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Srimokla O, Pan-Ngum W, Khamsiriwatchara A, Padungtod C, Tipmontree R, Choosri N, Saralamba S. Early warning systems for malaria outbreaks in Thailand: an anomaly detection approach. Malar J 2024; 23:11. [PMID: 38191421 PMCID: PMC10775623 DOI: 10.1186/s12936-024-04837-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Malaria continues to pose a significant health threat. Rapid identification of malaria infections and the deployment of active surveillance tools are crucial for achieving malaria elimination in regions where malaria is endemic, such as certain areas of Thailand. In this study, an anomaly detection system is introduced as an early warning mechanism for potential malaria outbreaks in countries like Thailand. METHODS Unsupervised clustering-based, and time series-based anomaly detection algorithms are developed and compared to identify abnormal malaria activity in Thailand. Additionally, a user interface tailored for anomaly detection is designed, enabling the Thai malaria surveillance team to utilize these algorithms and visualize regions exhibiting unusual malaria patterns. RESULTS Nine distinct anomaly detection algorithms we developed. Their efficacy in pinpointing verified outbreaks was assessed using malaria case data from Thailand spanning 2012 to 2022. The historical average threshold-based anomaly detection method triggered three times fewer alerts, while correctly identifying the same number of verified outbreaks when compared to the current method used in Thailand. A limitation of this analysis is the small number of verified outbreaks; further consultation with the Division of Vector Borne Disease could help identify more verified outbreaks. The developed dashboard, designed specifically for anomaly detection, allows disease surveillance professionals to easily identify and visualize unusual malaria activity at a provincial level across Thailand. CONCLUSION An enhanced early warning system is proposed to bolster malaria elimination efforts for countries with a similar malaria profile to Thailand. The developed anomaly detection algorithms, after thorough comparison, have been optimized for integration with the current malaria surveillance infrastructure. An anomaly detection dashboard for Thailand is built and supports early detection of abnormal malaria activity. In summary, the proposed early warning system enhances the identification process for provinces at risk of outbreaks and offers easy integration with Thailand's established malaria surveillance framework.
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Affiliation(s)
- Oraya Srimokla
- Nuffield Department of Medicine, University of Oxford, Broad St, Oxford, OX13AZ, UK
| | - Wirichada Pan-Ngum
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Ratchawithi Rd, Bangkok, 10400, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Ratchawithi Rd, Bangkok, 10400, Thailand
| | - Amnat Khamsiriwatchara
- Center of Excellence for Biomedical and Public Health Informatics, Faculty of Tropical Medicine, Mahidol University, Ratchawithi Rd, Bangkok, 10400, Thailand
| | - Chantana Padungtod
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Talat Kwan, Bangkok, Nonthaburi, 11000, Thailand
| | - Rungrawee Tipmontree
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Talat Kwan, Bangkok, Nonthaburi, 11000, Thailand
| | - Noppon Choosri
- College of Arts, Media and Technology, Chiang Mai University, Sukhothai 5 Alley, Mueang Chiang Mai, Chiang Mai, 50200, Thailand
| | - Sompob Saralamba
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Ratchawithi Rd, Bangkok, 10400, Thailand.
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Sa-Ngamuang C, Lawpoolsri S, Su Yin M, Barkowsky T, Cui L, Prachumsri J, Haddawy P. Assessment of malaria risk in Southeast Asia: a systematic review. Malar J 2023; 22:339. [PMID: 37940923 PMCID: PMC10631000 DOI: 10.1186/s12936-023-04772-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Several countries in Southeast Asia are nearing malaria elimination, yet eradication remains elusive. This is largely due to the challenge of focusing elimination efforts, an area where risk prediction can play an essential supporting role. Despite its importance, there is no standard numerical method to quantify the risk of malaria infection. Thus, there is a need for a consolidated view of existing definitions of risk and factors considered in assessing risk to analyse the merits of risk prediction models. This systematic review examines studies of the risk of malaria in Southeast Asia with regard to their suitability in addressing the challenges of malaria elimination in low transmission areas. METHODS A search of four electronic databases over 2010-2020 retrieved 1297 articles, of which 25 met the inclusion and exclusion criteria. In each study, examined factors included the definition of the risk and indicators of malaria transmission used, the environmental and climatic factors associated with the risk, the statistical models used, the spatial and temporal granularity, and how the relationship between environment, climate, and risk is quantified. RESULTS This review found variation in the definition of risk used, as well as the environmental and climatic factors in the reviewed articles. GLM was widely adopted as the analysis technique relating environmental and climatic factors to malaria risk. Most of the studies were carried out in either a cross-sectional design or case-control studies, and most utilized the odds ratio to report the relationship between exposure to risk and malaria prevalence. CONCLUSIONS Adopting a standardized definition of malaria risk would help in comparing and sharing results, as would a clear description of the definition and method of collection of the environmental and climatic variables used. Further issues that need to be more fully addressed include detection of asymptomatic cases and considerations of human mobility. Many of the findings of this study are applicable to other low-transmission settings and could serve as a guideline for further studies of malaria in other regions.
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Affiliation(s)
- Chaitawat Sa-Ngamuang
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Myat Su Yin
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Thomas Barkowsky
- Bremen Spatial Cognition Center (BSCC), University of Bremen, Bremen, Germany
| | - Liwang Cui
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Jetsumon Prachumsri
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Peter Haddawy
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, Thailand.
- Bremen Spatial Cognition Center (BSCC), University of Bremen, Bremen, Germany.
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Looareesuwan P, Krudsood S, Lawpoolsri S, Tangpukdee N, Matsee W, Nguitragool W, Wilairatana P. Gametocyte prevalence and risk factors of P. falciparum malaria patients admitted at the Hospital for Tropical Diseases, Thailand: a 20-year retrospective study. Malar J 2023; 22:321. [PMID: 37872594 PMCID: PMC10591378 DOI: 10.1186/s12936-023-04728-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The incidence of malaria in Thailand has dramatically declined over the past two decades, and the goal is to eliminate malaria by 2025. Despite significant progress, one of the key challenges to malaria elimination are undetected gametocyte carriers. Human migration adds complexity to the malaria situation, as it not only sustains local transmission but also poses the risk of spreading drug-resistant parasites. Currently, no study has assessed the prevalence of gametocytes across multiple years in Plasmodium falciparum malaria patients in Thailand, and the risk factors for gametocyte carriage have not been fully explored. METHODS Medical records of all P. falciparum malaria patients admitted from January 1, 2001 to December 31, 2020 at the Hospital for Tropical Diseases, Thailand, were retrospectively examined and a total of 1962 records were included for analysis. Both P. falciparum parasites and gametocytes were diagnosed by microscopy. A regression model was used to evaluate predictors of gametocyte carriage. RESULTS The study demonstrated gametocyte prevalence in low malaria transmission areas. Nine risk factors for gametocyte carriage were identified: age between 15 and 24 years [adjusted odds ratio (aOR) = 1.96, 95% confidence interval (CI) 1.18-3.26], Karen ethnicity (aOR = 2.59, 95% CI 1.56-4.29), preadmission duration of fever > 7 days (aOR = 5.40, 95% CI 3.92-7.41), fever on admission (> 37.5 °C) (aOR = 0.61, 95% CI 0.48-0.77), haemoglobin ≤ 8 g/dL (aOR = 3.32, 95% CI 2.06-5.33), asexual parasite density > 5000-25,000/µL (aOR = 0.71, 95% CI 0.52-0.98), asexual parasite density > 25,000-100,000/µL (aOR = 0.74, 95% CI 0.53-1.03), asexual parasite density > 100,000/µL (aOR = 0.51, 95% CI 0.36-0.72), platelet count ≤ 100,000/µL (aOR = 0.65, 95% CI 0.50-0.85, clinical features of severe malaria (aOR = 2.33, 95% CI 1.76-3.10) and dry season (aOR = 1.41, 95% CI 1.10-1.80). An increasing incidence of imported transnational malaria cases was observed over the past two decades. CONCLUSIONS This is the first study to determine the prevalence of gametocytes among patients with symptomatic P. falciparum malaria, identify the risk factors for gametocyte carriage, and potential gametocyte carriers in Thailand. Blocking transmission is one of the key strategies for eliminating malaria in these areas. The results might provide important information for targeting gametocyte carriers and improving the allocation of resources for malaria control in Thailand. This study supports the already nationally recommended use of a single dose of primaquine in symptomatic P. falciparum malaria patients to clear gametocytes.
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Affiliation(s)
- Panita Looareesuwan
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Srivicha Krudsood
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.
- Clinical Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Noppadon Tangpukdee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Wasin Matsee
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Wang Nguitragool
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.
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Legendre E, Girond F, Herbreteau V, Hoeun S, Rebaudet S, Thu AM, Rae JD, Lehot L, Dieng S, Delmas G, Nosten F, Gaudart J, Landier J. 'Forest malaria' in Myanmar? Tracking transmission landscapes in a diversity of environments. Parasit Vectors 2023; 16:324. [PMID: 37700295 PMCID: PMC10498628 DOI: 10.1186/s13071-023-05915-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/05/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND In the Greater Mekong Subregion, case-control studies and national-level analyses have shown an association between malaria transmission and forest activities. The term 'forest malaria' hides the diversity of ecosystems in the GMS, which likely do not share a uniform malaria risk. To reach malaria elimination goals, it is crucial to document accurately (both spatially and temporally) the influence of environmental factors on malaria to improve resource allocation and policy planning within given areas. The aim of this ecological study is to characterize the association between malaria dynamics and detailed ecological environments determined at village level over a period of several years in Kayin State, Myanmar. METHODS We characterized malaria incidence profiles at village scale based on intra- and inter-annual variations in amplitude, seasonality, and trend over 4 years (2016-2020). Environment was described independently of village localization by overlaying a 2-km hexagonal grid over the region. Specifically, hierarchical classification on principal components, using remote sensing data of high spatial resolution, was used to assign a landscape and a climate type to each grid cell. We used conditional inference trees and random forests to study the association between the malaria incidence profile of each village, climate and landscape. Finally, we constructed eco-epidemiological zones to stratify and map malaria risk in the region by summarizing incidence and environment association information. RESULTS We identified a high diversity of landscapes (n = 19) corresponding to a gradient from pristine to highly anthropogenically modified landscapes. Within this diversity of landscapes, only three were associated with malaria-affected profiles. These landscapes were composed of a mosaic of dense and sparse forest fragmented by small agricultural patches. A single climate with moderate rainfall and a temperature range suitable for mosquito presence was also associated with malaria-affected profiles. Based on these environmental associations, we identified three eco-epidemiological zones marked by later persistence of Plasmodium falciparum, high Plasmodium vivax incidence after 2018, or a seasonality pattern in the rainy season. CONCLUSIONS The term forest malaria covers a multitude of contexts of malaria persistence, dynamics and populations at risk. Intervention planning and surveillance could benefit from consideration of the diversity of landscapes to focus on those specifically associated with malaria transmission.
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Affiliation(s)
- Eva Legendre
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, 27 boulevard Jean Moulin, 13005, Marseille, France.
| | - Florian Girond
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Vincent Herbreteau
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
| | - Sokeang Hoeun
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Stanislas Rebaudet
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, 27 boulevard Jean Moulin, 13005, Marseille, France
- Hôpital Européen Marseille, Marseille, France
| | - Aung Myint Thu
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
| | - Jade Dean Rae
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Oxford, UK
| | - Laurent Lehot
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, 27 boulevard Jean Moulin, 13005, Marseille, France
| | - Sokhna Dieng
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, 27 boulevard Jean Moulin, 13005, Marseille, France
| | - Gilles Delmas
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Oxford, UK
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Oxford, UK
| | - Jean Gaudart
- Aix Marseille Univ, IRD, INSERM, AP-HM, SESSTIM, La Timone Hospital, BioSTIC, Biostatistics and ICT, Marseille, France
| | - Jordi Landier
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, 27 boulevard Jean Moulin, 13005, Marseille, France
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
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Rahmani AA, Susanna D, Febrian T. The relationship between climate change and malaria in South-East Asia: A systematic review of the evidence. F1000Res 2023; 11:1555. [PMID: 37867624 PMCID: PMC10585202 DOI: 10.12688/f1000research.125294.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background: Climatic change is an inescapable fact that implies alterations in seasons where weather occurrences have their schedules shift from the regular and magnitudes intensify to more extreme variations over a multi-year period. Southeast Asia is one of the many regions experiencing changes in climate and concurrently still has endemicities of malaria. Given that previous studies have suggested the influence of climate on malaria's vector the Anopheles mosquitoes and parasite the Plasmodium group, this study was conducted to review the evidence of associations made between malaria cases and climatic variables in Southeast Asia throughout a multi-year period. Methods: Our systematic literature review was informed by the PRISMA guidelines and registered in PROSPERO: CRD42022301826 on 5 th February 2022. We searched for original articles in English and Indonesian that focused on the associations between climatic variables and malaria cases. Results: The initial identification stage resulted in 535 records of possible relevance and after abstract screening and eligibility assessment we included 19 research articles for the systematic review. Based on the reviewed articles, changing temperatures, precipitation, humidity and windspeed were considered for statistical association across a multi-year period and are correlated with malaria cases in various regions throughout Southeast Asia. Conclusions: According to the review of evidence, climatic variables that exhibited a statistically significant correlation with malaria cases include temperatures, precipitation, and humidity. The strength of each climatic variable varies across studies. Our systematic review of the limited evidence indicates that further research for the Southeast Asia region remains to be explored.
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Affiliation(s)
- Ardhi Arsala Rahmani
- Doctoral Program in Public Health, Universitas Indonesia, Depok, Jawa Barat, 16424, Indonesia
| | - Dewi Susanna
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, Jawa Barat, 16424, Indonesia
| | - Tommi Febrian
- Global Green Growth Institute (GGGI), Jakarta, Daerah Khusus Ibukota (DKI), 12950, Indonesia
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Zhao Y, Aung PL, Ruan S, Win KM, Wu Z, Soe TN, Soe MT, Cao Y, Sattabongkot J, Kyaw MP, Cui L, Menezes L, Parker DM. Spatio-temporal trends of malaria incidence from 2011 to 2017 and environmental predictors of malaria transmission in Myanmar. Infect Dis Poverty 2023; 12:2. [PMID: 36709318 PMCID: PMC9883610 DOI: 10.1186/s40249-023-01055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/13/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Myanmar bears the heaviest malaria burden in the Greater Mekong Subregion (GMS). This study assessed the spatio-temporal dynamics and environmental predictors of Plasmodium falciparum and Plasmodium vivax malaria in Myanmar. METHODS Monthly reports of malaria cases at primary health centers during 2011-2017 were analyzed to describe malaria distribution across Myanmar at the township and state/region levels by spatial autocorrelation (Moran index) and spatio-temporal clustering. Negative binomial generalized additive models identified environmental predictors for falciparum and vivax malaria, respectively. RESULTS From 2011 to 2017, there was an apparent reduction in malaria incidence in Myanmar. Malaria incidence peaked in June each year. There were significant spatial autocorrelation and clustering with extreme spatial heterogeneity in malaria cases and test positivity across the nation (P < 0.05). Areas with higher malaria incidence were concentrated along international borders. Primary clusters of P. falciparum persisted in western townships, while clusters of P. vivax shifted geographically over the study period. The primary cluster was detected from January 2011 to December 2013 and covered two states (Sagaing and Kachin). Annual malaria incidence was highest in townships with a mean elevation of 500‒600 m and a high variance in elevation (states with both high and low elevation). There was an apparent linear relationship between the mean normalized difference vegetative index and annual P. falciparum incidence (P < 0.05). CONCLUSION The decreasing trends reflect the significant achievement of malaria control efforts in Myanmar. Prioritizing the allocation of resources to high-risk areas identified in this study can achieve effective disease control.
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Affiliation(s)
- Yan Zhao
- grid.412449.e0000 0000 9678 1884Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122 Liaoning China
| | - Pyae Linn Aung
- Myanmar Health Network Organization, Yangon, Myanmar ,grid.10223.320000 0004 1937 0490Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Shishao Ruan
- grid.412449.e0000 0000 9678 1884Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122 Liaoning China
| | - Kyawt Mon Win
- grid.415741.2Department of Public Health, Ministry of Health, NayPyiTaw, Myanmar
| | - Zifang Wu
- grid.412449.e0000 0000 9678 1884Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122 Liaoning China
| | - Than Naing Soe
- grid.415741.2Department of Public Health, Ministry of Health, NayPyiTaw, Myanmar
| | - Myat Thu Soe
- Myanmar Health Network Organization, Yangon, Myanmar
| | - Yaming Cao
- grid.412449.e0000 0000 9678 1884Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122 Liaoning China
| | - Jetsumon Sattabongkot
- grid.10223.320000 0004 1937 0490Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Liwang Cui
- grid.170693.a0000 0001 2353 285XDivision of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL 33612 USA
| | - Lynette Menezes
- grid.170693.a0000 0001 2353 285XDivision of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL 33612 USA
| | - Daniel M. Parker
- grid.266093.80000 0001 0668 7243Department of Population Health and Disease Prevention, Department of Epidemiology, University of California, Irvine, USA
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Cui L, Sattabongkot J, Aung PL, Brashear A, Cao Y, Kaewkungwal J, Khamsiriwatchara A, Kyaw MP, Lawpoolsri S, Menezes L, Miao J, Nguitragool W, Parker D, Phuanukoonnon S, Roobsoong W, Siddiqui F, Soe MT, Sriwichai P, Yang Z, Zhao Y, Zhong D. Multidisciplinary Investigations of Sustained Malaria Transmission in the Greater Mekong Subregion. Am J Trop Med Hyg 2022; 107:138-151. [PMID: 36228909 DOI: 10.4269/ajtmh.21-1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/28/2022] [Indexed: 11/07/2022] Open
Abstract
In the course of malaria elimination in the Greater Mekong Subregion (GMS), malaria epidemiology has experienced drastic spatiotemporal changes with residual transmission concentrated along international borders and the rising predominance of Plasmodium vivax. The emergence of Plasmodium falciparum parasites resistant to artemisinin and partner drugs renders artemisinin-based combination therapies less effective while the potential spread of multidrug-resistant parasites elicits concern. Vector behavioral changes and insecticide resistance have reduced the effectiveness of core vector control measures. In recognition of these problems, the Southeast Asian International Center of Excellence for Malaria Research (ICEMR) has been conducting multidisciplinary research to determine how human migration, antimalarial drug resistance, vector behavior, and insecticide resistance sustain malaria transmission at international borders. These efforts allow us to comprehensively understand the ecology of border malaria transmission and develop population genomics tools to identify and track parasite introduction. In addition to employing in vivo, in vitro, and molecular approaches to monitor the emergence and spread of drug-resistant parasites, we also use genomic and genetic methods to reveal novel mechanisms of antimalarial drug resistance of parasites. We also use omics and population genetics approaches to study insecticide resistance in malaria vectors and identify changes in mosquito community structure, vectorial potential, and seasonal dynamics. Collectively, the scientific findings from the ICEMR research activities offer a systematic view of the factors sustaining residual malaria transmission and identify potential solutions to these problems to accelerate malaria elimination in the GMS.
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Affiliation(s)
- Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | | | - Awtum Brashear
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Yaming Cao
- Department of Immunology, China Medical University, Shenyang, China
| | | | | | | | | | - Lynette Menezes
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jun Miao
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Wang Nguitragool
- Mahidol Vivax Research Unit, Mahidol University, Bangkok, Thailand
| | - Daniel Parker
- Department of Epidemiology, University of California at Irvine, Irvine, California
| | | | | | - Faiza Siddiqui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Myat Thu Soe
- Myanmar Health Network Organization, Yangon, Myanmar
| | - Patchara Sriwichai
- Department of Medical Entomology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Yan Zhao
- Department of Immunology, China Medical University, Shenyang, China
| | - Daibin Zhong
- Program in Public Health, University of California at Irvine, Irvine, California
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Choisy M, McBride A, Chambers M, Ho Quang C, Nguyen Quang H, Xuan Chau NT, Thi GN, Bonell A, Evans M, Ming D, Ngo-Duc T, Quang Thai P, Dang Giang DH, Dan Thanh HN, Ngoc Nhung H, Lowe R, Maude R, Elyazar I, Surendra H, Ashley EA, Thwaites L, van Doorn HR, Kestelyn E, Dondorp AM, Thwaites G, Vinh Chau NV, Yacoub S. Climate change and health in Southeast Asia - defining research priorities and the role of the Wellcome Trust Africa Asia Programmes. Wellcome Open Res 2022; 6:278. [PMID: 36176331 PMCID: PMC9493397 DOI: 10.12688/wellcomeopenres.17263.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
This article summarises a recent virtual meeting organised by the Oxford University Clinical Research Unit in Vietnam on the topic of climate change and health, bringing local partners, faculty and external collaborators together from across the Wellcome and Oxford networks. Attendees included invited local and global climate scientists, clinicians, modelers, epidemiologists and community engagement practitioners, with a view to setting priorities, identifying synergies and fostering collaborations to help define the regional climate and health research agenda. In this summary paper, we outline the major themes and topics that were identified and what will be needed to take forward this research for the next decade. We aim to take a broad, collaborative approach to including climate science in our current portfolio where it touches on infectious diseases now, and more broadly in our future research directions. We will focus on strengthening our research portfolio on climate-sensitive diseases, and supplement this with high quality data obtained from internal studies and external collaborations, obtained by multiple methods, ranging from traditional epidemiology to innovative technology and artificial intelligence and community-led research. Through timely agenda setting and involvement of local stakeholders, we aim to help support and shape research into global heating and health in the region.
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Affiliation(s)
- Marc Choisy
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Angela McBride
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Mary Chambers
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Chanh Ho Quang
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | - Huy Nguyen Quang
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | | | - Giang Nguyen Thi
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | - Ana Bonell
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Megan Evans
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Damien Ming
- Department of Infectious Disease, Imperial College London, London, UK
| | - Thanh Ngo-Duc
- University of Science and Technology of Hanoi, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Pham Quang Thai
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- School of Preventative Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | - Ho Ngoc Dan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | - Hoang Ngoc Nhung
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | - Rachel Lowe
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Barcelona Supercomputing Center, Barcelona, Spain
| | - Richard Maude
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Iqbal Elyazar
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Henry Surendra
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic
| | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Arjen M. Dondorp
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Sophie Yacoub
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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9
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Choisy M, McBride A, Chambers M, Ho Quang C, Nguyen Quang H, Xuan Chau NT, Thi GN, Bonell A, Evans M, Ming D, Ngo-Duc T, Quang Thai P, Dang Giang DH, Dan Thanh HN, Ngoc Nhung H, Lowe R, Maude R, Elyazar I, Surendra H, Ashley EA, Thwaites L, van Doorn HR, Kestelyn E, Dondorp AM, Thwaites G, Vinh Chau NV, Yacoub S. Climate change and health in Southeast Asia - defining research priorities and the role of the Wellcome Trust Africa Asia Programmes. Wellcome Open Res 2022; 6:278. [PMID: 36176331 PMCID: PMC9493397 DOI: 10.12688/wellcomeopenres.17263.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 05/18/2024] Open
Abstract
This article summarises a recent virtual meeting organised by the Oxford University Clinical Research Unit in Vietnam on the topic of climate change and health, bringing local partners, faculty and external collaborators together from across the Wellcome and Oxford networks. Attendees included invited local and global climate scientists, clinicians, modelers, epidemiologists and community engagement practitioners, with a view to setting priorities, identifying synergies and fostering collaborations to help define the regional climate and health research agenda. In this summary paper, we outline the major themes and topics that were identified and what will be needed to take forward this research for the next decade. We aim to take a broad, collaborative approach to including climate science in our current portfolio where it touches on infectious diseases now, and more broadly in our future research directions. We will focus on strengthening our research portfolio on climate-sensitive diseases, and supplement this with high quality data obtained from internal studies and external collaborations, obtained by multiple methods, ranging from traditional epidemiology to innovative technology and artificial intelligence and community-led research. Through timely agenda setting and involvement of local stakeholders, we aim to help support and shape research into global heating and health in the region.
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Affiliation(s)
- Marc Choisy
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Angela McBride
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Mary Chambers
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Chanh Ho Quang
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | - Huy Nguyen Quang
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | | | - Giang Nguyen Thi
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | - Ana Bonell
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Megan Evans
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Damien Ming
- Department of Infectious Disease, Imperial College London, London, UK
| | - Thanh Ngo-Duc
- University of Science and Technology of Hanoi, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Pham Quang Thai
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- School of Preventative Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | - Ho Ngoc Dan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | - Hoang Ngoc Nhung
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | - Rachel Lowe
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Barcelona Supercomputing Center, Barcelona, Spain
| | - Richard Maude
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Iqbal Elyazar
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Henry Surendra
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic
| | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Arjen M. Dondorp
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Sophie Yacoub
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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10
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Ramìrez-Aldana R, Gomez-Verjan JC, Bello-Chavolla OY, Naranjo L. A spatio-temporal study of state-wide case-fatality risks during the first wave of the COVID-19 pandemic in Mexico. GEOSPATIAL HEALTH 2022; 17. [PMID: 35352540 DOI: 10.4081/gh.2022.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
spatio-temporal analysis of the first wave of the coronavirus (COVID-19) pandemic in Mexico (April to September 2020) was performed by state. Descriptive analyses through diagrams, mapping, animations and time series representations were carried out. Greater risks were observed at certain times in specific regions. Various trends and clusters were observed and analysed by fitting linear mixed models and time series clustering. The association of co-morbidities and other variables were studied by fitting a spatial panel data linear model (SPLM). On average, the greatest risks were observed in Baja California Norte, Chiapas and Sonora, while some other densely populated states, e.g., Mexico City, had lower values. The trends varied by state and a four-order polynomial, including fixed and random effects, was necessary to model them. The most common risk development was observed in states belonging to two clusters and consisted of an initial increase followed by a decrease. Some states presented cluster configurations with a retarded risk increase before the decrease, while the risk increased throughout the time of study in others. A cyclic behaviour with a second increasing trend was also observed in some states. The SPLM approach revealed a positive significant association with respect to case fatality risk between certain groups, such as males and individuals aged 50 years and more, and the prevalence of chronic kidney disease, cardiovascular disease, asthma and hypertension. The analysis may provide valuable insight into COVID-19 dynamics applicable in future outbreaks, as well as identify determinants signifying certain trends at the state level. The combination of spatial and temporal information may provide a better understanding of the fatalities due to COVID-19.
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Affiliation(s)
| | | | | | - Lizbeth Naranjo
- 2Department of Mathematics, Faculty of Sciences, National Autonomous University of Mexico, Mexico City.
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11
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Chang HH, Chang MC, Kiang M, Mahmud AS, Ekapirat N, Engø-Monsen K, Sudathip P, Buckee CO, Maude RJ. Low parasite connectivity among three malaria hotspots in Thailand. Sci Rep 2021; 11:23348. [PMID: 34857842 PMCID: PMC8640040 DOI: 10.1038/s41598-021-02746-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/17/2021] [Indexed: 12/25/2022] Open
Abstract
Identifying sources and sinks of malaria transmission is critical for designing effective intervention strategies particularly as countries approach elimination. The number of malaria cases in Thailand decreased 90% between 2012 and 2020, yet elimination has remained a major public health challenge with persistent transmission foci and ongoing importation. There are three main hotspots of malaria transmission in Thailand: Ubon Ratchathani and Sisaket in the Northeast; Tak in the West; and Yala in the South. However, the degree to which these hotspots are connected via travel and importation has not been well characterized. Here, we develop a metapopulation model parameterized by mobile phone call detail record data to estimate parasite flow among these regions. We show that parasite connectivity among these regions was limited, and that each of these provinces independently drove the malaria transmission in nearby provinces. Overall, our results suggest that due to the low probability of domestic importation between the transmission hotspots, control and elimination strategies can be considered separately for each region.
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Affiliation(s)
- Hsiao-Han Chang
- grid.38348.340000 0004 0532 0580Institute of Bioinformatics and Structural Biology and Department of Life Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Meng-Chun Chang
- grid.38348.340000 0004 0532 0580Institute of Bioinformatics and Structural Biology and Department of Life Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Mathew Kiang
- grid.168010.e0000000419368956Department of Epidemiology and Population Health, Stanford University, Stanford, CA USA
| | - Ayesha S. Mahmud
- grid.47840.3f0000 0001 2181 7878Department of Demography, University of California, Berkeley, USA
| | - Nattwut Ekapirat
- grid.10223.320000 0004 1937 0490Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Prayuth Sudathip
- grid.415836.d0000 0004 0576 2573Division of Vector Borne Diseases, Ministry of Public Health, Nonthaburi, Thailand
| | - Caroline O. Buckee
- grid.38142.3c000000041936754XHarvard TH Chan School of Public Health, Harvard University, Boston, USA
| | - Richard J. Maude
- grid.10223.320000 0004 1937 0490Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand ,grid.38142.3c000000041936754XHarvard TH Chan School of Public Health, Harvard University, Boston, USA ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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12
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Choisy M, McBride A, Chambers M, Ho Quang C, Nguyen Quang H, Xuan Chau NT, Thi GN, Bonell A, Evans M, Ming D, Ngo-Duc T, Quang Thai P, Dang Giang DH, Dan Thanh HN, Ngoc Nhung H, Lowe R, Maude R, Elyazar I, Surendra H, Ashley EA, Thwaites L, van Doorn HR, Kestelyn E, Dondorp AM, Thwaites G, Vinh Chau NV, Yacoub S. Climate change and health in Southeast Asia - defining research priorities and the role of the Wellcome Trust Africa Asia Programmes. Wellcome Open Res 2021; 6:278. [PMID: 36176331 PMCID: PMC9493397 DOI: 10.12688/wellcomeopenres.17263.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 02/26/2024] Open
Abstract
This article summarises a recent virtual meeting organised by the Oxford University Clinical Research Unit in Vietnam on the topic of climate change and health, bringing local partners, faculty and external collaborators together from across the Wellcome and Oxford networks. Attendees included invited local and global climate scientists, clinicians, modelers, epidemiologists and community engagement practitioners, with a view to setting priorities, identifying synergies and fostering collaborations to help define the regional climate and health research agenda. In this summary paper, we outline the major themes and topics that were identified and what will be needed to take forward this research for the next decade. We aim to take a broad, collaborative approach to including climate science in our current portfolio where it touches on infectious diseases now, and more broadly in our future research directions. We will focus on strengthening our research portfolio on climate-sensitive diseases, and supplement this with high quality data obtained from internal studies and external collaborations, obtained by multiple methods, ranging from traditional epidemiology to innovative technology and artificial intelligence and community-led research. Through timely agenda setting and involvement of local stakeholders, we aim to help support and shape research into global heating and health in the region.
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Affiliation(s)
- Marc Choisy
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Angela McBride
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Mary Chambers
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Chanh Ho Quang
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | - Huy Nguyen Quang
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | | | - Giang Nguyen Thi
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | - Ana Bonell
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Megan Evans
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Damien Ming
- Department of Infectious Disease, Imperial College London, London, UK
| | - Thanh Ngo-Duc
- University of Science and Technology of Hanoi, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Pham Quang Thai
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- School of Preventative Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | | | - Ho Ngoc Dan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | - Hoang Ngoc Nhung
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
| | - Rachel Lowe
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Barcelona Supercomputing Center, Barcelona, Spain
| | - Richard Maude
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Iqbal Elyazar
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Henry Surendra
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic
| | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Arjen M. Dondorp
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Sophie Yacoub
- Oxford University Clinical Research Unit, Ho Chi Minh City and Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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13
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Gallalee S, Ward AV, Aye MM, Aung NKZ, Dunn JC, Lavenberg S, Lourenço C, Dunning J, Thi A, Le Menach A, Tun MM. Factors associated with the decline of malaria in Myanmar's Ayeyarwady Region between 2013 and 2017. Sci Rep 2021; 11:20470. [PMID: 34650123 PMCID: PMC8516986 DOI: 10.1038/s41598-021-99737-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/24/2021] [Indexed: 12/04/2022] Open
Abstract
The burden of malaria in Myanmar has declined rapidly in recent years; cases decreased from 333,871 in 2013 to 85,019 in 2017 (75% decrease). Decline of malaria in the Ayeyarwady Region of Myanmar reflects this trend with an 86% decrease in cases over this period. In this exploratory analysis, quantitative and qualitative information were assessed to explore potential factors responsible for the decline of malaria in Ayeyarwady. Data on malaria incidence, programmatic financing, surveillance, case management, vector control interventions, climate and ecological factors, and policies and guidelines spanning 2013 to 2017 were compiled. Poisson regression models that adjust for correlation were used to analyze the association between annual malaria case numbers with malaria intervention factors at the township level. Between 2013 and 2017, there was a decrease in mean township-level malaria incidence per 1000 from 3.03 (SD 4.59) to 0.34 (SD 0.79); this decline coincided with the implementation of the government’s multi-pronged malaria elimination strategy, an increase of approximately 50.8 million USD in malaria funding nationally, and a period of deforestation in the region. Increased funding in Ayeyarwady was invested in interventions associated with the decline in caseload, and the important roles of surveillance and case management should be maintained while Myanmar works towards malaria elimination.
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Affiliation(s)
- Sarah Gallalee
- Clinton Health Access Initiative, Inc., Boston, MA, USA.
| | | | - Moe Moe Aye
- Clinton Health Access Initiative, Inc., Boston, MA, USA
| | | | - Julia C Dunn
- Clinton Health Access Initiative, Inc., Boston, MA, USA
| | | | | | | | - Aung Thi
- Myanmar Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | | | - Myat Min Tun
- Myanmar Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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14
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Maude RJ, Ngo TD, Tran DT, Nguyen BTH, Dang DV, Tran LK, Gregory M, Maude RR, Sinha I, Pongsoipetch K, Martin NJ. Risk factors for malaria in high incidence areas of Viet Nam: a case-control study. Malar J 2021; 20:373. [PMID: 34535140 PMCID: PMC8446736 DOI: 10.1186/s12936-021-03908-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/07/2021] [Indexed: 12/05/2022] Open
Abstract
Background A key step to advancing the goal of malaria elimination in Viet Nam by 2030 is focusing limited resources for treatment and prevention to groups most at risk for malaria transmission. Methods To better understand risk factors for malaria transmission in central Viet Nam, a survey of 1000 malaria positive cases and 1000 malaria negative controls was conducted. Cases and controls were matched for age and gender and self-presented at commune health stations (CHS) in Binh Phuoc, Dak Nong and Dak Lak Provinces. Diagnoses were confirmed with microscopy, rapid diagnostic test and PCR. Participants were interviewed about 50 potential risk factors for malaria, which included information about occupation, forest visitation, travel, healthcare-seeking behaviour and prior use of anti-malaria interventions. Participants were enrolled by trained government health workers and the samples were analysed in Vietnamese government laboratories. Data were analysed by univariable, block-wise and multivariable logistic regression. Results Among cases, 61.8% had Plasmodium falciparum, 35.2% Plasmodium vivax and 3% mixed species infections. Median (IQR) age was 27 (21–36) years and 91.2% were male. Twenty-five risk factors were associated with being a case and eleven with being a control. Multivariable analysis found that malaria cases correlated with forest workers, recent forest visitation, longer duration of illness, having a recorded fever, number of malaria infections in the past year, having had prior malaria treatment and having previously visited a clinic. Conclusions This study demonstrates the benefits of increased statistical power from matched controls in malaria surveillance studies, which allows identification of additional independent risk factors. It also illustrates an example of research partnership between academia and government to collect high quality data relevant to planning malaria elimination activities. Modifiable risk factors and implications of the findings for malaria elimination strategy are presented. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03908-7.
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Affiliation(s)
- Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand. .,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK. .,Harvard TH Chan School of Public Health, Harvard University, Boston, USA. .,The Open University, Milton Keynes, UK.
| | - Thang Duc Ngo
- National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Duong Thanh Tran
- National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Binh Thi Huong Nguyen
- National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Dung Viet Dang
- National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | | | | | - Rapeephan R Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Ipsita Sinha
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - Kulchada Pongsoipetch
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
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15
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Ooi CH, Phang WK, Kent Liew JW, Lau YL. Spatial and Temporal Patterns of Plasmodium knowlesi Malaria in Sarawak from 2008 to 2017. Am J Trop Med Hyg 2021; 104:1814-1819. [PMID: 33755585 PMCID: PMC8103491 DOI: 10.4269/ajtmh.20-1304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/22/2021] [Indexed: 12/16/2022] Open
Abstract
Zoonotic knowlesi malaria has replaced human malaria as the most prevalent malaria disease in Malaysia. The persistence of knowlesi malaria in high-risk transmission areas or hotspots can be discouraging to existing malaria elimination efforts. In this study, retrospective data of laboratory-confirmed knowlesi malaria cases were obtained from the Sarawak Health Department to investigate the spatiotemporal patterns and clustering of knowlesi malaria in the state of Sarawak from 2008 to 2017. Purely spatial, purely temporal, and spatiotemporal analyses were performed using SaTScan software to define clustering of knowlesi malaria incidence. Purely spatial and spatiotemporal analyses indicated most likely clusters of knowlesi malaria in the northern region of Sarawak, along the Sarawak-Kalimantan border, and the inner central region of Sarawak between 2008 and 2017. Temporal cluster was detected between September 2016 and December 2017. This study provides evidence of the existence of statistically significant Plasmodium knowlesi malaria clusters in Sarawak, Malaysia. The analysis approach applied in this study showed potential in establishing surveillance and risk management system for knowlesi malaria control as Malaysia approaches human malaria elimination.
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Affiliation(s)
- Choo Huck Ooi
- Vector Borne Disease Section, Sarawak Health Department, Ministry of Health Malaysia, Kuching, Malaysia;,Address correspondence to Choo Huck Ooi, Vector Borne Disease Section, Sarawak Health Department, Ministry of Health Malaysia, Diplomatik Rd., Off Bako Rd., Kuching 93050, Malaysia, E-mail: or Yee Ling Lau, Department of Parasitology, Faculty of Medicine, University of Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 50603, Malaysia, E-mail:
| | - Wei Kit Phang
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jonathan Wee Kent Liew
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yee Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Address correspondence to Choo Huck Ooi, Vector Borne Disease Section, Sarawak Health Department, Ministry of Health Malaysia, Diplomatik Rd., Off Bako Rd., Kuching 93050, Malaysia, E-mail: or Yee Ling Lau, Department of Parasitology, Faculty of Medicine, University of Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 50603, Malaysia, E-mail:
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16
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A foci cohort analysis to monitor successful and persistent foci under Thailand's Malaria Elimination Strategy. Malar J 2021; 20:118. [PMID: 33639951 PMCID: PMC7910787 DOI: 10.1186/s12936-021-03648-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/04/2022] Open
Abstract
Background Thailand’s success in reducing malaria burden is built on the efficient “1-3-7” strategy applied to the surveillance system. The strategy is based on rapid case notification within 1 day, case investigation within 3 days, and targeted foci response to reduce the spread of Plasmodium spp. within 7 days. Autochthonous transmission is still occurring in the country, threatening the goal of reaching malaria-free status by 2024. This study aimed to assess the effectiveness of the 1-3-7 strategy and identify factors associated with presence of active foci. Methods Data from the national malaria information system were extracted from fiscal years 2013 to 2019; after data cleaning, the final dataset included 81,012 foci. A Cox’s proportional hazards model was built to investigate factors linked with the probability of becoming an active focus from 2015 to 2019 among foci that changed status from non-active to active focus during the study period. We performed a model selection technique based on the Akaike Information Criteria (AIC). Results The number of yearly active foci decreased from 2227 to 2013 to 700 in 2019 (68.5 %), and the number of autochthonous cases declined from 17,553 to 3,787 (78.4 %). The best Cox’s hazard model showed that foci in which vector control interventions were required were 18 % more likely to become an active focus. Increasing compliance with the 1-3-7 strategy had a protective effect, with a 22 % risk reduction among foci with over 80 % adherence to 1-3-7 timeliness protocols. Other factors associated with likelihood to become or remain an active focus include previous classification as an active focus, presence of Plasmodium falciparum infections, level of forest disturbance, and location in border provinces. Conclusions These results identified factors that favored regression of non-active foci to active foci during the study period. The model and relative risk map align with the national malaria program’s district stratification and shows strong spatial heterogeneity, with high probability to record active foci in border provinces. The results of the study may be useful for honing Thailand’s program to eliminate malaria and for other countries aiming to accelerate malaria elimination.
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Phang WK, Hamid MHA, Jelip J, Mudin RN, Chuang TW, Lau YL, Fong MY. Spatial and Temporal Analysis of Plasmodium knowlesi Infection in Peninsular Malaysia, 2011 to 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249271. [PMID: 33322414 PMCID: PMC7764745 DOI: 10.3390/ijerph17249271] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 12/12/2022]
Abstract
The life-threatening zoonotic malaria cases caused by Plasmodium knowlesi in Malaysia has recently been reported to be the highest among all malaria cases; however, previous studies have mainly focused on the transmission of P. knowlesi in Malaysian Borneo (East Malaysia). This study aimed to describe the transmission patterns of P. knowlesi infection in Peninsular Malaysia (West Malaysia). The spatial distribution of P. knowlesi was mapped across Peninsular Malaysia using Geographic Information System techniques. Local indicators of spatial associations were used to evaluate spatial patterns of P. knowlesi incidence. Seasonal autoregressive integrated moving average models were utilized to analyze the monthly incidence of knowlesi malaria in the hotspot region from 2012 to 2017 and to forecast subsequent incidence in 2018. Spatial analysis revealed that hotspots were clustered in the central-northern region of Peninsular Malaysia. Time series analysis revealed the strong seasonality of transmission from January to March. This study provides fundamental information on the spatial distribution and temporal dynamic of P. knowlesi in Peninsular Malaysia from 2011 to 2018. Current control policy should consider different strategies to prevent the transmission of both human and zoonotic malaria, particularly in the hotspot region, to ensure a successful elimination of malaria in the future.
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Affiliation(s)
- Wei Kit Phang
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (W.K.P.); (Y.L.L.); (M.Y.F.)
| | - Mohd Hafizi Abdul Hamid
- Disease Control Division, Ministry of Health Malaysia, Putrajaya 62000, Malaysia; (M.H.A.H.); (J.J.); (R.N.M.)
| | - Jenarun Jelip
- Disease Control Division, Ministry of Health Malaysia, Putrajaya 62000, Malaysia; (M.H.A.H.); (J.J.); (R.N.M.)
| | - Rose Nani Mudin
- Disease Control Division, Ministry of Health Malaysia, Putrajaya 62000, Malaysia; (M.H.A.H.); (J.J.); (R.N.M.)
| | - Ting-Wu Chuang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Correspondence: ; Tel.: +886-2-27361661
| | - Yee Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (W.K.P.); (Y.L.L.); (M.Y.F.)
| | - Mun Yik Fong
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (W.K.P.); (Y.L.L.); (M.Y.F.)
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Ashton RA, Prosnitz D, Andrada A, Herrera S, Yé Y. Evaluating malaria programmes in moderate- and low-transmission settings: practical ways to generate robust evidence. Malar J 2020; 19:75. [PMID: 32070357 PMCID: PMC7027277 DOI: 10.1186/s12936-020-03158-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/09/2020] [Indexed: 12/15/2022] Open
Abstract
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 dose-response 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 framework provides practical guidance in evaluation design, analysis, and interpretation to ensure that the evaluation meets national malaria programme priority questions and guides decision-making at national and sub-national levels.
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Affiliation(s)
- Ruth A Ashton
- MEASURE Evaluation, Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2300, New Orleans, LA, USA.
| | | | | | - Samantha Herrera
- MEASURE Evaluation, ICF, Rockville, MD, USA.,Save the Children, Washington, DC, USA
| | - Yazoumé Yé
- MEASURE Evaluation, ICF, Rockville, MD, USA
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