Addressing hard‐to‐reach populations for achieving malaria elimination in the Asia Pacific Malaria Elimination Network countries

Abstract

Member countries of the Asia Pacific MalariaElimination Network are pursuing the regional goal of malaria elimination by 2030. The countries are in different phases of malaria elimination, but most have demonstrated success in shrinking the malaria map in the region. However, continued transmission in hard-to-reach populations, including border and forest malaria, remains an important challenge. In this article, we review strategies for improving intervention coverage in hard-to-reach populations. Currently available preventive measures, including long-lasting insecticidal nets and long-lasting insecticidal hammocks, and prompt diagnosis and treatment need to be expanded to hard-to-reach populations. This can be done through mobile malaria clinics, village volunteer malaria workers and screening posts. Malaria surveillance in the hard-to-reach areas can be enhanced through tools such as spatial decision support systems.Policy changes by the malaria programs will be required for implementing the strategies outlined in this article. However, strategies or tools may be suitable for some population groups but difficult to implement in other groups.

Space–Time Clustering Characteristics of Malaria in Bhutan at the End Stages of Elimination

“…Control measures across the international border (in Assam) are sporadically implemented and transmission is maintained due to the local populations living in villages near to forest fringe areas [ 29 ]. Cross-border movement has been acknowledged as one of the key challenges in malaria elimination [ 5 , 13 , 28 ], leading to a series of cross-border meetings being held to strengthen collaboration between India and Bhutan to achieve malaria elimination [ 30 ]. However, the presence of a P. falciparum cluster in Langchenphu (in Samdrup Jongkhar District) should precipitate a call for the VDCP to invest time and resources to study the local drivers of malaria.…”

“…The identification of malaria clusters can help in the delineation of problem areas and the application of targeted program interventions suitable in the elimination phase [ 11 ]. Focused interventions in areas with a higher risk of malaria are likely to be more cost-effective than uniform resource allocation, particularly in resource-constrained settings for sustainable elimination programs [ 9 , 12 , 13 ]. In addition, knowledge of seasonal patterns will aid in the estimation of time for malaria transmission for initiating suitable and appropriate control measures [ 14 , 15 ].…”

Malaria molecular surveillance in the Peruvian Amazon with a novel highly multiplexed Plasmodium falciparum Ampliseq assay

“…Although the WHO has developed and updated protocols to standardize study designs to assess antimalarial therapeutic efficacy in vivo , this requires considerable logistical efforts to reach a minimum sample size (2). These requirements are especially challenging and costly in areas of moderate to low malaria transmission and with hard-to-reach populations at risk of malaria (3–5). Molecular parasite genotyping tools can strengthen malaria surveillance systems by monitoring the emergence and spread of drug resistance, hrp2 and hrp3 deletions, quantification of malaria importation risk and characterization of changing transmission intensity.…”

“…Molecular markers associated with drug resistance are reliable predictors of treatment responses (2,4,5), can provide warning for emerging resistance, guide treatment policies (6), and even replace therapeutic efficacy studies in low malaria transmission areas (4,5,7,8). The value of these markers was demonstrated in Southeast Asia where P. falciparum resistance against artemisinin (ART) was associated with mutations in the Kelch protein 13 (K13) (9)(10)(11)(12), and resistance mutations in this same gene recently emerged in Africa (13).…”

Foreword to Special Issue: Malaria elimination in the Asia‐Pacific

“…In an era of diminishing resources, malaria elimination efforts increasingly need ways to maximise the long-term benefit of donor funding while increasing domestic resources for malaria and health systems strengthening in the long term.This special issue entitled Malaria elimination in the Asia-Pacific provides critical evidence in many of the areas outlined above, such as reaching hard-to-reach populations, the adequate treatment of P. vivax, examining donor support and policy reform. Wangdi et al (2021) emphasise the importance of ensuring access to effective interventions for patients at risk in border or forested areas through, for example, mobile clinics, screening posts and village volunteers. Burkot and Gilbert (2021) offer a country perspective from the Solomon Islands on the impact of foreign aid on malaria elimination efforts with recommendations for future priorities on the integration of malaria services within the general health system.…”