillance in Jabi Tehnan district of northwestern Ethiopia were utilized in this study. They were collected using Centers for Disease Control and Prevention (CDC) light traps deployed in selected households per village, placed indoors and outdoors, spanning three agroecological settings (dry mountain, plateau, and semiarid highlands) between June 2020 and May 2021. The engorged mosquitoes were analyzed for host blood meal sources and Plasmodium infection via polymerase chain reaction (PCR) and/or sequencing. Infection rates and bovine and human blood indices were calculated and compared for abundant species; between indoors and outdoors and between agroecology using a chi-squared test for equality of proportion in R package at a significant level of p ≤ 0.05.ResultsA total of 246 mosquitoes were successfully typed (indoor, 121; outdoor, 125), with greater relative abundance indoors in mountain and plateau highlands, and outdoors in semiarid areas. Despite ecological differences in blood-fed capture rates, cattle served as the most utilized blood meal source by 11 anopheline species with an overall bovine blood index (BBI) of 74.4%. This trend was dictated by Anopheles gambiae s.l. (198/246; BBI = 73.7%), which exhibited the most plastic feeding habits that included humans (human blood index = 15.7%) and other livestock and rodents. A total of five anopheline species (An. gambiae s.l., An. funestus s.l., An. coustani s.l., An. pretoriensis, and An. pharoensis) fed on humans, of which the first three were found infected with Plasmodium parasites. Most of the infected specimens were An. arabiensis (5.6%, 11/198) and had recently fed mainly on cattle (72.7%, 8/11); one each of infected An. funestus s.l. and An. coustani s.l. had fed on humans and cattle, respectively.ConclusionsThe results demonstrate communal feeding on cattle by anophelines including primary and secondary malaria vectors. This study also indicates the importance of cattle-targeted interventions for sustainable control of malaria vectors in the study areas.Graphical abstract

The Role of Community Health Promoters in Combating Malaria in Kenya: The Case of Nyakach Sub-County, Kisumu County

About 250 million malaria cases are reported annually in the world. The disease disproportionately affects warm, humid regions, including many tropical countries such as Kenya. The Kenyan government has implemented measures to control malaria, including the deployment of community health promoters (CHPs). However, little is known about the effectiveness of CHPs in combating malaria cases in highly endemic areas like Nyakach Sub-County and Kisumu County. Specifically, the study assessed the impact of CHPs’ in malaria surveillance. The study was underpinned by the health belief model. A cross-sectional descriptive study design was employed, with a mixed methods approach aimed at collecting both quantitative and qualitative data from households and CHPs in the Sub-County. Cluster sampling was employed for quantitative data collection, while snowball sampling was used for qualitative data, guided by data saturation. Thematic analysis was done for themes and contingency tables developed for categories, while a multiple regression analysis was conducted to determine the relationships among the independent variable (malaria surveillance), the moderating variable (motivation and willingness of CHPs), and the dependent variable (combating malaria cases). Findings reveal that regular visits by CHPs have been effective in identifying potential malaria cases in the community. At p value=0.000, there was a moderate positive relationship between combating of malaria cases and malaria surveillance activities conducted by CHPs (r = 0.507, n=277). The study recommends strengthening existing surveillance approaches used by the CHPs. The study further recommends regular training programs for CHPs to ensure they are well-equipped with the latest techniques and knowledge for effective malaria surveillance.

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.

Comprehensive evaluation of malaria reactive surveillance and response strategies in Lao People’s Democratic Republic: a mixed-methods study

ObjectivesTo achieve malaria elimination by 2030, the Lao People’s Democratic Republic (PDR) adopted a reactive surveillance and response (RASR) strategy of malaria case notification within 1 day, case investigation and...

Malaria reporting timeliness analysis and factors associated with delayed notification, 2018-2022, Nepal.

In order to monitor public health trends and identify disease outbreaks early, efficient and reliable notification and surveillance systems are essential. Nepal uses a 1-3-7 malaria surveillance approach. The Short Message System (SMS) -based system for timely notification has been established. However, knowledge gaps exist regarding the timeliness of notification, treatment initiation, and case-based investigations. Hence, this study identifies the timeliness of notification and factors associated with delayed notification. This study used a cross-sectional approach and used secondary malaria surveillance data from Nepal's national malaria elimination program for the period of 2018 to 2022. The study revealed that the majority (79.9%) of malaria cases were male, with a male-to-female ratio of 3.96:1. Occupation was found to be significantly associated with delayed notification. Repatriate workers had 0.60 times lower odds of experiencing delayed notification compared to the reference occupation. Similarly, individuals diagnosed in the Sudurpaschim and Lumbini provinces had significantly lower odds (0.48 and 0.38, respectively) of encountering delayed notification compared to the reference province. Furthermore, relying on a single laboratory tool for malaria diagnosis (either RDT or microscopy only) was significantly associated with delayed notification. Individuals diagnosed solely with RDT or microscopy had 2.04 and 1.79 times higher odds of experiencing delayed notification, respectively, compared to those diagnosed using both laboratory tools. This study provides insight into the timeliness of surveillance system approach by assessing delayed notification and the factors associated with it. No delays are identified in median notification, treatment time and in case investigation. Improvement in the timeliness of malaria reporting over the years was observed. Provinces with high burden of malaria and repatriate workers showed lower delayed notification and conversely, cases diagnosed with single laboratory tool showed delayed notification time.

Loop-Mediated Isothermal Amplification for Diagnosis of Zoonotic Malaria.

Zoonotic malaria, caused by Plasmodium knowlesi, Plasmodium cynomolgi, Plasmodium coatneyi, and Plasmodium inui, is a significant global health concern. The gold standard microscopy, while widely used for malaria diagnosis, faces limitations in differentiating between malaria species. Polymerase chain reaction (PCR), despite its accuracy, is characterized by high costs and time-consuming procedures. This study aims to develop and validate a rapid and accurate diagnostic test for detecting four simian Plasmodium species by using loop-mediated isothermal amplification (LAMP). Loop-mediated isothermal amplification is a cost-effective and faster molecular testing alternative for malaria diagnosis. The project involved designing specific primers, testing sensitivity and specificity against various parasites (including human Plasmodium species, protozoa, and helminths), and evaluating the LAMP assay using 60 macaque samples infected with simian Plasmodium. The LAMP assay exhibited a sensitivity profile enabling the detection of P. knowlesi, P. coatneyi, and P. cynomolgi across a concentration gradient from 5 × 108 down to 5 × 105 parasites/µL. Notably, P. inui was detectable at 5 × 108 parasites/µL. Furthermore, the specificity of the primer tailored for the four simian Plasmodium species was proven, as it produced a positive amplification exclusively for the respective target species and generated negative results for nontarget species. The results indicated that the LAMP assay is capable of detecting simian Plasmodium within a short span of 60 minutes, without any false positives from other samples. This new test has the potential to revolutionize malaria diagnosis, surveillance, and control, thereby mitigating the impact of zoonotic malaria in regions of endemicity.

Improving Coordination to Strengthen Operationalization of Malaria Surveillance and Routine Data Quality: Landscape Analysis of Current Surveillance-Related Initiatives.

Improving the visibility and global coordination of malaria surveillance and data quality improvement initiatives is required to optimize sharing of best practices, tools, and approaches and to promote efficient, effective, and equitable distribution of resources. With these aims in mind, Rollback Malaria's Surveillance, Monitoring and Evaluation Working Group established the Surveillance Practice and Data Quality Committee in May 2021. As a priority initiative, the committee conducted a landscape analysis of implementing partners' (IPs') malaria surveillance-related projects. A questionnaire that included questions on current project objectives, activities, geographic scope, and lessons learned was distributed among committee members and other IPs. Three years since its inception, information has been submitted regarding 49 projects by 25 IPs and funded by 17 donors. To present and share the landscaping results, an interactive dashboard was published to the Rollback Malaria's Global Malaria Dashboard website (endmalaria.org) in March 2021. It is the first time that multiple stakeholders have shared such information regarding surveillance projects.

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.

Spatiotemporal, Demographic, and Climatic Drivers of Malaria Transmission in the Endemic Setting of Jazan, Saudi Arabia: A Retrospective Study.

Despite progress, malaria remains endemic in Jazan, Saudi Arabia necessitating updated epidemiological research to guide elimination strategies. This study analyzed recent surveillance data to elucidate drivers of sustained transmission. A retrospective, epidemiological study was conducted using malaria surveillance data from the Jazan region of Saudi Arabia over a 3-year period from January 2018 to December 2020. Deidentified records of all confirmed malaria cases reported across Jazan during the study period were obtained from the Jazan Department of Health infectious disease surveillance system. Additional meteorological data was acquired to assess climatic correlates. The final analysis included 5255 confirmed cases meeting completeness criteria for key variables. Descriptive statistics characterized cases across demographic factors and spatial and temporal distributions. Correlations and linear regression modeling identified associations between monthly cases and weather parameters. Mapping visualized geographic patterns. Of 5255 confirmed cases, most were concentrated in Baish sector (50.8-72.0% annually), affected adult male foreigners (93.8-97.0%), peaked inconsistently across seasons, and were imported (85.4-94.9%). Non-Saudi nationality had 6-fold higher incidence versus Saudi citizens in 2020 (677.6 vs 23.1 per 100,000). Monthly cases associated negatively with temperature (p=0.015) and positively with windspeed (p=0.005). Malaria persistence in Jazan involves geographic and demographic hotspots driven by imported infections and climate effects on vectors. Tailored programming aligned with evolving local dynamics will be essential to sustain elimination gains. Surveillance, optimized interventions, and flexible adaptation to high-risk locations/populations and meteorological influences are key priorities.

Potential distribution of malaria vectors in Central Vietnam: A MaxEnt modeling approach.

In Central Vietnam, Anopheles dirus and Anopheles minimus are the primary malaria vector species. These Anopheles spp.' distribution and prevalence are determined by environmental, climatic, and socioeconomic conditions. This study aimed to predict the potential distribution of these two Anopheles spp. in this region. This study was conducted in 15 Central Vietnamese provinces. From 2014 to 2018, we utilized An. dirus and An. minimus presence records. Proxy data from the Google Earth Engine platform for the study area, encompassing environmental, climatic, and socioeconomic factors. MaxEnt software predicted the potential environmental, climatic, and socioeconomic suitability of these two Anopheles spp. in Central Vietnam. The test area under the curve values for An. dirus and An. minimus MaxEnt models averaged 0.801 and 0.806, respectively, showing excellent performance. Minimum air temperature had the greatest impact on the distribution of both species. A negative correlation between precipitation and normalized difference water index influences the occurrence of An. dirus. In the temperature range of 13-19.5°C, An. minimus is most likely to be present, with nighttime light detrimentally influencing its distribution. The Central Highlands region is inhabited by both species, with some presence in North-Central and South-Central Coastal areas. The importance of temperature in determining the presence of both species is emphasized by our findings, with subtle differences in the temperature-related factors shaping their distributions. The results highlight the need for focused malaria vector control and surveillance initiatives in the study area.

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.

Screening of malaria infections in human blood samples with varying parasite densities and anaemic conditions using AI-Powered mid-infrared spectroscopy

BackgroundEffective testing for malaria, including the detection of infections at very low densities, is vital for the successful elimination of the disease. Unfortunately, existing methods are either inexpensive but poorly sensitive or sensitive but costly. Recent studies have shown that mid-infrared spectroscopy coupled with machine learning (MIRs-ML) has potential for rapidly detecting malaria infections but requires further evaluation on diverse samples representative of natural infections in endemic areas. The aim of this study was, therefore, to demonstrate a simple AI-powered, reagent-free, and user-friendly approach that uses mid-infrared spectra from dried blood spots to accurately detect malaria infections across varying parasite densities and anaemic conditions.MethodsPlasmodium falciparum strains NF54 and FCR3 were cultured and mixed with blood from 70 malaria-free individuals to create various malaria parasitaemia and anaemic conditions. Blood dilutions produced three haematocrit ratios (50%, 25%, 12.5%) and five parasitaemia levels (6%, 0.1%, 0.002%, 0.00003%, 0%). Dried blood spots were prepared on Whatman™ filter papers and scanned using attenuated total reflection-Fourier Transform Infrared (ATR-FTIR) for machine-learning analysis. Three classifiers were trained on an 80%/20% split of 4655 spectra: (I) high contrast (6% parasitaemia vs. negative), (II) low contrast (0.00003% vs. negative) and (III) all concentrations (all positive levels vs. negative). The classifiers were validated with unseen datasets to detect malaria at various parasitaemia levels and anaemic conditions. Additionally, these classifiers were tested on samples from a population survey in malaria-endemic villages of southeastern Tanzania.ResultsThe AI classifiers attained over 90% accuracy in detecting malaria infections as low as one parasite per microlitre of blood, a sensitivity unattainable by conventional RDTs and microscopy. These laboratory-developed classifiers seamlessly transitioned to field applicability, achieving over 80% accuracy in predicting natural P. falciparum infections in blood samples collected during the field survey. Crucially, the performance remained unaffected by various levels of anaemia, a common complication in malaria patients.ConclusionThese findings suggest that the AI-driven mid-infrared spectroscopy approach holds promise as a simplified, sensitive and cost-effective method for malaria screening, consistently performing well despite variations in parasite densities and anaemic conditions. The technique simply involves scanning dried blood spots with a desktop mid-infrared scanner and analysing the spectra using pre-trained AI classifiers, making it readily adaptable to field conditions in low-resource settings. In this study, the approach was successfully adapted to field use, effectively predicting natural malaria infections in blood samples from a population-level survey in Tanzania. With additional field trials and validation, this technique could significantly enhance malaria surveillance and contribute to accelerating malaria elimination efforts.

A five years malaria surveillance data analysis of North Shewa zone, Amhara region, Ethiopia: July 2018 to June 2023

BackgroundMalaria is a critical public health concern in Ethiopia, with significant socioeconomic consequences. Malaria data trend analysis is essential for understanding transmission patterns and adopting evidence-based malaria control measures. The purpose of this study was to determine the 5 year distribution of malaria in North Shewa zone, Amhara region, Ethiopia, in 2023.MethodsA descriptive cross-sectional study design was employed to analyse the 5 year trend of malaria surveillance data in the North Shewa zone of the Amhara regional, Ethiopia, spanning from July 2018 to June 2023. The malaria indicator data were gathered from the zone’s public health emergency management database. Malaria data from the previous 5 years was collected, compiled, processed, and analysed using Microsoft Excel 2019.ResultsAmong a total of 434,110 suspected cases 47,889 (11.03%) cases were confirmed as malaria, with an average annual malaria incidence rate of 4.4 per 1000 population in the Zone. Malaria cases exhibited an increase from Epidemiological Week (Epi week) 37 to Epi week 49 (September to November) and again from Epi week 22 to week 30 (May to July). Individuals aged 15 and above, and all districts in the Zone except Angolela were notably affected by malaria.ConclusionDespite implementing various measures to reduce malaria incidence, the disease continues to persist in the zone. Therefore, the Zone Health Department should intensify its preventive and control efforts.

Leveraging mobile phones to improve malaria healthcare service delivery in Buhera rural communities: implications for practice and policy

ABSTRACT Malaria remains a public health burden in many sub-Saharan African countries. Integrating mobile phones to reduce the burden is inevitable as they assist in reporting malaria, intensifying information, education and communication, understanding malaria transmission, mapping hotspot areas and predicting malaria seasonal variations. However, the use of mobile phones in tackling malaria remains nascent in rural communities. The study used multistage cluster sampling and purposive sampling to collect qualitative data from healthcare workers in resource-constrained rural areas. The study shows that printed media and community outreach activities are prominent methods used to create awareness of malaria during malaria peak seasons. Voice calls, short message service and mobile applications have been used to capture and report malaria incidences. However, poor network coverage, insufficient infrastructure, digital illiteracy, absence of active e-health policy and insufficient funding hinder the effective use of mobile phones in rural areas. There is a need to establish community networks in rural communities to improve internet access and connectivity, promote public-private partnerships and develop robust strategies for sustainable funding of m-health projects deployed to improve access to care. Mobile phones can aid in reporting, detecting and managing malaria cases, commodities, surveillance, hotspot mapping, awareness and community engagement.

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.