Malaria elimination in remote communities requires integration of malaria control activities into general health care: an observational study and interrupted time series analysis in Myanmar

McLean, Alistair R. D.; Wai, Hla Phyo; Thu, Aung Myat; Khant, Zay Soe; Indrasuta, Chanida; Ashley, Elizabeth A.; Kyaw, Thar Tun; Day, Nicholas P. J.; Dondorp, Arjen M.; White, Nicholas J.; Smithuis, Frank

doi:10.1186/s12916-018-1172-x

Cited by 55 publications

(61 citation statements)

References 34 publications

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“…In recent years, Myanmar has made signi cant progress in reducing malaria morbidity and mortality, with the reduction of malaria cases by 72% from 2012 to 2018, with a similar trend found in another study [39]. These achievements re ected a substantial improvement in case diagnosis and treatment and vector control, particularly at the periphery and among populations at risk of malaria, and increasing nancial support from the Global Fund and other donors as well [40,41]. In response to the threaten by the emergence and spread of P. falciparum resistant to artemisinin, the world's rst line antimalarial [42] in Cambodia, Thailand, Vietnam, Laos and Myanmar [4,43,44], WHO set its sights on malaria elimination in the GMS in order to contain this threat [6].…”

Section: Discussionsupporting

confidence: 55%

From Control to Elimination: A Spatial-Temporal Analysis of Malaria Along the China-Myanmar Border

Huang¹,

Zhang²,

Xue³

et al. 2020

Preprint

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Background: Malaria cases have declined significantly along the China-Myanmar border in the past 10 years and this region is going through a process from control to elimination. The aim of this study is to investigate the epidemiology of malaria along the border, will identify challenges in the progress from control to elimination. Methods: National reported malaria cases from China and Myanmar, along with the data of 18 Chinese border counties and 23 townships in Myanmar were obtained from a web-based diseases information reporting system in China and the national malaria control program of Myanmar, respectively. Epidemiological data was analyzed, including the number of reported cases, annual parasite index and proportion of vivax infection. Spatial mapping of the API at county or township level in 2014 and 2018 was performed by ArcGIS. The relationship of malaria endemicity on both sides of the border was evaluated by regression analysis. Results: The number of reported malaria cases and API declined in the border counties or townships. In 2014, 392 malaria cases were reported from 18 Chinese border counties, including 8.42% indigenous cases and 91.58%% imported cases, while the highest API (0.11) was occurred in Yingjiang County. There have been no indigenous cases reported since 2017, but 164 imported cases were reported in 2018 and 97.56% were imported from Myanmar. The average API in 2014 in 23 Myanmar townships was significantly greater than that of 18 Chinese counties (P<0.01). However, the API decreased significantly in Myanmar side from 2014 to 2018 (P<0.01). The number of townships with an API between 0~1 increased to 15 in 2018, compared to only five in 2014, while still four townships had API>10. Plasmodium vivax was the predominant species along the border. The number of reported malaria cases and the proportion of vivax infection in the 18 Chinese counties were strongly correlated with those of the 23 Myanmar townships (P<0.05).Conclusions: Malaria elimination is approaching along the China-Myanmar border. However, in order to achieve the malaria elimination in this region and prevent the re-establishment of malaria in China after elimination, continued political, financial and scientific commitment is required.

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Section: Discussionsupporting

confidence: 55%

From Control to Elimination: A Spatial-Temporal Analysis of Malaria Along the China-Myanmar Border

Huang¹,

Zhang²,

Xue³

et al. 2020

Preprint

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“…Funds and personnel are being reassigned from malaria and other programmes to enable COVID-19 response efforts. Malaria elimination campaigns must reach marginalised groups living in remote and border areas [26], but these programmes are at particular risk of being scaled back for logistic or economic reasons associated with COVID-19, putting communities at risk. Together, these complex issues are compromising the provision of health care and surveillance for malaria and threatening elimination efforts.…”

Section: Particular Challenges Of Managing Malaria During Covid-19mentioning

confidence: 99%

Identifying and combating the impacts of COVID-19 on malaria

Rogerson

Beeson

Laman

et al. 2020

BMC Med

117

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Background: The COVID-19 pandemic has resulted in millions of infections, hundreds of thousands of deaths and major societal disruption due to lockdowns and other restrictions introduced to limit disease spread. Relatively little attention has been paid to understanding how the pandemic has affected treatment, prevention and control of malaria, which is a major cause of death and disease and predominantly affects people in less well-resourced settings. Main body: Recent successes in malaria control and elimination have reduced the global malaria burden, but these gains are fragile and progress has stalled in the past 5 years. Withdrawing successful interventions often results in rapid malaria resurgence, primarily threatening vulnerable young children and pregnant women. Malaria programmes are being affected in many ways by COVID-19. For prevention of malaria, insecticide-treated nets need regular renewal, but distribution campaigns have been delayed or cancelled. For detection and treatment of malaria, individuals may stop attending health facilities, out of fear of exposure to COVID-19, or because they cannot afford transport, and health care workers require additional resources to protect themselves from COVID-19. Supplies of diagnostics and drugs are being interrupted, which is compounded by production of substandard and falsified medicines and diagnostics. These disruptions are predicted to double the number of young African children dying of malaria in the coming year and may impact efforts to control the spread of drug resistance. Using examples from successful malaria control and elimination campaigns, we propose strategies to re-establish malaria control activities and maintain elimination efforts in the context of the COVID-19 pandemic, which is likely to be a long-term challenge. All sectors of society, including governments, donors, private sector and civil society organisations, have crucial roles to play to prevent malaria resurgence. Sparse resources must be allocated efficiently to ensure integrated health care systems that can sustain control activities against COVID-19 as well as malaria and other priority infectious diseases. Conclusion: As we deal with the COVID-19 pandemic, it is crucial that other major killers such as malaria are not ignored. History tells us that if we do, the consequences will be dire, particularly in vulnerable populations.

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“…An ITS approach was chosen since surveillance data were available covering the period before IRS, during sustained implementation, and after withdrawal of IRS. In Myanmar, an ITS analysis used an alternative impact indicator, exploring if an expansion of services provided by community health workers (CHWs) was associated with changes in blood examination rates by CHWs [46]. In the Myanmar study, the authors present similar findings from a range of alternative models to strengthen their conclusions (triangulation).…”

Section: Interrupted Time Series Analysesmentioning

confidence: 93%

Evaluating malaria programmes in moderate- and low-transmission settings: practical ways to generate robust evidence

Ashton

Prosnitz

Andrada

et al. 2020

Malar J

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Background: Many countries have made substantial progress in scaling-up and sustaining malaria intervention coverage, leading to more focalized and heterogeneous transmission in many settings. Evaluation provides valuable information for programmes to understand if interventions have been implemented as planned and with quality, if the programme had the intended impact on malaria burden, and to guide programmatic decision-making. Low-, moderate-, and heterogeneous-transmission settings present unique evaluation challenges because of dynamic and targeted intervention strategies. This paper provides illustration of evaluation approaches and methodologies for these transmission settings, and suggests how to answer evaluation questions specific to the local context. Methods:The Roll Back Malaria Monitoring and Evaluation Reference Group formed a task force in October 2017 to lead development of this framework. The task force includes representatives from National Malaria Programmes, funding agencies, and malaria research and implementing partners. The framework builds on existing guidance for process and outcome evaluations and impact evaluations specifically in high transmission settings. Results:The theory of change describes how evaluation questions asked by national malaria programmes in different contexts influence evaluation design. The transmission setting, existing stratification, and data quality and availability are also key considerations. The framework is intended for adaption by countries to their local context, and use for evaluation at sub-national level. Confirmed malaria incidence is recommended as the primary impact indicator due to its sensitivity to detect changes in low-transmission settings. It is expected that process evaluations provide sufficient evidence for programme monitoring and improvement, while impact evaluations are needed following adoption of new mixes of interventions, operational strategies, tools or policies, particularly in contexts of changing malaria epidemiology. Impact evaluations in low-, moderate-, or heterogeneous-transmission settings will likely use plausibility designs, and methods highlighted by the framework include interrupted time series, district-level doseresponse analyses, and constructed control methods. Triangulating multiple data sources and analyses is important to strengthen the plausibility argument. Conclusions:This framework provides a structure to assist national malaria programmes and partners to design evaluations in low-, moderate-or heterogeneous-transmission settings. Emphasizing a continuous cycle along the causal pathway linking process evaluation to impact evaluation and then programmatic decision-making, the © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and in...

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Malaria elimination in remote communities requires integration of malaria control activities into general health care: an observational study and interrupted time series analysis in Myanmar

Cited by 55 publications

References 34 publications

From Control to Elimination: A Spatial-Temporal Analysis of Malaria Along the China-Myanmar Border

From Control to Elimination: A Spatial-Temporal Analysis of Malaria Along the China-Myanmar Border

Identifying and combating the impacts of COVID-19 on malaria

Evaluating malaria programmes in moderate- and low-transmission settings: practical ways to generate robust evidence

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