Designing malaria surveillance strategies for mobile and migrant populations in Nepal: a mixed-methods study

Smith, Jennifer L.; Ghimire, Prakash; Rijal, Komal Raj; Maglior, Alysse; Hollis, Sara; Andrade-Pacheco, Ricardo; Thakur, Garib Das; Adhikari, Nabaraj; Shrestha, Upendra Thapa; Banjara, Megha Raj; Lal, Bibek Kumar; Jacobson, Jerry O.; Bennett, Adam

doi:10.1186/s12936-019-2791-1

Cited by 24 publications

(32 citation statements)

References 27 publications

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“…This is that with massive developmental projects underway in most countries, there is rampant human movement, largely by way of migrant labour between these countries. Those countries in Asia that are now eliminating malaria, such as Timor Leste, Bhutan and Nepal, are in the tropical belt and they remain highly vulnerable to the re-establishment of malaria due to the presence of malaria vectors, and groups of migrant labour who move freely between them and their neighbouring countries (Indonesia and India respectively) with ongoing transmission [ 20 – 22 ]. They often reside in the recipient country for several months offering a continuous source of parasites.…”

Section: Discussionmentioning

confidence: 99%

Mass radical treatment of a group of foreign workers to mitigate the risk of re-establishment of malaria in Sri Lanka

Marasinghe

Karunasena²,

Seneratne

et al. 2020

Malar J

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Background Following malaria elimination, Sri Lanka was free from indigenous transmission for six consecutive years, until the first introduced case was reported in December 2018. The source of transmission (index case) was a member of a group of 32 migrant workers from India and the location of transmission was their residence reporting a high prevalence of the primary vector for malaria. Despite extensive vector control the situation was highly susceptible to onward transmission if another of the group developed malaria. Therefore, Mass Radical Treatment (MRT) of the group of workers for Plasmodium vivax malaria was undertaken to mitigate this risk. Method The workers were screened for malaria by microscopy and RDT, their haemoglobin level assessed, and tested for Glucose 6 phosphate dehydrogenase deficiency (G6PD) using the Care Start RDT and Brewers test prior to treatment with chloroquine (CQ) 25 mg/kg body weight (over three days) and primaquine (PQ) (0.25 mg/kg/day bodyweight for 14 days) following informed consent. All were monitored for adverse events. Results None of the foreign workers were parasitaemic at baseline screening and their haemoglobin levels ranged from 9.7–14.7 g/dl. All 31 individuals (excluding the index case treated previously) were treated with the recommended dose of CQ. The G6PD test results were inconclusive in 45% of the RDT results and were discrepant between the two tests in 31% of the remaining test events. Seven workers who tested G6PD deficient in either test were excluded from PQ and the rest, 24 workers, received PQ. No serious adverse events occurred. Conclusions Mass treatment may be an option in prevention of reintroduction settings for groups of migrants who are likely to be carrying latent malaria infections, and resident in areas of high receptivity. However, in the case of Plasmodium vivax and Plasmodium ovale, a more reliable and affordable point-of-care test for G6PD activity would be required. Most countries which are eliminating malaria now are in the tropical zone and face considerable and similar risks of malaria re-introduction due to massive labour migration between them and neighbouring countries. Regional elimination of malaria should be the focus of global strategy if malaria elimination from countries is to be worthwhile and sustainable.

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Section: Discussionmentioning

confidence: 99%

Mass radical treatment of a group of foreign workers to mitigate the risk of re-establishment of malaria in Sri Lanka

Marasinghe

Karunasena²,

Seneratne

et al. 2020

Malar J

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“…Over the last decades, Plasmodium vivax has predominated malaria transmission in Nepal, which is highly seasonal with the majority of transmission occurring from June to September [3,8]. The burden of malaria is high amongst population from ethnic minorities and lower socio-economic status, with higher number of cases in young men, and mobile and migrant populations of border areas [9,10].…”

Section: Introductionmentioning

confidence: 99%

The durability of long-lasting insecticidal nets distributed to the households between 2009 and 2013 in Nepal

et al. 2020

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Background: Understanding and improving the durability of long-lasting insecticidal nets (LLINs) in the field are critical for planning future implementation strategies including behavioral change for care and maintenance. LLIN distribution at high coverage is considered to be one of the adjunctive transmission reduction strategies in Nepal's Malaria Strategic Plan 2014-2025. The main objective of this study was to assess the durability through assessment of community usage, physical integrity, residual bio-efficacy, and chemical retention in LLINs: Interceptor®, Yorkool®, and PermaNet ®2.0 which were used in Nepal during 2009 through 2013. Methods: Assessments were conducted on random samples (n = 440) of LLINs from the eleven districts representing four ecological zones: Terai plain region (Kailali and Kanchanpur districts), outer Terai fluvial ecosystem (Surkhet, Dang, and Rupandhei districts), inner Terai forest ecosystem (Mahhothari, Dhanusa, and Illam districts), and Hills and river valley (Kavrepalanchock and Sindhupalchok districts). For each LLIN, fabric integrity in terms of proportionate hole index (pHI) and residual bio-efficacy were assessed. However, for chemical retention, a representative sample of 44 nets (15 Yorkool®, 10 Permanet®2.0, and 19 Interceptor®) was evaluated. Data were analyzed using descriptive statistics stratified by LLINs brand, districts, and duration of exposure. Results: On average, duration of use of LLINs was shortest for the Yorkool® samples, followed by PermaNet® 2.0 and Interceptor® with median ages of 8.9 (IQR = 0.4), 23.8 (IQR = 3.2), and 50.1 (IQR = 3.2) months, respectively. Over 80% of field distributed Yorkool® and PermaNet® 2.0 nets were in good condition (pHI< 25) compared to Interceptor® (66%). Bio-efficacy analysis showed that average mortality rates of Interceptor and Yorkool were below World Health Organization (WHO) optimal effectiveness of ≥ 80% compared to 2-year-old PermaNet 2.0 which attained 80%. Chemical retention analysis was consistent with bio-efficacy results.

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“…Although malaria elimination status can be achieved with zero indigenous cases, and the number of Imported Malaria cases doesn't affect the achievement of this status, Imported Malaria cases may easily lead to local transmission, as a signi cant part of Nepal has a favorable climate for malaria transmission. The study by Smith et al, (2019) found that there was a positive association between monthly indigenous cases and the previous month's importation rate in three high malaria risk districts in Nepal: Kailali, Kanchanpur, and Bardiya. According to the study, a one percent increase in the previous month's Imported Malaria cases led to a two percent increase in local transmission (61).…”

Section: Discussionmentioning

confidence: 99%

“…The study by Smith et al, (2019) found that there was a positive association between monthly indigenous cases and the previous month's importation rate in three high malaria risk districts in Nepal: Kailali, Kanchanpur, and Bardiya. According to the study, a one percent increase in the previous month's Imported Malaria cases led to a two percent increase in local transmission (61).…”

Section: Discussionmentioning

confidence: 99%

“…As they are mobile most of the time, programs may not always reach them. A recent study done in three high malaria-risk districts, Kailali, Kanchanpur, and Bardiya, found that the migrant workers are mostly ignorant of the basic understanding of malaria transmission and prevention, rarely use the insecticide-treated bed nets, and tend not to seek care when they get sick (61).…”

Section: Discussionmentioning

confidence: 99%

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Spatio-temporal patterns of malaria in Nepal from 2005 to 2018: a country progressing towards malaria elimination

Ryan¹

2021

Preprint

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Background Nepal is attempting to eliminate malaria by 2026. Despite decreased malaria burden in Nepal between 2004 and 2018, studies have shown that some malaria indicators are increasing in certain parts of the country and that malaria has shifted to previously non-endemic areas. The objective of this study is to analyze the spatio-temporal patterns of malaria in Nepal from 2005 to 2018, following the introduction of Long-Lasting Insecticidal Nets (LLINs) as vector control intervention. Methods Data describing five different malaria indicators were obtained from annual reports of the Department of Health Services of the Government of Nepal: incidence of Indigenous Malaria, Imported Malaria, PV ( Plasmodium vivax) Malaria, PF ( Plasmodium falciparum) Malaria, and Total Malaria. Spatial variation in temporal trend method was employed in SaTScan software to detect the unusually high or low temporal trends of malaria indicators, and to generate their spatio-temporal clusters. Results All five indicators revealed spatiotemporal clusters of increasing malaria. Indigenous Malaria increased by 113.71% in a cluster of three mountainous districts where malaria was previously non-endemic. Most clusters of Imported Malaria had an increasing trend. The most prominent cluster included Kathmandu, the capital, where Imported Malaria increased by 156.22%. PV and PF Malaria also had clusters with an increasing trend. There were two clusters of Total Malaria with an increasing trend. Even though some clusters had decreasing trends in malaria indicators, the rate of decrease incidence in the clusters was lower than that outside the clusters. Conclusion The overall malaria burden is decreasing in Nepal as the country progresses closer to the elimination deadline. However, several spatiotemporal clusters showed increasing trends of malaria incidence. Furthermore, in clusters where a decreasing incidence trend was observed, the rate of decrease was far lower than the rate outside the cluster. Thus, it is necessary to focus vector control interventions in all these clusters. This information can help public health officials to make decisions for implementing vector control interventions to successfully eliminate malaria form the country.

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Designing malaria surveillance strategies for mobile and migrant populations in Nepal: a mixed-methods study

Cited by 24 publications

References 27 publications

Mass radical treatment of a group of foreign workers to mitigate the risk of re-establishment of malaria in Sri Lanka

Mass radical treatment of a group of foreign workers to mitigate the risk of re-establishment of malaria in Sri Lanka

The durability of long-lasting insecticidal nets distributed to the households between 2009 and 2013 in Nepal

Spatio-temporal patterns of malaria in Nepal from 2005 to 2018: a country progressing towards malaria elimination

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