Challenges for the diagnosis and treatment of malaria in low transmission settings in San Lorenzo, Esmeraldas, Ecuador

Mosquera-Romero, Mayte; Zuluaga-Idárraga, Lina; Tobón-Castaño, Alberto

doi:10.1186/s12936-018-2591-z

Cited by 18 publications

(18 citation statements)

References 14 publications

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“…HSPs ought to assess all febrile patients and outpatients systematically in terms of malaria morbidity risk. Similarly, this issue was raised in other studies from endemic countries and low transmission areas while few studies from clear areas are available [13,[28][29][30], although there exist globally serious defects in correct MCM [12,31,32]. To put it another way, it is urgently required that interventions for appropriate MCM, especially, in the private sector be applied.…”

Section: Hsps Readinessmentioning

confidence: 98%

“…In clear areas and countries in elimination phase, system readiness, an appropriate malaria case management (MCM), such as identification, diagnosis, appropriate treatment and urgent report of malaria cases to the public sector, and system vigilance were decreased [11]. In these areas, the management of suspected malaria or febrile cases is defective due to the very low or absence of malaria transmission [12,13]. Therefore, the sustainability of elimination status and appropriate MCM are necessary for pre-elimination.…”

Section: Introductionmentioning

confidence: 99%

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Malaria situation in a clear area of Iran: an approach for the better understanding of the health service providers’ readiness and challenges for malaria elimination in clear areas

Azizi

Davtalab-Esmaeili

Farahbakhsh

et al. 2020

Malar J

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Background: Malaria mortality and morbidity have decreased in recent years. Malaria elimination (ME) and effective efforts to achieve ME is one of the most important priorities for health systems in countries in the elimination phase. In very low transmission areas, the ME programme is faced with serious challenges. This study aimed to assess the trend while getting a better understanding of Health Service Providers' (HSPs) readiness and challenges for ME in a clear area of Iran. Methods: This study was performed in two phases. At first, the malaria trend in East Azerbaijan Province, was surveyed from 2001 to 2018; afterward, it was compared with the national situation for a better understanding of the second phase of the study. Data were collected from the Ministry of Health's protocol and the health centre of the province. In the second phase, malaria control programme experts, health system researchers, and health managers' opinions were collected via in-depth interviews. They were asked regarding HSPs readiness and appropriate Malaria Case Management (MCM) in a clear area and possible challenges. Results: A total of 135 and 154,560 cases were reported in the last 18 years in East Azerbaijan Province and Iran, respectively. The incidence rate decreased in East Azerbaijan Province from 0.4/10,000 in 2001 to zero in 2018. Furthermore, no indigenous transmission was reported for 14 years. Also, for the first time, there was no indigenous transmission in Iran in 2018. The main elicited themes of HSPs readiness through in-depth interviews were: appropriate MCM, holistic and role-playing studies for assessment of HSPs performance, system mobilization, improving identification and diagnosis of suspected cases in the first line. Similarly, the main possible challenges were found to be decreasing health system sensitivity, malaria re-introduction, and withdrawing febrile suspected cases from the surveillance chain. Conclusion: Health systems in eliminating phase should be aware that the absence of malaria cases reported does not necessarily mean that malaria is eliminated; in order to obtain valid data and to determine whether it is

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Section: Hsps Readinessmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Malaria situation in a clear area of Iran: an approach for the better understanding of the health service providers’ readiness and challenges for malaria elimination in clear areas

Azizi

Davtalab-Esmaeili

Farahbakhsh

et al. 2020

Malar J

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“…The finding that testing was higher in strata with active malaria transmission is consistent with other studies. While malaria is top-of-mind for health staff in malaria-endemic areas, symptoms may be overlooked in other areas [3,16]. In the Dominican Republic, increased testing in stratum 3 may be explained by the health system structure, where hospitals, located outside active malaria foci, have a more significant role in patient care compared to primary health facilities.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, febrile illness is not specific to malaria; many other conditions have a similar clinical presentation. In addition to fever, sweating and chills are other symptoms that complete the typical triad for malaria, especially for P. vivax [16].…”

Section: Operational Definition For Suspected Malaria Casesmentioning

confidence: 99%

Performance of passive case detection for malaria surveillance: results from nine countries in Mesoamerica and the Dominican Republic

Ríos-Zertuche

Carter

Harris

et al. 2021

Malar J

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Background In malaria elimination settings, available metrics for malaria surveillance have been insufficient to measure the performance of passive case detection adequately. An indicator for malaria suspected cases with malaria test (MSCT) is proposed to measure the rate of testing on persons presenting to health facilities who satisfy the definition of a suspected malaria case. This metric does not rely on prior knowledge of fever prevalence, seasonality, or external denominators, and can be used to compare detection rates in suspected cases within and between countries, including across settings with different levels of transmission. Methods To compute the MSCT, an operational definition for suspected malaria cases was established, including clinical and epidemiological criteria. In general, suspected cases included: (1) persons with fever detected in areas with active malaria transmission; (2) persons with fever identified in areas with no active transmission and travel history to, or residence in areas with active transmission (either national or international); and (3) persons presenting with fever, chills and sweating from any area. Data was collected from 9 countries: Belize, Colombia (in areas with active transmission), Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, and Panama (September–March 2020). A sample of eligible medical records for 2018 was selected from a sample of health facilities in each country. An algorithm was constructed to assess if a malaria test was ordered or performed for cases that met the suspected case definition. Results A sample of 5873 suspected malaria cases was obtained from 239 health facilities. Except for Nicaragua and Colombia, malaria tests were requested in less than 10% of all cases. More cases were tested in areas with active transmission than areas without cases. Travel history was not systematically recorded in any country. Conclusions A statistically comparable, replicable, and standardized metric was proposed to measure suspected malaria cases with a test (microscopy or rapid diagnostic test) that enables assessing the performance of passive case detection. Cross-country findings have important implications for malaria and infectious disease surveillance, which should be promptly addressed as countries progress towards malaria elimination. Local and easy-to-implement tools could be implemented to assess and improve passive case detection.

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“…However, epidemiological and molecular surveillance will be crucial with the resurgence of Plasmodium vivax and Plasmodium malaria [69,70]. Diagnosis and treatment will be improved with the introduction of multi-species rapid diagnostic tests (RDTs) to detect other species outside of Plasmodium falciparum and staff monitoring [71,72].…”

Section: Discussionmentioning

confidence: 99%

Stratification At The Health District Level And Targeting of Malaria Control Interventions In Mali

Cissoko

Magassa

Sanogo

et al. 2021

Preprint

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IntroductionMalaria has been the leading cause of morbidity and mortality for several decades in Mali, with an increase from 2017 to 2020 (2,884,837 confirmed cases and 1,454 deaths). On the recommendation of the World Health Organization (WHO) and in the interests of efficient use of resources, Mali has begun a process of stratifying the health districts to target malaria control strategies.MethodMalaria, entomological and environmental data were collected through the local health information system (LHIS), the Demographic and Health Survey (DHS 2018), research institutions and MALI-METEO services. The WHO has recommended stratification at the district level consisted of assigning each district to one of 4 classes according to criteria based on incidence adjusted for attendance rate. Variables associated with monthly malaria incidence at the district level were identified using a general additive non-linear regression model.ResultsFrom 2017 to 2019, the median incidence across 75 health districts of Mali was 129.34 cases per 1,000 person-year (IQR=86.48). The results showed different periods of high malaria transmission in health districts level and durations varying from 2 to 6 months, showing a double peak for some health districts, which were located in the flooded areas. environmental variables such as rainfall, vegetation index (NDVI), maximum temperature and relative humidity were significantly associated at malaria incidence with a lag of around one month. A strata defines a geographical area with similar epidemiological, environmental and socio-economic factors. Stratification resulted in 12 health districts of very low transmission, 19 low transmission, 20 moderate transmission and 24 in high transmission areas. The number of rounds of season malaria chemoprevention will be based on the number of months in the high transmission period.ConclusionThis first stratification in Mali will allow targeting malaria control strategies. This approach will be dynamic and revised yearly in order to integrate information from the national epidemiological surveillance.

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Challenges for the diagnosis and treatment of malaria in low transmission settings in San Lorenzo, Esmeraldas, Ecuador

Cited by 18 publications

References 14 publications

Malaria situation in a clear area of Iran: an approach for the better understanding of the health service providers’ readiness and challenges for malaria elimination in clear areas

Malaria situation in a clear area of Iran: an approach for the better understanding of the health service providers’ readiness and challenges for malaria elimination in clear areas

Performance of passive case detection for malaria surveillance: results from nine countries in Mesoamerica and the Dominican Republic

Stratification At The Health District Level And Targeting of Malaria Control Interventions In Mali

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