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Lee JS, Tyler ARB, Veinot TC, Yakel E. Now Is the Time to Strengthen Government-Academic Data Infrastructures to Jump-Start Future Public Health Crisis Response. JMIR Public Health Surveill 2024; 10:e51880. [PMID: 38656780 PMCID: PMC11079773 DOI: 10.2196/51880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/24/2024] [Accepted: 03/05/2024] [Indexed: 04/26/2024] Open
Abstract
During public health crises, the significance of rapid data sharing cannot be overstated. In attempts to accelerate COVID-19 pandemic responses, discussions within society and scholarly research have focused on data sharing among health care providers, across government departments at different levels, and on an international scale. A lesser-addressed yet equally important approach to sharing data during the COVID-19 pandemic and other crises involves cross-sector collaboration between government entities and academic researchers. Specifically, this refers to dedicated projects in which a government entity shares public health data with an academic research team for data analysis to receive data insights to inform policy. In this viewpoint, we identify and outline documented data sharing challenges in the context of COVID-19 and other public health crises, as well as broader crisis scenarios encompassing natural disasters and humanitarian emergencies. We then argue that government-academic data collaborations have the potential to alleviate these challenges, which should place them at the forefront of future research attention. In particular, for researchers, data collaborations with government entities should be considered part of the social infrastructure that bolsters their research efforts toward public health crisis response. Looking ahead, we propose a shift from ad hoc, intermittent collaborations to cultivating robust and enduring partnerships. Thus, we need to move beyond viewing government-academic data interactions as 1-time sharing events. Additionally, given the scarcity of scholarly exploration in this domain, we advocate for further investigation into the real-world practices and experiences related to sharing data from government sources with researchers during public health crises.
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Affiliation(s)
- Jian-Sin Lee
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | - Tiffany Christine Veinot
- School of Information, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Elizabeth Yakel
- School of Information, University of Michigan, Ann Arbor, MI, United States
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Pillay MT, Minakawa N, Kim Y, Kgalane N, Ratnam JV, Behera SK, Hashizume M, Sweijd N. Utilizing a novel high-resolution malaria dataset for climate-informed predictions with a deep learning transformer model. Sci Rep 2023; 13:23091. [PMID: 38155182 PMCID: PMC10754862 DOI: 10.1038/s41598-023-50176-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/15/2023] [Indexed: 12/30/2023] Open
Abstract
Climatic factors influence malaria transmission via the effect on the Anopheles vector and Plasmodium parasite. Modelling and understanding the complex effects that climate has on malaria incidence can enable important early warning capabilities. Deep learning applications across fields are proving valuable, however the field of epidemiological forecasting is still in its infancy with a lack of applied deep learning studies for malaria in southern Africa which leverage quality datasets. Using a novel high resolution malaria incidence dataset containing 23 years of daily data from 1998 to 2021, a statistical model and XGBOOST machine learning model were compared to a deep learning Transformer model by assessing the accuracy of their numerical predictions. A novel loss function, used to account for the variable nature of the data yielded performance around + 20% compared to the standard MSE loss. When numerical predictions were converted to alert thresholds to mimic use in a real-world setting, the Transformer's performance of 80% according to AUROC was 20-40% higher than the statistical and XGBOOST models and it had the highest overall accuracy of 98%. The Transformer performed consistently with increased accuracy as more climate variables were used, indicating further potential for this prediction framework to predict malaria incidence at a daily level using climate data for southern Africa.
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Affiliation(s)
- Micheal T Pillay
- Department of Vector Ecology and Environment, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4, Sakamoto, Nagasaki City, 852-8523, Japan.
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki City, Japan.
| | - Noboru Minakawa
- Department of Vector Ecology and Environment, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4, Sakamoto, Nagasaki City, 852-8523, Japan
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo: The University of Tokyo, 7-3-1 Hongo, Bunkyo Ward, Tokyo, 113-8654, Japan
| | - Nyakallo Kgalane
- Limpopo Department of Health, Malaria Control: 18 College Street, Polokwane, 0700, South Africa
| | - Jayanthi V Ratnam
- Application Laboratory, Japan Agency for Marine-Earth Science and Technology (JAMSTEC), 3173-25, Showa-Machi, Kanazawa-Ku, Yokohama-City, Kanagawa, 236-0001, Japan
| | - Swadhin K Behera
- Application Laboratory, Japan Agency for Marine-Earth Science and Technology (JAMSTEC), 3173-25, Showa-Machi, Kanazawa-Ku, Yokohama-City, Kanagawa, 236-0001, Japan
| | - Masahiro Hashizume
- Graduate School of Medicine Department of Global Health Policy, The University of Tokyo: The University of Tokyo, 7-3-1 Hongo, Bunkyo Ward, Tokyo, 113-8654, Japan
| | - Neville Sweijd
- Alliance for Collaboration on Climate & Earth Systems Science (ACCESS), CSIR, Lower Hope Road, Rosebank, 770, Cape Town, South Africa
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Evans MV, Ihantamalala FA, Randriamihaja M, Aina AT, Bonds MH, Finnegan KE, Rakotonanahary RJL, Raza-Fanomezanjanahary M, Razafinjato B, Raobela O, Raholiarimanana SH, Randrianavalona TH, Garchitorena A. Applying a zero-corrected, gravity model estimator reduces bias due to heterogeneity in healthcare utilization in community-scale, passive surveillance datasets of endemic diseases. Sci Rep 2023; 13:21288. [PMID: 38042891 PMCID: PMC10693580 DOI: 10.1038/s41598-023-48390-0] [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: 03/13/2023] [Accepted: 11/26/2023] [Indexed: 12/04/2023] Open
Abstract
Data on population health are vital to evidence-based decision making but are rarely adequately localized or updated in continuous time. They also suffer from low ascertainment rates, particularly in rural areas where barriers to healthcare can cause infrequent touch points with the health system. Here, we demonstrate a novel statistical method to estimate the incidence of endemic diseases at the community level from passive surveillance data collected at primary health centers. The zero-corrected, gravity-model (ZERO-G) estimator explicitly models sampling intensity as a function of health facility characteristics and statistically accounts for extremely low rates of ascertainment. The result is a standardized, real-time estimate of disease incidence at a spatial resolution nearly ten times finer than typically reported by facility-based passive surveillance systems. We assessed the robustness of this method by applying it to a case study of field-collected malaria incidence rates from a rural health district in southeastern Madagascar. The ZERO-G estimator decreased geographic and financial bias in the dataset by over 90% and doubled the agreement rate between spatial patterns in malaria incidence and incidence estimates derived from prevalence surveys. The ZERO-G estimator is a promising method for adjusting passive surveillance data of common, endemic diseases, increasing the availability of continuously updated, high quality surveillance datasets at the community scale.
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Affiliation(s)
- Michelle V Evans
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France.
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar.
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA.
| | - Felana A Ihantamalala
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA
| | - Mauricianot Randriamihaja
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar
| | | | - Matthew H Bonds
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA
| | - Karen E Finnegan
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA
| | - Rado J L Rakotonanahary
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA
| | | | | | - Oméga Raobela
- National Malaria Program, Ministry of Health, Antananarivo, Madagascar
| | | | | | - Andres Garchitorena
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
- NGO Pivot, Ranomafana, Ifanadiana, Madagascar
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4
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Kitawa YS, Asfaw ZG. Space-time modelling of monthly malaria incidence for seasonal associated drivers and early epidemic detection in Southern Ethiopia. Malar J 2023; 22:301. [PMID: 37814300 PMCID: PMC10563281 DOI: 10.1186/s12936-023-04742-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/04/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Although Ethiopia has made great strides in recent years to reduce the threat of malaria, the disease remains a significant issue in most districts of the country. It constantly disappears in parts of the areas before reappearing in others with erratic transmission rates. Thus, developing a malaria epidemic early warning system is important to support the prevention and control of the incidence. METHODS Space-time malaria risk mapping is essential to monitor and evaluate priority zones, refocus intervention, and enable planning for future health targets. From August 2013 to May 2019, the researcher considered an aggregated count of genus Plasmodium falciparum from 149 districts in Southern Ethiopia. Afterwards, a malaria epidemic early warning system was developed using model-based geostatistics, which helped to chart the disease's spread and future management. RESULTS Risk factors like precipitation, temperature, humidity, and nighttime light are significantly associated with malaria with different rates across the districts. Districts in the southwest, including Selamago, Bero, and Hamer, had higher rates of malaria risk, whereas in the south and centre like Arbaminch and Hawassa had moderate rates. The distribution is inconsistent and varies across time and space with the seasons. CONCLUSION Despite the importance of spatial correlation in disease risk mapping, it may occasionally be a good idea to generate epidemic early warning independently in each district to get a quick picture of disease risk. A system like this is essential for spotting numerous inconsistencies in lower administrative levels early enough to take corrective action before outbreaks arise.
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Affiliation(s)
- Yonas Shuke Kitawa
- Department of Statistics, College of Natural and Computational Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Zeytu Gashaw Asfaw
- Department of Bio-statistics and Epidemiology, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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5
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Dabaro D, Birhanu Z, Adissu W, Yilma D, Yewhalaw D. Prevalence and predictors of asymptomatic malaria infection in Boricha District, Sidama Region, Ethiopia: implications for elimination strategies. Malar J 2023; 22:284. [PMID: 37752572 PMCID: PMC10521520 DOI: 10.1186/s12936-023-04722-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Malaria remains a major public health threat in Ethiopia despite the tremendous progress made towards the 2030 elimination targets. The silent transmission of asymptomatic infection is one of the factors that enhance the persistence of the disease as a public health issue and impedes efforts to eliminate malaria. Thus, this study aimed at investigating the prevalence and risk factors of asymptomatic malaria infection in Boricha district, Sidama region of Ethiopia. METHODS A community-based cross-sectional study was conducted in eight selected kebeles (smallest administrative unit) in Boricha district. Representative households were chosen using a multi-stage sampling technique. A total of 573 participants were included in the study. Malaria diagnosis was performed using rapid diagnostic test (RDT) and microscopy. A structured questionnaire was administered to collect socio-demographic information. Epi data 3.1 was employed for data entry, and SPSS version 25 was used for analysis. RESULTS Of the 573 asymptomatic participants tested, 6.1% were found to be positive by RDT and 4.0% by microscopy. Participants aged under 5 years (AOR = 1.57, 95% CI 0.46-5.39) and 5-14 years old (AOR = 2.42, 95% CI 1.08-5.40), Insecticide-treated net utilization (AOR = 8.41; 95% CI 1.09-65.08), travel history (AOR = 6.85, 95% CI 2.32-20.26) and living in a house with windows (AOR = 2.11, 95% CI 1.02-4.36) were significantly associated with the asymptomatic malaria infection. CONCLUSION The findings of this study revealed that prevalence of asymptomatic malaria infection was higher in the study area. As a result, rigorous implementation of existing interventions, such as vector control and anti-malaria drugs, is strongly recommended. In addition, devising new ones that are suited to the contextual situations is highly suggested.
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Affiliation(s)
- Desalegn Dabaro
- Yirgalem Hospital Medical College, Yirgalem, Ethiopia.
- Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia.
| | - Zewdie Birhanu
- Department of Health Education and Behavioral Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Wondimagegn Adissu
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
- Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Daniel Yilma
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
- Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Delenasaw Yewhalaw
- Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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6
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Pujol A, Brokhattingen N, Matambisso G, Mbeve H, Cisteró P, Escoda A, Maculuve S, Cuna B, Melembe C, Ndimande N, Munguambe H, Montaña J, Nhamússua L, Simone W, Tetteh KKA, Drakeley C, Gamain B, Chitnis CE, Chauhan V, Quintó L, Chidimatembue A, Martí-Soler H, Galatas B, Guinovart C, Saúte F, Aide P, Macete E, Mayor A. Detecting temporal and spatial malaria patterns from first antenatal care visits. Nat Commun 2023; 14:4004. [PMID: 37414792 PMCID: PMC10326053 DOI: 10.1038/s41467-023-39662-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
Pregnant women attending first antenatal care (ANC) visits represent a promising malaria surveillance target in Sub-Saharan Africa. We assessed the spatio-temporal relationship between malaria trends at ANC (n = 6471) and in children in the community (n = 3933) and at health facilities (n = 15,467) in southern Mozambique (2016-2019). ANC P. falciparum rates detected by quantitative polymerase chain reaction mirrored rates in children, regardless of gravidity and HIV status (Pearson correlation coefficient [PCC] > 0.8, χ²<1.1), with a 2-3 months lag. Only at rapid diagnostic test detection limits at moderate-to-high transmission, did multigravidae show lower rates than children (PCC = 0.61, 95%CI[-0.12-0.94]). Seroprevalence against the pregnancy-specific antigen VAR2CSA reflected declining malaria trends (PCC = 0.74, 95%CI[0.24-0.77]). 60% (9/15) of hotspots detected from health facility data (n = 6662) using a novel hotspot detector, EpiFRIenDs, were also identified with ANC data (n = 3616). Taken together, we show that ANC-based malaria surveillance offers contemporary information on temporal trends and geographic distribution of malaria burden in the community.
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Affiliation(s)
- Arnau Pujol
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | | | - Glória Matambisso
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Henriques Mbeve
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pau Cisteró
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Anna Escoda
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sónia Maculuve
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Boaventura Cuna
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Cardoso Melembe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Nelo Ndimande
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Júlia Montaña
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Lídia Nhamússua
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Wilson Simone
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Kevin K A Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Benoit Gamain
- Université Paris Cité, INSERM, BIGR, F-75014, Paris, France
| | - Chetan E Chitnis
- Malaria Parasite Biology and Vaccines, Department of Parasites & Insect Vectors, Institut Pasteur, Paris, France
| | - Virander Chauhan
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | | | - Beatriz Galatas
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Eusébio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Department of Physiologic Sciences, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique.
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7
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Herawati MH, Besral, Lolong DB, Pracoyo NE, Sukoco NEW, Supratikta H, Veruswati M, Asyary A. Service availability and readiness of malaria surveillance information systems implementation at primary health centers in Indonesia. PLoS One 2023; 18:e0284162. [PMID: 37104477 PMCID: PMC10138467 DOI: 10.1371/journal.pone.0284162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/24/2023] [Indexed: 04/28/2023] Open
Abstract
One of the most important indicators in malaria eradication is the malaria surveillance information system (SISMAL) for recording and reporting medical cases. This paper aims to describe the availability and readiness of SISMALs at primary health centers (PHCs) in Indonesia. A cross-sectional survey was implemented in seven provinces for this study. The data was analyzed using bivariate, multivariate, and linear regression. The availability of the information system was measured by assessing the presence of the electronic malaria surveillance information system (E-SISMAL) at the studied PHCs. The readiness was measured by averaging each component of the assessment. From 400 PHC samples, only 58.5% had available SISMALs, and their level of readiness was only 50.2%. Three components had very low levels of readiness: (1) the availability of personnel (40.9%), (2) SISMAL integration and storage (50.2%), and (3) the availability of data sources and indicators (56.8%). Remote and border (DTPK) areas had a 4% better readiness score than non-DTPK areas. Endemic areas were 1.4% better than elimination areas, while regions with low financial capacity were 3.78% better than regions with high financial capacity, with moderate capacity (2.91%). The availability rate of the SISMAL at PHCs is only 58.5%. Many PHCs still do not have SISMALs. The readiness of the SISMAL at these PHCs is significantly related to DTPK/remote area, high endemicity status, and low financial capacity. This study found that the implementation of SISMAL is more accessible to malaria surveillance for the remote area and regions with low financial capacity. Therefore, this effort will well-fit to address barrier to malaria surveillance in developing countries.
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Affiliation(s)
| | - Besral
- Department of Biostatistics and Population Studies, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | | | | | | | - Hadi Supratikta
- National Research and Innovation Agency, Jakarta, Indonesia
- Study Program of Management Studies, Postgraduate School, Universitas Pamulang, South Tangerang, Banten, Indonesia
| | - Meita Veruswati
- Study Program of Public Health, Faculty of Health Sciences, Universitas Muhammadiyah Prof. Dr. HAMKA, Jakarta, Indonesia
- PhD in Business and Management, Postgraduate School, Management and Science University, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Al Asyary
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
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8
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Aidoo EK, Aboagye FT, Botchway FA, Osei-Adjei G, Appiah M, Duku-Takyi R, Sakyi SA, Amoah L, Badu K, Asmah RH, Lawson BW, Krogfelt KA. Reactive Case Detection Strategy for Malaria Control and Elimination: A 12 Year Systematic Review and Meta-Analysis from 25 Malaria-Endemic Countries. Trop Med Infect Dis 2023; 8:tropicalmed8030180. [PMID: 36977181 PMCID: PMC10058581 DOI: 10.3390/tropicalmed8030180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
Reactive case detection (RACD) is the screening of household members and neighbors of index cases reported in passive surveillance. This strategy seeks asymptomatic infections and provides treatment to break transmission without testing or treating the entire population. This review discusses and highlights RACD as a recommended strategy for the detection and elimination of asymptomatic malaria as it pertains in different countries. Relevant studies published between January 2010 and September 2022 were identified mainly through PubMed and Google Scholar. Search terms included "malaria and reactive case detection", "contact tracing", "focal screening", "case investigation", "focal screen and treat". MedCalc Software was used for data analysis, and the findings from the pooled studies were analyzed using a fixed-effect model. Summary outcomes were then presented using forest plots and tables. Fifty-four (54) studies were systematically reviewed. Of these studies, 7 met the eligibility criteria based on risk of malaria infection in individuals living with an index case < 5 years old, 13 met the eligibility criteria based on risk of malaria infection in an index case household member compared with a neighbor of an index case, and 29 met the eligibility criteria based on risk of malaria infection in individuals living with index cases, and were included in the meta-analysis. Individuals living in index case households with an average risk of 2.576 (2.540-2.612) were more at risk of malaria infection and showed pooled results of high variation heterogeneity chi-square = 235.600, (p < 0.0001) I2 = 98.88 [97.87-99.89]. The pooled results showed that neighbors of index cases were 0.352 [0.301-0.412] times more likely to have a malaria infection relative to index case household members, and this result was statistically significant (p < 0.001). The identification and treatment of infectious reservoirs is critical to successful malaria elimination. Evidence to support the clustering of infections in neighborhoods, which necessitates the inclusion of neighboring households as part of the RACD strategy, was presented in this review.
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Affiliation(s)
- Ebenezer Krampah Aidoo
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Frank Twum Aboagye
- Biomedical and Public Health Research Unit, Council for Scientific and Industrial Research-Water Research Institute, Accra AH 38, Ghana
| | - Felix Abekah Botchway
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - George Osei-Adjei
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Michael Appiah
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Ruth Duku-Takyi
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, Kwame Nkrumah University of Science & Technology, University Post Office, Kumasi AK 039, Ghana
| | - Linda Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra LG 581, Ghana
| | - Kingsley Badu
- Department of Theoretical & Applied Biology, Kwame Nkrumah University of Science & Technology, University Post Office, Kumasi AK 039, Ghana
| | - Richard Harry Asmah
- Department of Biomedical Sciences, School of Basic and Biomedical Science, University of Health & Allied Sciences, Ho PMB 31, Ghana
| | - Bernard Walter Lawson
- Department of Theoretical & Applied Biology, Kwame Nkrumah University of Science & Technology, University Post Office, Kumasi AK 039, Ghana
| | - Karen Angeliki Krogfelt
- Department of Science and Environment, Unit of Molecular and Medical Biology, The PandemiX Center, Roskilde University, 4000 Roskilde, Denmark
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, 2300 Copenhagen, Denmark
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9
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Pujol A, Brokhattingen N, Matambisso G, Mbeve H, Cisteró P, Escoda A, Maculuve S, Cuna B, Melembe C, Ndimande N, Munguambe H, Lopez JM, Nhamussa L, Simone W, Tetteh K, Drakeley C, Gamain B, Chitnis C, Chauhan VS, Quintó L, Chidimatembue A, Soler HM, Galatas B, Guinovart C, Saute F, Aide P, Macete E, Mayor A. Detecting temporal and spatial malaria patterns from first antenatal care visits. RESEARCH SQUARE 2023:rs.3.rs-2592126. [PMID: 36865132 PMCID: PMC9980210 DOI: 10.21203/rs.3.rs-2592126/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Pregnant women attending first antenatal care (ANC) visits represent a promising malaria surveillance target in Sub-Saharan Africa. Here we assessed the spatio-temporal relationship between malaria at ANC (n=6,471), in children at the community(n=9,362) and at health facilities (n=15,467) in southern Mozambique (2016-2019). ANC P. falciparum rates detected by quantitative polymerase chain reaction mirrored rates in children, regardless of gravidity and HIV status (Pearson correlation coefficient [PCC]>0.8, χ²<1.1), with a 2-3 months lag. Only at rapid diagnostic test detection limits at moderate-to-high transmission, multigravidae showed lower rates than children (PCC=0.61, 95%CI[-0.12-0.94]). Seroprevalence against the pregnancy-specific antigen VAR2CSA reflected declining malaria trends (PCC=0.74, 95%CI[0.24-0.77]). 80% (12/15) of hotspots detected from health facility data using a novel hotspot detector, EpiFRIenDs, were also identified with ANC data. The results show that ANC-based malaria surveillance offers contemporary information on temporal trends and the geographic distribution of malaria burden in the community.
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Affiliation(s)
- Arnau Pujol
- ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona / Centro de Investigação em Saúde da Manhiça
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, United Kingdom
| | | | | | | | | | | | | | - Beatriz Galatas
- ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona / Centro de Investigação em Saúde da Manhiça
| | | | | | | | | | - Alfredo Mayor
- ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona / Centro de Investigação em Saúde da Manhiça
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10
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Stresman G, Stratil AS, Gomane S, Armando S, Rodrigues M, Candrinho B, Roca-Feltrer A. Optimizing Routine Malaria Surveillance Data in Urban Environments: A Case Study in Maputo City, Mozambique. Am J Trop Med Hyg 2023; 108:24-31. [PMID: 36191871 PMCID: PMC9904158 DOI: 10.4269/ajtmh.22-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023] Open
Abstract
In urban settings in malaria-endemic countries, malaria incidence is not well characterized and assumed to be typically very low and consisting largely of imported infections. In such contexts, surveillance systems should adapt to ensure that data are of sufficient spatial and temporal resolution to inform appropriate programmatic interventions. The aim of this research was to 1) assess spatial and temporal trends in reported malaria cases in Maputo City, Mozambique, using an expanded case notification form and 2) to determine how malaria surveillance can be optimized to characterize the local epidemiological context, which can then be used to inform targeted entomological investigations and guide implementation of localized malaria responses. This study took place in all six health facilities of KaMavota District in Maputo City, Mozambique. A questionnaire was administered to all confirmed cases from November 2019 to August 2021. Households of cases were retrospectively geolocated using local landmarks as reference. Overall, 2,380 malaria cases were reported, with the majority being uncomplicated (97.7%) and a median age of 21 years; 70.8% of cases had reported traveling outside the city in the past month with nine reporting traveling internationally. Maps of the 1,314 malaria cases that were geolocated showed distinct spatial patterns. The expanded case notification form enables a more granular overview of the malaria epidemiology in Maputo City; the geolocation data clearly show the areas where endemic transmission is likely, thus informing where resources should be prioritized. As urbanization is rapidly increasing in malaria endemic areas, identifying systems and key variables to collect ensures an operational way to characterize urban malaria through optimization of routine data to inform decision-making.
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Affiliation(s)
- Gillian Stresman
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London United Kingdom
| | | | | | | | | | | | - Arantxa Roca-Feltrer
- Malaria Consortium, London, United Kingdom;,Address correspondence to Arantxa Roca-Feltrer, Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA 98121. E-mail:
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11
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Potter R, Tesfazghi K, Poyer S, Eliades MJ. Private Sector Contributions to National Malaria Surveillance Systems in Elimination Settings: Lessons Learned from Cambodia, Lao PDR, Myanmar, and Vietnam. Am J Trop Med Hyg 2023; 108:14-23. [PMID: 35914687 PMCID: PMC9904159 DOI: 10.4269/ajtmh.22-0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
Comprehensive malaria case surveillance is necessary to achieve and sustain malaria elimination. In the Greater Mekong Subregion (GMS), the private sector plays a substantial role in malaria treatment. Yet, none of the six GMS countries collects complete case data from private sector points-of-care. Between 2016 and 2019, the GMS Elimination of Malaria through Surveillance program supported national malaria programs in Cambodia, Lao PDR, Myanmar, and Vietnam to execute elimination strategies by engaging the private sector in malaria case management, generating private sector case data, and integrating these data into national surveillance systems. The project enrolled 21,903 private sector outlets, covering between 52% and 80% of the private sector in targeted geographies, which were trained and equipped to perform rapid diagnostic tests (RDTs) and report malaria case data. By 2019, the private providers enrolled in the program reported a total of 3,521,586 suspected cases and 96,400 confirmed malaria cases into national surveillance systems, representing 16% of the total reported caseload by these countries (Cambodia, 25%; Lao PDR, 5%; Myanmar, 12%; Vietnam, 8%). Results demonstrated that with comprehensive support, such as training, provision of free or subsidized RDTs, first-line treatments, and routine supportive supervision, private providers can provide quality malaria case management and achieve high reporting rates.
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Affiliation(s)
| | - Kemi Tesfazghi
- Population Services International, Vientiane, Laos;,Address correspondence to Kemi Tesfazghi, 1120 19th St. NW #600, Washington, DC 20036. E-mail:
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12
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Butzin-Dozier Z, Athni TS, Benjamin-Chung J. A Review of the Ring Trial Design for Evaluating Ring Interventions for Infectious Diseases. Epidemiol Rev 2022; 44:29-54. [PMID: 35593400 PMCID: PMC10362935 DOI: 10.1093/epirev/mxac003] [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: 05/30/2021] [Revised: 03/25/2022] [Accepted: 05/12/2022] [Indexed: 12/29/2022] Open
Abstract
In trials of infectious disease interventions, rare outcomes and unpredictable spatiotemporal variation can introduce bias, reduce statistical power, and prevent conclusive inferences. Spillover effects can complicate inference if individual randomization is used to gain efficiency. Ring trials are a type of cluster-randomized trial that may increase efficiency and minimize bias, particularly in emergency and elimination settings with strong clustering of infection. They can be used to evaluate ring interventions, which are delivered to individuals in proximity to or contact with index cases. We conducted a systematic review of ring trials, compare them with other trial designs for evaluating ring interventions, and describe strengths and weaknesses of each design. Of 849 articles and 322 protocols screened, we identified 26 ring trials, 15 cluster-randomized trials, 5 trials that randomized households or individuals within rings, and 1 individually randomized trial. The most common interventions were postexposure prophylaxis (n = 23) and focal mass drug administration and screening and treatment (n = 7). Ring trials require robust surveillance systems and contact tracing for directly transmitted diseases. For rare diseases with strong spatiotemporal clustering, they may have higher efficiency and internal validity than cluster-randomized designs, in part because they ensure that no clusters are excluded from analysis due to zero cluster incidence. Though more research is needed to compare them with other types of trials, ring trials hold promise as a design that can increase trial speed and efficiency while reducing bias.
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13
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Dlamini SN, Fall IS, Mabaso SD. Bayesian Geostatistical Modeling to Assess Malaria Seasonality and Monthly Incidence Risk in Eswatini. J Epidemiol Glob Health 2022; 12:340-361. [PMID: 35976542 PMCID: PMC9382628 DOI: 10.1007/s44197-022-00054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022] Open
Abstract
Eswatini is on the brink of malaria elimination and had however, had to shift its target year to eliminate malaria on several occasions since 2015 as the country struggled to achieve its zero malaria goal. We conducted a Bayesian geostatistical modeling study using malaria case data. A Bayesian distributed lags model (DLM) was implemented to assess the effects of seasonality on cases. A second Bayesian model based on polynomial distributed lags was implemented on the dataset to improve understanding of the lag effect of environmental factors on cases. Results showed that malaria increased during the dry season with proportion 0.051 compared to the rainy season with proportion 0.047 while rainfall of the preceding month (Lag2) had negative effect on malaria as it decreased by proportion − 0.25 (BCI: − 0.46, − 0.05). Night temperatures of the preceding first and second month were significantly associated with increased malaria in the following proportions: at Lag1 0.53 (BCI: 0.23, 0.84) and at Lag2 0.26 (BCI: 0.01, 0.51). Seasonality was an important predictor of malaria with proportion 0.72 (BCI: 0.40, 0.98). High malaria rates were identified for the months of July to October, moderate rates in the months of November to February and low rates in the months of March to June. The maps produced support-targeted malaria control interventions. The Bayesian geostatistical models could be extended for short-term and long-term forecasting of malaria supporting-targeted response both in space and time for effective elimination.
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Affiliation(s)
- Sabelo Nick Dlamini
- Department of Geography, University of Eswatini, Kwaluseni, Manzini, M200, Eswatini. .,World Health Organization, 27 Geneva, Geneva, Switzerland.
| | | | - Sizwe Doctor Mabaso
- Department of Geography, University of Eswatini, Kwaluseni, Manzini, M200, Eswatini
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14
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García GA, Atkinson B, Donfack OT, Hilton ER, Smith JM, Eyono JNM, Iyanga MM, Vaz LM, Mba Nguema Avue R, Pollock J, Ratsirarson J, Aldrich EM, Phiri WP, Smith DL, Schwabe C, Guerra CA. Real-time, spatial decision support to optimize malaria vector control: The case of indoor residual spraying on Bioko Island, Equatorial Guinea. PLOS DIGITAL HEALTH 2022; 1:e0000025. [PMID: 36812503 PMCID: PMC9931250 DOI: 10.1371/journal.pdig.0000025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/15/2022] [Indexed: 06/18/2023]
Abstract
Public health interventions require evidence-based decision-making to maximize impact. Spatial decision support systems (SDSS) are designed to collect, store, process and analyze data to generate knowledge and inform decisions. This paper discusses how the use of a SDSS, the Campaign Information Management System (CIMS), to support malaria control operations on Bioko Island has impacted key process indicators of indoor residual spraying (IRS): coverage, operational efficiency and productivity. We used data from the last five annual IRS rounds (2017 to 2021) to estimate these indicators. IRS coverage was calculated as the percentage of houses sprayed per unit area, represented by 100x100 m map-sectors. Optimal coverage was defined as between 80% and 85%, and under and overspraying as coverage below 80% and above 85%, respectively. Operational efficiency was defined as the fraction of map-sectors that achieved optimal coverage. Daily productivity was expressed as the number of houses sprayed per sprayer per day (h/s/d). These indicators were compared across the five rounds. Overall IRS coverage (i.e. percent of total houses sprayed against the overall denominator by round) was highest in 2017 (80.2%), yet this round showed the largest proportion of oversprayed map-sectors (36.0%). Conversely, despite producing a lower overall coverage (77.5%), the 2021 round showed the highest operational efficiency (37.7%) and the lowest proportion of oversprayed map-sectors (18.7%). In 2021, higher operational efficiency was also accompanied by marginally higher productivity. Productivity ranged from 3.3 h/s/d in 2020 to 3.9 h/s/d in 2021 (median 3.6 h/s/d). Our findings showed that the novel approach to data collection and processing proposed by the CIMS has significantly improved the operational efficiency of IRS on Bioko. High spatial granularity during planning and deployment together with closer follow-up of field teams using real-time data supported more homogeneous delivery of optimal coverage while sustaining high productivity.
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Affiliation(s)
- Guillermo A. García
- Medical Care Development International, Silver Spring, MD, United States of America
| | - Brent Atkinson
- Medical Care Development International, Silver Spring, MD, United States of America
| | | | - Emily R. Hilton
- Institute for Health Metrics and Evaluation, Univeristy of Washington, Seattle, WA, United States of America
| | - Jordan M. Smith
- Medical Care Development International, Malabo, Equatorial Guinea
| | | | | | | | | | - John Pollock
- Medical Care Development, Augusta, ME, United States of America
| | - Josea Ratsirarson
- Medical Care Development International, Silver Spring, MD, United States of America
| | | | - Wonder P. Phiri
- Medical Care Development International, Malabo, Equatorial Guinea
| | - David L. Smith
- Institute for Health Metrics and Evaluation, Univeristy of Washington, Seattle, WA, United States of America
| | | | - Carlos A. Guerra
- Medical Care Development International, Silver Spring, MD, United States of America
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15
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Oyegoke OO, Maharaj L, Akoniyon OP, Kwoji I, Roux AT, Adewumi TS, Maharaj R, Oyebola BT, Adeleke MA, Okpeku M. Malaria diagnostic methods with the elimination goal in view. Parasitol Res 2022; 121:1867-1885. [PMID: 35460369 PMCID: PMC9033523 DOI: 10.1007/s00436-022-07512-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/01/2022] [Indexed: 01/08/2023]
Abstract
Malaria control measures have been in use for years but have not completely curbed the spread of infection. Ultimately, global elimination is the goal. A major playmaker in the various approaches to reaching the goal is the issue of proper diagnosis. Various diagnostic techniques were adopted in different regions and geographical locations over the decades, and these have invariably produced diverse outcomes. In this review, we looked at the various approaches used in malaria diagnostics with a focus on methods favorably used during pre-elimination and elimination phases as well as in endemic regions. Microscopy, rapid diagnostic testing (RDT), loop-mediated isothermal amplification (LAMP), and polymerase chain reaction (PCR) are common methods applied depending on prevailing factors, each with its strengths and limitations. As the drive toward the elimination goal intensifies, the search for ideal, simple, fast, and reliable point-of-care diagnostic tools is needed more than ever before to be used in conjunction with a functional surveillance system supported by the ideal vaccine.
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Affiliation(s)
- Olukunle O Oyegoke
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Leah Maharaj
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Oluwasegun P Akoniyon
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Illiya Kwoji
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Alexandra T Roux
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Taiye S Adewumi
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Rajendra Maharaj
- Office of Malaria Research, Medical Research Council, Durban, South Africa
| | | | - Matthew A Adeleke
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Moses Okpeku
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa.
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16
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Moukénet A, de Cola MA, Ward C, Beakgoubé H, Baker K, Donovan L, Laoukolé J, Richardson S. Health management information system (HMIS) data quality and associated factors in Massaguet district, Chad. BMC Med Inform Decis Mak 2021; 21:326. [PMID: 34809622 PMCID: PMC8609810 DOI: 10.1186/s12911-021-01684-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022] Open
Abstract
Background Quality data from Health Management Information Systems (HMIS) are important for tracking the effectiveness of malaria control interventions. However, HMIS data in many resource-limited settings do not currently meet standards set by the World Health Organization (WHO). We aimed to assess HMIS data quality and associated factors in Chad. Methods A cross-sectional study was conducted in 14 health facilities in Massaguet district. Data on children under 15 years were obtained from the HMIS and from the external patient register covering the period January–December 2018. An additional questionnaire was administered to 16 health centre managers to collect data on contextual variables. Patient registry data were aggregated and compared with the HMIS database at district and health centre level. Completeness and accuracy indicators were calculated as per WHO guidelines. Multivariate logistic regressions were performed on the Verification Factor for attendance, suspected and confirmed malaria cases for three age groups (1 to < 12 months, 1 to < 5 years and 5 to < 15 years) to identify associations between health centre characteristics and data accuracy. Results Health centres achieved a high level of data completeness in HMIS. Malaria data were over-reported in HMIS for children aged under 15 years. There was an association between workload and higher odds of inaccuracy in reporting of attendance among children aged 1 to < 5 years (Odds ratio [OR]: 10.57, 95% CI 2.32–48.19) and 5– < 15 years (OR: 6.64, 95% CI 1.38–32.04). Similar association was found between workload and stock-outs in register books, and inaccuracy in reporting of malaria confirmed cases. Meanwhile, we found that presence of a health technician, and of dedicated staff for data management, were associated with lower inaccuracy in reporting of clinic attendance in children aged under five years. Conclusion Data completeness was high while the accuracy was low. Factors associated with data inaccuracy included high workload and the unavailability of required data collection tools. The results suggest that improvement in working conditions for clinic personnel may improve HMIS data quality. Upgrading from paper-based forms to a web-based HMIS may provide a solution for improving data accuracy and its utility for future evaluations of health interventions. Results from this study can inform the Ministry of Health and it partners on the precautions to be taken in the use of HMIS data and inform initiatives for improving its quality. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01684-7.
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Affiliation(s)
- Azoukalné Moukénet
- Malaria Consortium Chad Country Office, Angle Bureau de L'Entente Des Eglises (EEMET), Rue 2175, Porte 0150, B.P. 6180, N'Djamena, Chad
| | - Monica Anna de Cola
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | - Charlotte Ward
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Honoré Beakgoubé
- Malaria Consortium Chad Country Office, Angle Bureau de L'Entente Des Eglises (EEMET), Rue 2175, Porte 0150, B.P. 6180, N'Djamena, Chad
| | - Kevin Baker
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | - Laura Donovan
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | | | - Sol Richardson
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK.
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17
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de Morais CM, de Carvalho Monteiro KH, Brito-Sousa JD, Monteiro WM, Sampaio VS, Endo PT, Kelner J. Malaria Trigram: improving the visualization of recurrence data for malaria elimination. Malar J 2021; 20:431. [PMID: 34717641 PMCID: PMC8557107 DOI: 10.1186/s12936-021-03964-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although considerable success in reducing the incidence of malaria has been achieved in Brazil in recent years, an increase in the proportion of cases caused by the harder-to-eliminate Plasmodium vivax parasite can be noted. Recurrences in P. vivax malaria cases are due to new mosquito-bite infections, drug resistance or especially from relapses arising from hypnozoites. As such, new innovative surveillance strategies are needed. The aim of this study was to develop an infographic visualization tool to improve individual-level malaria surveillance focused on malaria elimination in the Brazilian Amazon. METHODS Action Research methodology was employed to deal with the complex malaria surveillance problem in the Amazon region. Iterative cycles were used, totalling four cycles with a formal validation of an operational version of the Malaria Trigram tool at the end of the process. Further probabilistic data linkage was carried out so that information on the same patients could be linked, allowing for follow-up analysis since the official system was not planned in such way that includes this purpose. RESULTS An infographic user interface was developed for the Malaria Trigram that incorporates all the visual and descriptive power of the Trigram concept. It is a multidimensional and interactive historical representation of malaria cases per patient over time and provides visual input to decision-makers on recurrences of malaria. CONCLUSIONS The Malaria Trigram is aimed to help public health professionals and policy makers to recognise and analyse different types of patterns in malaria events, including recurrences and reinfections, based on the current Brazilian health surveillance system, the SIVEP-Malária system, with no additional primary data collection or change in the current process. By using the Malaria Trigram, it is possible to plan and coordinate interventions for malaria elimination that are integrated with other parallel actions in the Brazilian Amazon region, such as vector control management, effective drug and vaccine deployment strategies.
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Affiliation(s)
- Cleber Matos de Morais
- Centro de Informática, Universidade Federal de Pernambuco, Recife, Brazil.
- Departamento de Mídias Digitais, Universidade Federal da Paraíba, João Pessoa, Brazil.
| | | | | | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Vanderson Souza Sampaio
- Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Patricia Takako Endo
- Programa de Pós-Graduação em Engenharia da Computação, Universidade de Pernambuco, Recife, Brazil.
| | - Judith Kelner
- Centro de Informática, Universidade Federal de Pernambuco, Recife, Brazil
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18
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Kostkova P, Saigí-Rubió F, Eguia H, Borbolla D, Verschuuren M, Hamilton C, Azzopardi-Muscat N, Novillo-Ortiz D. Data and Digital Solutions to Support Surveillance Strategies in the Context of the COVID-19 Pandemic. Front Digit Health 2021; 3:707902. [PMID: 34713179 PMCID: PMC8522016 DOI: 10.3389/fdgth.2021.707902] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/30/2021] [Indexed: 12/23/2022] Open
Abstract
Background: In order to prevent spread and improve control of infectious diseases, public health experts need to closely monitor human and animal populations. Infectious disease surveillance is an established, routine data collection process essential for early warning, rapid response, and disease control. The quantity of data potentially useful for early warning and surveillance has increased exponentially due to social media and other big data streams. Digital epidemiology is a novel discipline that includes harvesting, analysing, and interpreting data that were not initially collected for healthcare needs to enhance traditional surveillance. During the current COVID-19 pandemic, the importance of digital epidemiology complementing traditional public health approaches has been highlighted. Objective: The aim of this paper is to provide a comprehensive overview for the application of data and digital solutions to support surveillance strategies and draw implications for surveillance in the context of the COVID-19 pandemic and beyond. Methods: A search was conducted in PubMed databases. Articles published between January 2005 and May 2020 on the use of digital solutions to support surveillance strategies in pandemic settings and health emergencies were evaluated. Results: In this paper, we provide a comprehensive overview of digital epidemiology, available data sources, and components of 21st-century digital surveillance, early warning and response, outbreak management and control, and digital interventions. Conclusions: Our main purpose was to highlight the plausible use of new surveillance strategies, with implications for the COVID-19 pandemic strategies and then to identify opportunities and challenges for the successful development and implementation of digital solutions during non-emergency times of routine surveillance, with readiness for early-warning and response for future pandemics. The enhancement of traditional surveillance systems with novel digital surveillance methods opens a direction for the most effective framework for preparedness and response to future pandemics.
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Affiliation(s)
- Patty Kostkova
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Interdisciplinary Research Group on ICTs, Barcelona, Spain
| | - Hans Eguia
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,SEMERGEN New Technologies Working Group, Madrid, Spain
| | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Marieke Verschuuren
- Division of Country Health Policies and Systems, Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Clayton Hamilton
- Division of Country Health Policies and Systems, Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems, Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, Regional Office for Europe, World Health Organization, Copenhagen, Denmark
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19
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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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20
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Rahi M, Sharma A. For malaria elimination India needs a platform for data integration. BMJ Glob Health 2021; 5:bmjgh-2020-004198. [PMID: 33380414 PMCID: PMC7780526 DOI: 10.1136/bmjgh-2020-004198] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- National Institute of Malaria Research, New Delhi, India .,International Centre For Genetic Engineering and Biotechnology, New Delhi, India
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21
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Lucas TCD, Nandi AK, Chestnutt EG, Twohig KA, Keddie SH, Collins EL, Howes RE, Nguyen M, Rumisha SF, Python A, Arambepola R, Bertozzi‐Villa A, Hancock P, Amratia P, Battle KE, Cameron E, Gething PW, Weiss DJ. Mapping malaria by sharing spatial information between incidence and prevalence data sets. J R Stat Soc Ser C Appl Stat 2021. [DOI: 10.1111/rssc.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Andre Python
- Big Data Institute University of Oxford Oxford UK
| | | | - Amelia Bertozzi‐Villa
- Big Data Institute University of Oxford Oxford UK
- Institute for Disease Modeling Bellevue Washington USA
| | | | | | | | - Ewan Cameron
- Big Data Institute University of Oxford Oxford UK
| | - Peter W. Gething
- Big Data Institute University of Oxford Oxford UK
- Telethon Kids Institute Perth Children's Hospital Perth Australia
- Curtin University Perth Australia
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22
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Tizifa TA, Nkhono W, Mtengula S, van Vugt M, Munn Z, Kabaghe AN. Leveraging phone-based mobile technology to improve data quality at health facilities in rural Malawi: a best practice project. Malar J 2021; 20:203. [PMID: 33906650 PMCID: PMC8077781 DOI: 10.1186/s12936-021-03742-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To further reduce malaria burden, identification of areas with highest burden for targeted interventions needs to occur. Routine health information has the potential to indicate where and when clinical malaria occurs the most. Developing countries mostly use paper-based data systems however they are error-prone as they require manual aggregation, tallying and transferring of data. Piloting was done using electronic data capture (EDC) with a cheap and user friendly software in rural Malawian primary healthcare setting to improve the quality of health records. METHODS Audit and feedback tools from the Joanna Briggs Institute (Practical Application of Clinical Evidence System and Getting Research into Practice) were used in four primary healthcare facilities. Using this approach, the best available evidence for a malaria information system (MIS) was identified. Baseline audit of the existing MIS was conducted in the facilities based on available best practice for MIS; this included ensuring data consistency and completeness in MIS by sampling 25 random records of malaria positive cases. Implementation of an adapted evidence-based EDC system using tablets on an OpenDataKit platform was done. An end line audit following implementation was then conducted. Users had interviews on experiences and challenges concerning EDC at the beginning and end of the survey. RESULTS The existing MIS was paper-based, occupied huge storage space, had some data losses due to torn out papers and were illegible in some facilities. The existing MIS did not have documentation of necessary parameters, such as malaria deaths and treatment within 14 days. Training manuals and modules were absent. One health centre solely had data completeness and consistency at 100% of the malaria-positive sampled records. Data completeness and consistency rose to 100% with readily available records containing information on recent malaria treatment. Interview findings at the end of the survey showed that EDC was acceptable among users and they agreed that the tablets and the OpenDataKit were easy to use, improved productivity and quality of care. CONCLUSIONS Improvement of data quality and use in the Malawian rural facilities was achieved through the introduction of EDC using OpenDataKit. Health workers in the facilities showed satisfaction with the use of EDC.
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Affiliation(s)
- Tinashe A. Tizifa
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Training and Research Unit of Excellence (TRUE), School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - William Nkhono
- Training and Research Unit of Excellence (TRUE), School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Spencer Mtengula
- Training and Research Unit of Excellence (TRUE), School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Michele van Vugt
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Zachary Munn
- JBI, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Alinune N. Kabaghe
- Training and Research Unit of Excellence (TRUE), School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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Digitized smart surveillance and micromanagement using information technology for malaria elimination in Mangaluru, India: an analysis of five-year post-digitization data. Malar J 2021; 20:139. [PMID: 33685454 PMCID: PMC7938374 DOI: 10.1186/s12936-021-03656-8] [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: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Malaria control system (MCS), an Information technology (IT)-driven surveillance and monitoring intervention is being adopted for elimination of malaria in Mangaluru city, Karnataka, India since October 2015. This has facilitated ‘smart surveillance’ followed by required field response within a timeline. The system facilitated data collection of individual case, data driven mapping and strategies for malaria elimination programme. This paper aims to present the analysis of post-digitization data of 5 years, discuss the current operational functionalities of MCS and its impact on the malaria incidence. Methods IT system developed for robust malaria surveillance and field response is being continued in the sixth year. Protocol for surveillance control was followed as per the national programme guidelines mentioned in an earlier publication. Secondary data from the malaria control system was collated and analysed. Incidence of malaria, active surveillance, malariogenic conditions and its management, malariometric indices, shrinking malaria maps were also analysed. Results Smart surveillance and subsequent response for control was sustained and performance improved in five years with participation of all stakeholders. Overall malaria incidence significantly reduced by 83% at the end of 5 years when compared with year of digitization (DY) (p < 0.001). Early reporting of new cases (within 48 h) was near total followed by complete treatment and vector control. Slide positivity rate (SPR) decreased from 10.36 (DY) to 6.5 (PDY 5). Annual parasite incidence (API) decreased from 16.17 (DY) to 2.64 (PDY 5). There was a negative correlation between contact smears and incidence of malaria. Five-year data analyses indicated declining trends in overall malaria incidence and correlation between closures by 14 days. The best impact on reduction in incidence of malaria was recorded in the pre-monsoon months (~ 85%) compared to lower impact in July–August months (~ 40%). Conclusion MCS helped to micromanage control activities, such as robust reporting, incidence-centric active surveillance, early and complete treatment, documentation of full treatment of each malaria patient, targeted mosquito control measures in houses surrounding reported cases. The learnings and analytical output from the data helped to modify strategies for control of both disease and the vector, heralding the city into the elimination stage.
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Abstract
BACKGROUND Cross-border malaria is a major barrier to elimination efforts. Along the Venezuela-Brazil-Guyana border, intense human mobility fueled primarily by a humanitarian crisis and illegal gold mining activities has increased the occurrence of cross-border cases in Brazil. Roraima, a Brazilian state situated between Venezuela and Guyana, bears the greatest burden. This study analyses the current cross-border malaria epidemiology in Northern Brazil between the years 2007 and 2018. METHODS De-identified data on reported malaria cases in Brazil were obtained from the Malaria Epidemiological Surveillance Information System for the years 2007 to 2018. Pearson's Chi-Square test of differences was utilized to assess differences between characteristics of cross-border cases originating from Venezuela and Guyana, and between border and transnational cases. A logistic regression model was used to predict imported status of cases. RESULTS Cross-border cases from Venezuela and Guyana made up the majority of border and transnational cases since 2012, and Roraima remained the largest receiving state for cross-border cases over this period. There were significant differences in the profiles of border and transnational cases originating from Venezuela and Guyana, including type of movement and nationality of patients. Logistic regression results demonstrated Venezuelan and Guyanese nationals, Brazilian miners, males, and individuals of working age had heightened odds of being an imported case. Furthermore, Venezuelan citizens had heightened odds of seeking care in municipalities adjacent Venezuela, rather than transnational municipalities. CONCLUSIONS Cross-border malaria contributes to the malaria burden at the Venezuela-Guyana-Brazil border. The identification of distinct profiles of case importation provides evidence on the need to strengthen surveillance at border areas, and to deploy tailored strategies that recognize different mobility routes, such as the movement of refuge-seeking individuals and of Brazilians working in mining.
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Affiliation(s)
- Nicholas J Arisco
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 1, Room 1002A, Boston, MA, 02115, USA
| | - Cassio Peterka
- Diretoria de Vigilancia Epidemiológica, Secretaria de Estado de Saúde Do DF, Brasília, DF, 70390-125, Brazil
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 1, Room 1002A, Boston, MA, 02115, USA.
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Epstein A, Namuganga JF, Kamya EV, Nankabirwa JI, Bhatt S, Rodriguez-Barraquer I, Staedke SG, Kamya MR, Dorsey G, Greenhouse B. Estimating malaria incidence from routine health facility-based surveillance data in Uganda. Malar J 2020; 19:445. [PMID: 33267886 PMCID: PMC7709253 DOI: 10.1186/s12936-020-03514-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/19/2020] [Indexed: 12/03/2022] Open
Abstract
Background Accurate measures of malaria incidence are essential to track progress and target high-risk populations. While health management information system (HMIS) data provide counts of malaria cases, quantifying the denominator for incidence using these data is challenging because catchment areas and care-seeking behaviours are not well defined. This study’s aim was to estimate malaria incidence using HMIS data by adjusting the population denominator accounting for travel time to the health facility. Methods Outpatient data from two public health facilities in Uganda (Kihihi and Nagongera) over a 3-year period (2011–2014) were used to model the relationship between travel time from patient village of residence (available for each individual) to the facility and the relative probability of attendance using Poisson generalized additive models. Outputs from the model were used to generate a weighted population denominator for each health facility and estimate malaria incidence. Among children aged 6 months to 11 years, monthly HMIS-derived incidence estimates, with and without population denominators weighted by probability of attendance, were compared with gold standard measures of malaria incidence measured in prospective cohorts. Results A total of 48,898 outpatient visits were recorded across the two sites over the study period. HMIS incidence correlated with cohort incidence over time at both study sites (correlation in Kihihi = 0.64, p < 0.001; correlation in Nagongera = 0.34, p = 0.045). HMIS incidence measures with denominators unweighted by probability of attendance underestimated cohort incidence aggregated over the 3 years in Kihihi (0.5 cases per person-year (PPY) vs 1.7 cases PPY) and Nagongera (0.3 cases PPY vs 3.0 cases PPY). HMIS incidence measures with denominators weighted by probability of attendance were closer to cohort incidence, but remained underestimates (1.1 cases PPY in Kihihi and 1.4 cases PPY in Nagongera). Conclusions Although malaria incidence measured using HMIS underestimated incidence measured in cohorts, even when adjusting for probability of attendance, HMIS surveillance data are a promising and scalable source for tracking relative changes in malaria incidence over time, particularly when the population denominator can be estimated by incorporating information on village of residence.
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Affiliation(s)
- Adrienne Epstein
- Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | | | | | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Samir Bhatt
- Department of Infectious Disease Epidemiology, St Marys Hospital, Imperial College, London, UK
| | - Isabel Rodriguez-Barraquer
- Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Bryan Greenhouse
- Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Chan Zuckerberg Biohub, San Francisco, CA, USA
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Exploring Vector-Borne Disease Surveillance and Response Systems in Beijing, China: A Qualitative Study from the Health System Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228512. [PMID: 33212908 PMCID: PMC7698447 DOI: 10.3390/ijerph17228512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Abstract
Background: Climate change may contribute to higher incidence and wider geographic spread of vector borne diseases (VBDs). Effective monitoring and surveillance of VBDs is of paramount importance for the prevention of and timely response to outbreaks. Although international regulations exist to support this, barriers and operational challenges within countries hamper efficient monitoring. As a first step to optimise VBD surveillance and monitoring, it is important to gain a deeper understanding of system characteristics and experiences in to date non-endemic regions at risk of becoming endemic in the future. Therefore, this study qualitatively analyses the nature and flexibility of VBD surveillance and response in Beijing. Methods: In this qualitative study, eleven experts working in Beijing’s vector-borne diseases surveillance and response system were interviewed about vector-borne disease surveillance, early warning, response, and strengths and weaknesses of the current approach. Results: Vector-borne disease surveillance occurs using passive syndromic surveillance and separate vector surveillance. Public health authorities use internet reporting networks to determine vector-borne disease risk across Beijing. Response toward a vector-borne disease outbreak is uncommon in this setting due to the currently low occurrence of outbreaks. Conclusions: A robust network of centralised institutions provides the continuity and flexibility needed to adapt and manage possible vector-borne disease threats. Opportunities exist for population-based health promotion and the integration of environment and climate monitoring in vector-borne disease surveillance.
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Fola AA, Kattenberg E, Razook Z, Lautu-Gumal D, Lee S, Mehra S, Bahlo M, Kazura J, Robinson LJ, Laman M, Mueller I, Barry AE. SNP barcodes provide higher resolution than microsatellite markers to measure Plasmodium vivax population genetics. Malar J 2020; 19:375. [PMID: 33081815 PMCID: PMC7576724 DOI: 10.1186/s12936-020-03440-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Genomic surveillance of malaria parasite populations has the potential to inform control strategies and to monitor the impact of interventions. Barcodes comprising large numbers of single nucleotide polymorphism (SNP) markers are accurate and efficient genotyping tools, however may need to be tailored to specific malaria transmission settings, since 'universal' barcodes can lack resolution at the local scale. A SNP barcode was developed that captures the diversity and structure of Plasmodium vivax populations of Papua New Guinea (PNG) for research and surveillance. METHODS Using 20 high-quality P. vivax genome sequences from PNG, a total of 178 evenly spaced neutral SNPs were selected for development of an amplicon sequencing assay combining a series of multiplex PCRs and sequencing on the Illumina MiSeq platform. For initial testing, 20 SNPs were amplified in a small number of mono- and polyclonal P. vivax infections. The full barcode was then validated by genotyping and population genetic analyses of 94 P. vivax isolates collected between 2012 and 2014 from four distinct catchment areas on the highly endemic north coast of PNG. Diversity and population structure determined from the SNP barcode data was then benchmarked against that of ten microsatellite markers used in previous population genetics studies. RESULTS From a total of 28,934,460 reads generated from the MiSeq Illumina run, 87% mapped to the PvSalI reference genome with deep coverage (median = 563, range 56-7586) per locus across genotyped samples. Of 178 SNPs assayed, 146 produced high-quality genotypes (minimum coverage = 56X) in more than 85% of P. vivax isolates. No amplification bias was introduced due to either polyclonal infection or whole genome amplification (WGA) of samples before genotyping. Compared to the microsatellite panels, the SNP barcode revealed greater variability in genetic diversity between populations and geographical population structure. The SNP barcode also enabled assignment of genotypes according to their geographic origins with a significant association between genetic distance and geographic distance at the sub-provincial level. CONCLUSIONS High-throughput SNP barcoding can be used to map variation of malaria transmission dynamics at sub-national resolution. The low cost per sample and genotyping strategy makes the transfer of this technology to field settings highly feasible.
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Affiliation(s)
- Abebe A Fola
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Eline Kattenberg
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
- Malariology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Zahra Razook
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- IMPACT Institute for Innovation in Mental and Physical Health and Clinical Translation, Deakin University, 75 Pigdons Road, Waurn Ponds, Geelong, VIC, 3216, Australia
| | - Dulcie Lautu-Gumal
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- IMPACT Institute for Innovation in Mental and Physical Health and Clinical Translation, Deakin University, 75 Pigdons Road, Waurn Ponds, Geelong, VIC, 3216, Australia
| | - Stuart Lee
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Somya Mehra
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- IMPACT Institute for Innovation in Mental and Physical Health and Clinical Translation, Deakin University, 75 Pigdons Road, Waurn Ponds, Geelong, VIC, 3216, Australia
| | - Melanie Bahlo
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - James Kazura
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Centre for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Leanne J Robinson
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Moses Laman
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Ivo Mueller
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Alyssa E Barry
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia.
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia.
- IMPACT Institute for Innovation in Mental and Physical Health and Clinical Translation, Deakin University, 75 Pigdons Road, Waurn Ponds, Geelong, VIC, 3216, Australia.
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Anand A, Favero R, Dentinger C, Ralaivaomisa A, Ramamonjisoa S, Rabozakandraina O, Razafimandimby E, Razafindrakoto J, Wolf K, Steinhardt L, Gomez P, Rabary M, Andriamananjara MN, Mioramalala SA, Rakotovao JP. Malaria case management and elimination readiness in health facilities of five districts of Madagascar in 2018. Malar J 2020; 19:351. [PMID: 33004061 PMCID: PMC7528237 DOI: 10.1186/s12936-020-03417-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/15/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Madagascar's Malaria National Strategic Plan 2018-2022 calls for progressive malaria elimination beginning in low-incidence districts (< 1 case/1000 population). Optimizing access to prompt diagnosis and quality treatment and improving outbreak detection and response will be critical to success. A malaria elimination readiness assessment (MERA) was performed in health facilities (HFs) of selected districts targeted for malaria elimination. METHODS A mixed methods survey was performed in September 2018 in five districts of Madagascar. Randomly selected HFs were assessed for availability of malaria commodities and frequency of training and supervision conducted. Health providers (HPs) and community health volunteers (CHVs) were interviewed, and outpatient consultations at HFs were observed. To evaluate elimination readiness, a composite score ranging from 0 to 100 was designed from all study tools and addressed four domains: (1) resource availability, (2) case management (CM), (3) data management and use, and (4) training, supervision, and technical assistance; scores were calculated for each HF catchment area and district based on survey responses. Stakeholder interviews on malaria elimination planning were conducted at national, regional and district levels. RESULTS A quarter of the 35 HFs surveyed had no rapid diagnostic tests (RDTs). Of 129 patients with reported or recorded fever among 300 consultations observed, HPs tested 56 (43%) for malaria. Three-quarters of the 35 HF managers reviewed data for trends. Only 68% of 41 HPs reported receiving malaria-specific training. Of 34 CHVs surveyed, 24% reported that treating fever was no longer among their responsibilities. Among treating CHVs, 13 (50%) reported having RDTs, and 11 (42%) had anti-malarials available. The average district elimination readiness score was 52 out of 100, ranging from 48 to 57 across districts. Stakeholders identified several challenges to commodity management, malaria CM, and epidemic response related to lack of training and funding disruptions. CONCLUSION This evaluation highlighted gaps in malaria CM and elimination readiness in Madagascar to address during elimination planning. Strategies are needed that include training, commodity provision, supervision, and support for CHVs. The MERA can be repeated to assess progress in filling identified gaps and is a feasible tool that could be used to assess elimination targets in other countries.
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Affiliation(s)
- Anjoli Anand
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA.
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Rachel Favero
- Maternal Child Survival Program, Washington, DC, USA
| | - Catherine Dentinger
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- US President's Malaria Initiative, US Centers for Disease Control and Prevention, Antananarivo, Madagascar
| | | | | | | | | | - Jocelyn Razafindrakoto
- US President's Malaria Initiative, US Centers for Disease Control and Prevention, Antananarivo, Madagascar
| | | | - Laura Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Potential for a web-based management information system to improve malaria control: An exploratory study in the Lahat District, South Sumatra Province, Indonesia. PLoS One 2020; 15:e0229838. [PMID: 32516344 PMCID: PMC7282623 DOI: 10.1371/journal.pone.0229838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background A web-based malaria reporting information system (MRIS) has the potential to improve malaria reporting and management. The aim of this study was to evaluate the existing manual paper-based MRIS and to provide a way to overcome the obstacles by developing a web-based MRIS in Indonesia. Methods An exploratory study was conducted in 2012 in Lahat District, South Sumatra Province of Indonesia. We evaluated the current reporting system and identified the potential benefits of using a web-based MRIS by in-depth interviews on selected key informants. Feasibility study was then conducted to develop a prototype system. A web-based MRIS was developed, integrated and synchronized, with suitability ranging from Primary Healthcare Centres (PHCs) to the Lahat District Health Office. Results The paper-based reporting system was sub-optimal due to a lack of transportation, communication, and human capacity. We developed a web-based MRIS to replace the current one. Although the web-based system has the potential to improve the malaria reporting information system, there were some barriers to its implementation, including lack of skilled operators, computer availability and lack of internet access. Recommended ways to overcome the obstacles are by training operators, making the application in an offline mode and able to be operated by mobile phone text messaging for malaria reporting. Conclusion The web-based MRIS has the potential to be implemented as an enhanced malaria reporting information system and investment in the system to support timely management responses is essential for malaria elimination. The developed application can be cloned to other areas that have similar characteristics and MRIS with a built-in web base to aid its application in the 5G future.
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Mihreteab S, Lubinda J, Zhao B, Rodriguez-Morales AJ, Karamehic-Muratovic A, Goitom A, Shad MY, Haque U. Retrospective data analyses of social and environmental determinants of malaria control for elimination prospects in Eritrea. Parasit Vectors 2020; 13:126. [PMID: 32164770 PMCID: PMC7068948 DOI: 10.1186/s13071-020-3974-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background The present study focuses on both long- and short-term malaria transmission in Eritrea and investigates the risk factors. Annual aggregates of information on malaria cases, deaths, diagnostics and control interventions from 2001 to 2008 and monthly reported data from 2009 to 2017 were obtained from the National Malaria Control Programme. We used a generalized linear regression model to examine the associations among total malaria cases, death, insecticide-treated net coverage, indoor residual spraying and climatic parameters. Results Reduction in malaria mortality is demonstrated by the milestone margins of over 97% by the end of 2017. Malaria incidence likewise declined during the period (from 33 to 5 per 1000 population), representing a reduction of about 86% (R2 = 0.3) slightly less than the decline in mortality. The distribution of insecticide treated nets generally declined between 2001 and 2014 (R2 = 0.16) before increasing from 2015 to 2017, while the number of people protected by indoor residual spraying slightly increased (R2 = 0.27). Higher rainfall was significantly associated with an increased number of malaria cases. The covariates rainfall and temperature are a better pair than IRS and LLIN to predict incidences. On the other hand, IRS and LLIN is a more significant pair to predict mortality cases. Conclusions While Eritrea has made significant progress towards malaria elimination, this progress should be maintained and further improved. Distribution, coverage and utilization of malaria control and elimination tools should be optimized and sustained to safeguard the gains made. Additionally, consistent annual performance evaluation of malaria indicators would ensure a continuous learning process from gains/threats of epidemics and resurgence in regions already earmarked for elimination.
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Affiliation(s)
- Selam Mihreteab
- National Malaria Control Programme, Ministry of Health, Asmara, Eritrea.
| | - Jailos Lubinda
- School of Geography and Environmental Sciences, Ulster University, Coleraine, UK
| | - Bingxin Zhao
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alfonso J Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia.,Medical School, Faculty of Health Sciences, UniFranz, Cochabamba, Bolivia.,Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | | | - Aman Goitom
- National Malaria Control Programme, Ministry of Health, Asmara, Eritrea
| | | | - Ubydul Haque
- Department of Geography, University of Florida, Gainesville, FL, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.,Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
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Okello G, Molyneux S, Zakayo S, Gerrets R, Jones C. Producing routine malaria data: an exploration of the micro-practices and processes shaping routine malaria data quality in frontline health facilities in Kenya. Malar J 2019; 18:420. [PMID: 31842872 PMCID: PMC6915927 DOI: 10.1186/s12936-019-3061-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/08/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Routine health information systems can provide near real-time data for malaria programme management, monitoring and evaluation, and surveillance. There are widespread concerns about the quality of the malaria data generated through routine information systems in many low-income countries. However, there has been little careful examination of micro-level practices of data collection which are central to the production of routine malaria data. METHODS Drawing on fieldwork conducted in two malaria endemic sub-counties in Kenya, this study examined the processes and practices that shape routine malaria data generation at frontline health facilities. The study employed ethnographic methods-including observations, records review, and interviews-over 18-months in four frontline health facilities and two sub-county health records offices. Data were analysed using a thematic analysis approach. RESULTS Malaria data generation was influenced by a range of factors including human resource shortages, tool design, and stock-out of data collection tools. Most of the challenges encountered by health workers in routine malaria data generation had their roots in wider system issues and at the national level where the framing of indicators and development of data collection tools takes place. In response to these challenges, health workers adopted various coping mechanisms such as informal task shifting and use of improvised tools. While these initiatives sustained the data collection process, they also had considerable implications for the data recorded and led to discrepancies in data that were recorded in primary registers. These discrepancies were concealed in aggregated monthly reports that were subsequently entered into the District Health Information Software 2. CONCLUSION Challenges to routine malaria data generation at frontline health facilities are not malaria or health information systems specific; they reflect wider health system weaknesses. Any interventions seeking to improve routine malaria data generation must look beyond just malaria or health information system initiatives and include consideration of the broader contextual factors that shape malaria data generation.
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Affiliation(s)
- George Okello
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O Box 230, 80108, Kilifi, Kenya.
| | - Sassy Molyneux
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O Box 230, 80108, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Scholastica Zakayo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O Box 230, 80108, Kilifi, Kenya
| | - Rene Gerrets
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline Jones
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O Box 230, 80108, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Khandekar E, Kramer R, Ali AS, Al-Mafazy AW, Egger JR, LeGrand S, Mkali HR, McKay M, Ngondi JM. Evaluating Response Time in Zanzibar's Malaria Elimination Case-Based Surveillance-Response System. Am J Trop Med Hyg 2019; 100:256-263. [PMID: 30526729 DOI: 10.4269/ajtmh.17-0546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
As countries transition toward malaria elimination, malaria programs rely on surveillance-response systems, which are often supported by web- and mobile phone-based reporting tools. Such surveillance-response systems are interventions for elimination, making it important to determine if they are operating optimally. A metric to measure this by is timeliness. This study used a mixed-methods approach to investigate the response time of Zanzibar's malaria elimination surveillance-response system, Malaria Case Notification (MCN). MCN conducts both passive and reactive case detection, supported by a mobile phone-based reporting tool called Coconut Surveillance. Using data obtained from RTI International and the Zanzibar Malaria Elimination Program (ZAMEP), analysis of summary statistics was conducted to investigate the association of response time with geography, and time series techniques were used to investigate trends in response time and its association with the number of reported cases. Results indicated that response time varied by the district in Zanzibar (0.6-6.05 days) and that it was not associated with calendar time or the number of reported cases. Survey responses and focus groups with a cadre of health workers, district malaria surveillance officers, shed light on operational challenges faced during case investigation, such as incomplete health records and transportation issues, which stem from deficiencies in aspects of ZAMEP's program management. These findings illustrate that timely response for malaria elimination depends on effective program management, despite the automation of web-based or mobile phone-based tools. For surveillance-response systems to work optimally, malaria programs should ensure that optimal management practices are in place.
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Affiliation(s)
- Eeshan Khandekar
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Randall Kramer
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Abdullah S Ali
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania
| | | | - Joseph R Egger
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, North Carolina
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A Novel Integrated and Labile eHealth System for Monitoring Dog Rabies Vaccination Campaigns. Vaccines (Basel) 2019; 7:vaccines7030108. [PMID: 31505844 PMCID: PMC6789753 DOI: 10.3390/vaccines7030108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/11/2022] Open
Abstract
The elimination of canine rabies through the implementation of high coverage mass dog vaccination campaigns is a complex task, particularly in the resource-limited countries of the rabies endemic world. Here we demonstrated the feasibility of applying targeted rabies vaccination campaigns to deliver more impactful intervention campaigns in resource-limited settings using evidence and lessons learnt from other diseases. With the use of strategic rabies intervention programs, we demonstrate the noteworthy reduction of rabies cases in two very different African settings. The strategic intervention was most significantly aided by the use of a custom-developed vaccination tracking device (the Global Alliance for Rabies Control (GARC) Data Logger) and an integrated rabies surveillance system (the Rabies Epidemiological Bulletin). Our first case study, an island-wide strategic dog vaccination on Tanzania's Unguja island, reduced the incidence of rabies by 71% in the first 16 months of implementation. In the second case study, a similar approach was applied in the metropolitan capital city of Zimbabwe and the incidence of rabies declined by 13% during the first 13 months of implementation. The methodologies and results presented here suggest that, in resource-limited settings, an optimal approach towards the elimination of dog rabies would revolve around strategic interventions, subject to the use of appropriate planning, surveillance, and vaccination tools.
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Davies C, Graffy R, Shandukani M, Baloyi E, Gast L, Kok G, Mbokazi F, Zita A, Zwane M, Magagula R, Mabuza A, Ramkrishna W, Morris N, Porteous J, Shirreff G, Blumberg L, Misiani E, Moonasar D. Effectiveness of 24-h mobile reporting tool during a malaria outbreak in Mpumalanga Province, South Africa. Malar J 2019; 18:45. [PMID: 30791909 PMCID: PMC6385402 DOI: 10.1186/s12936-019-2683-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/14/2019] [Indexed: 11/25/2022] Open
Abstract
Background As surveillance is a key strategy for malaria elimination in South Africa, ensuring strong surveillance systems is a National Department of Health priority. Historically, real time tracking of case trends and reporting within 24 h—a requirement in South Africa’s National surveillance guidelines—has not been possible. To enhance surveillance and response efficiency, a mobile surveillance tool, MalariaConnect, was developed using Unstructured Supplementary Service Data (USSD) technology. It was rolled out in health facilities in malaria endemic areas of South Africa to provide 24-h reporting of malaria cases. Methods To evaluate the efficiency of the mobile tool to detect an outbreak data were extracted from the paper based and MalariaConnect reporting systems in Bushbuckridge from 1 January to 18 June 2017. These data were subject to time series analyses to determine if MalariaConnect provided sufficient data reliably to detect increasing case trends reported through the paper system. The Chi squared test was used to determine goodness of fit between the following indicator data generated using MalariaConnect and paper reporting systems: timeliness, completeness, and precision. Results MalariaConnect adequately tracked case trends reported through the paper system. Timeliness of reporting increased significantly using MalariaConnect with 0.63 days to notification compared to 5.65 days using the paper-system (p < 0.05). The completeness of reporting was significantly higher for the paper system (100% completion; p < 0.05), compared to confirmed MalariaConnect cases (61%). There was a moderate association between data precision and the reporting system (p < 0.05). MalariaConnect provided an effective way of reliably and accurately identifying the onset of the malaria outbreak in Bushbuckridge. Conclusion Timeliness significantly improved using MalariaConnect and in a malaria elimination setting, can be used to markedly improve case investigation and response activities within the recommended 72-h period. Although data completeness and precision were lower compared to paper reporting, MalariaConnect data can be used to trigger outbreak responses.
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Affiliation(s)
- Craig Davies
- Malaria Programme, Clinton Health Access Initiative, Pretoria, South Africa
| | - Rebecca Graffy
- Malaria Programme, Clinton Health Access Initiative, Pretoria, South Africa
| | - Mbavhalelo Shandukani
- Department of Health, Malaria and Other Vector Borne Diseases, Pretoria, South Africa
| | - Ednah Baloyi
- Department of Health, Malaria and Other Vector Borne Diseases, Pretoria, South Africa
| | - Laura Gast
- Malaria Programme, Clinton Health Access Initiative, Pretoria, South Africa
| | - Gerdalize Kok
- Mpumalanga Department of Health, Malaria Control Programme, Mbombela, South Africa
| | - Frans Mbokazi
- Mpumalanga Department of Health, Malaria Control Programme, Mbombela, South Africa
| | - Alpheus Zita
- Mpumalanga Department of Health, Malaria Control Programme, Mbombela, South Africa
| | - Mandla Zwane
- Centre for Disease Control, Mpumalanga Department of Health and Social Development, Mbombela, South Africa
| | - Ray Magagula
- Mpumalanga Department of Health, Malaria Control Programme, Mbombela, South Africa
| | - Aaron Mabuza
- Malaria Programme, Clinton Health Access Initiative, Pretoria, South Africa
| | - Wayne Ramkrishna
- Department of Health, Malaria and Other Vector Borne Diseases, Pretoria, South Africa
| | | | | | - George Shirreff
- Malaria Programme, Clinton Health Access Initiative, Pretoria, South Africa
| | - Lucille Blumberg
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Eunice Misiani
- Department of Health, Malaria and Other Vector Borne Diseases, Pretoria, South Africa
| | - Devanand Moonasar
- Department of Health, Malaria and Other Vector Borne Diseases, Pretoria, South Africa. .,School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
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Baloyi RE, Shandukani MB, Graffy R, Misiani E, Mayet N, Mabunda E, Mabuza A, Qwabe B, Ngwenyama B, Reddy C, Moonasar D. Evaluating a 24-h mobile reporting system for malaria notifications in comparison with a paper-based system in South Africa, 2015. Malar J 2018; 17:308. [PMID: 30139370 PMCID: PMC6107938 DOI: 10.1186/s12936-018-2451-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As South Africa strives to achieve malaria elimination by 2018 (zero local cases) the country needs to strengthen its disease surveillance system by reducing the timeliness from case diagnosis to notification of key stakeholders in the malaria programme. This study evaluated the feasibility of a 24-h mobile reporting system, designed for speeding up malaria notifications, from primary healthcare facilities to district, provincial, and national malaria programmes in South Africa. METHODS A prospective descriptive study utilizing primary data collected from structured interviews with healthcare workers in public healthcare facilities was used to compare two reporting systems (24-h mobile reporting system and the paper-based reporting system) in malaria endemic provinces (Limpopo, Mpumalanga and KwaZulu-Natal). Data on completeness of reporting, simplicity, user acceptability and technical limitations were analysed. A Wilcoxon signed-rank test was used to compare the time difference between the two reporting systems. RESULTS There were 1819 cases of malaria reported through the paper-based system, and 63.2% (1149) of those cases were also reported through the 24-h mobile reporting system. Out of the 272 healthcare workers who were interviewed, 40% (108) had seen malaria patients and reported a case through the 24-h mobile reporting system. The median time for cases to be reported through the 24-h mobile reporting system was significantly shorter at < 1 day (range < 1 to 31 days) compared to the paper-based system at 3 days (range 2 to > 39 days) (p < 0.001). It was found that 26% (28) were able to use the system and send reports within 2 min, 94% (256) were willing to continue to use the system. Of the 108 healthcare workers who reported a case, 18.5% (20) experienced network challenges. CONCLUSIONS The 24-h mobile reporting system is user friendly and trained healthcare workers are willing to use the system, despite network limitations. The 24-h mobile reporting system reduces the time required for diagnosed cases to be notified by the health care facility to district, provincial and national levels. The 24-h mobile reporting system is a feasible option for malaria notification in South Africa and will assist with early detection of malaria outbreaks.
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Affiliation(s)
- Ramokone Ednah Baloyi
- South African Field Epidemiology Training Program, 1 Modderfontein Road, Sandringham, Johannesburg, South Africa. .,National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham, Johannesburg, South Africa.
| | | | - Rebecca Graffy
- Clinton Health Access Initiative, 31166 Francis Baard, Block b, 1st Floor, Hatfield, Pretoria, Gauteng, 0001, South Africa
| | - Eunice Misiani
- National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham, Johannesburg, South Africa
| | - Natalie Mayet
- National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham, Johannesburg, South Africa.,National Department of Health, Civitas Building, 222 Thabo Sehume Street, Pretoria, Gauteng, 0001, South Africa
| | - Eric Mabunda
- Limpopo Government Department of Health, 618 College Street, Polokwane, Limpopo, 0700, South Africa
| | - Aaron Mabuza
- Mpumalanga Government Department of Health, Building No.7, Government Boulevard, Riverside Park, Extension 2, Nelspruit, Mpumalanga, 1200, South Africa
| | - Bheki Qwabe
- KwaZulu-Natal Government Department of Health, Natalia Langalibalele (Longmarket) Street, Pietermaritzburg, KwaZulu-Natal, 3201, South Africa
| | - Bongani Ngwenyama
- National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham, Johannesburg, South Africa.,National Department of Health, Civitas Building, 222 Thabo Sehume Street, Pretoria, Gauteng, 0001, South Africa
| | - Carl Reddy
- South African Field Epidemiology Training Program, 1 Modderfontein Road, Sandringham, Johannesburg, South Africa.,National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham, Johannesburg, South Africa
| | - Devanand Moonasar
- National Department of Health, Civitas Building, 222 Thabo Sehume Street, Pretoria, Gauteng, 0001, South Africa
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Al Manir MS, Brenas JH, Baker CJ, Shaban-Nejad A. A Surveillance Infrastructure for Malaria Analytics: Provisioning Data Access and Preservation of Interoperability. JMIR Public Health Surveill 2018; 4:e10218. [PMID: 29907554 PMCID: PMC6026300 DOI: 10.2196/10218] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/16/2018] [Accepted: 05/08/2018] [Indexed: 12/19/2022] Open
Abstract
Background According to the World Health Organization, malaria surveillance is weakest in countries and regions with the highest malaria burden. A core obstacle is that the data required to perform malaria surveillance are fragmented in multiple data silos distributed across geographic regions. Furthermore, consistent integrated malaria data sources are few, and a low degree of interoperability exists between them. As a result, it is difficult to identify disease trends and to plan for effective interventions. Objective We propose the Semantics, Interoperability, and Evolution for Malaria Analytics (SIEMA) platform for use in malaria surveillance based on semantic data federation. Using this approach, it is possible to access distributed data, extend and preserve interoperability between multiple dynamic distributed malaria sources, and facilitate detection of system changes that can interrupt mission-critical global surveillance activities. Methods We used Semantic Automated Discovery and Integration (SADI) Semantic Web Services to enable data access and improve interoperability, and the graphical user interface-enabled semantic query engine HYDRA to implement the target queries typical of malaria programs. We implemented a custom algorithm to detect changes to community-developed terminologies, data sources, and services that are core to SIEMA. This algorithm reports to a dashboard. Valet SADI is used to mitigate the impact of changes by rebuilding affected services. Results We developed a prototype surveillance and change management platform from a combination of third-party tools, community-developed terminologies, and custom algorithms. We illustrated a methodology and core infrastructure to facilitate interoperable access to distributed data sources using SADI Semantic Web services. This degree of access makes it possible to implement complex queries needed by our user community with minimal technical skill. We implemented a dashboard that reports on terminology changes that can render the services inactive, jeopardizing system interoperability. Using this information, end users can control and reactively rebuild services to preserve interoperability and minimize service downtime. Conclusions We introduce a framework suitable for use in malaria surveillance that supports the creation of flexible surveillance queries across distributed data resources. The platform provides interoperable access to target data sources, is domain agnostic, and with updates to core terminological resources is readily transferable to other surveillance activities. A dashboard enables users to review changes to the infrastructure and invoke system updates. The platform significantly extends the range of functionalities offered by malaria information systems, beyond the state-of-the-art.
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Affiliation(s)
| | - Jon Haël Brenas
- Oak Ridge National Laboratory Center for for Biomedical Informatics, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Christopher Jo Baker
- Department of Computer Science, University of New Brunswick, Saint John, NB, Canada.,IPSNP Computing Inc, Saint John, NB, Canada
| | - Arash Shaban-Nejad
- Oak Ridge National Laboratory Center for for Biomedical Informatics, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, United States
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Affiliation(s)
- Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, San Francisco, California
| | - Jennifer L Smith
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, San Francisco, California
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Muchena G, Dube B, Chikodzore R, Pasipamire J, Murugasampillay S, Mberikunashe J. A review of progress towards sub-national malaria elimination in Matabeleland South Province, Zimbabwe (2011-2015): a qualitative study. Malar J 2018; 17:146. [PMID: 29615043 PMCID: PMC5883310 DOI: 10.1186/s12936-018-2299-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 03/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Malaria remains a public health problem in Zimbabwe. However, malaria elimination has become a foreseeable prospect with Matabeleland South Province making significant gains towards halting local malaria transmission. This study reviews malaria elimination progress and challenges to date utilizing the World Health Organization’s Malaria Programme Review framework. Results Between 2011 and 2015, malaria incidence was less than one case per 1000 population at risk in all districts save for Beitbridge and Gwanda. The majority of cases were from Beitbridge with local transmission in the same. Incidence declined in Bulilima (p = 0.01), Gwanda (p = 0.72) and Umzingwane (p = 0.44), increasing in Beitbridge (p = 0.35), Insiza (p = 0.79) and Mangwe (p = 0.60). Overall provincial incidence declined although this was not statistically significant. Malaria transmission was bimodal, with a major peak in April and a minor peak in October. A case based malaria surveillance system existed but was not real-time. Foci response guidelines were not domesticated. Artemisinin formed the backbone of case management regimens with primaquine for gametocyte clearance. Indoor residual spraying coverages were below the national target of 95% for rooms targeted for spraying. Conclusion Matabeleland South province has set precedence for targeting sub-national malaria elimination in Zimbabwe. This experience may prove useful for national scale up. There is need to improve surveillance, foci response and intensification of activities to halt residual malaria transmission in Beitbridge District.
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Affiliation(s)
- Gladwin Muchena
- Ministry of Health and Child Care, P. Bag A5225, Matabeleland South Province, Bulawayo, Zimbabwe.
| | - Busisani Dube
- Ministry of Health and Child Care, National Malaria Control Programme, Harare, Zimbabwe
| | - Rudo Chikodzore
- Ministry of Health and Child Care, P. Bag A5225, Matabeleland South Province, Bulawayo, Zimbabwe
| | - Jasper Pasipamire
- World Health Organization, Zimbabwe Country Office, Harare, Zimbabwe
| | | | - Joseph Mberikunashe
- Ministry of Health and Child Care, National Malaria Control Programme, Harare, Zimbabwe
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Reactive case detection of Plasmodium falciparum in western Kenya highlands: effective in identifying additional cases, yet limited effect on transmission. Malar J 2018. [PMID: 29534709 PMCID: PMC5851086 DOI: 10.1186/s12936-018-2260-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Identifying asymptomatic reservoirs of malaria parasites using index cases as entry points into the community is potentially a cost-effective way towards achieving malaria elimination. Methods Within 1 year, 1430 confirmed malaria cases were identified in Marani hospital, western Kenya. Fifty cases were followed up, and 108 index case household members and 612 neighbours within a 100 m radius were screened. As controls, samples were collected from 510 individuals matched with index cases and located at a distance of ≥ 500 m from them. Infections were diagnosed by microscopy and PCR while simultaneously collecting malaria vectors indoor using pyrethrum spray catches. Results In the index case and neighbour households, the prevalence of infection was approximately twice as high as in control households (by PCR: index cases households: 28.9%, neighbours: 25.3%, matched controls: 12.9%). In index case households, the indoor vector density (Anopheles gambiae and Anopheles funestus) was higher (0.46 female/house/night) than in neighbouring (0.31 f/h/n) and control houses (0.29 f/h/n). Conclusions Screening index case households and neighbours approximately doubles the chance to detect asymptomatic infections compared to randomly selected households. However, even if all cases were followed up, only a small proportion (˂ 10%) of the asymptomatic reservoir in the population would have been identified. Control programmes need to weigh the increased chance to find cases around index cases vs. the logistical challenges to target this subgroup within the population.
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Mitsakakis K, Hin S, Müller P, Wipf N, Thomsen E, Coleman M, Zengerle R, Vontas J, Mavridis K. Converging Human and Malaria Vector Diagnostics with Data Management towards an Integrated Holistic One Health Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E259. [PMID: 29401670 PMCID: PMC5858328 DOI: 10.3390/ijerph15020259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/27/2018] [Accepted: 01/31/2018] [Indexed: 01/22/2023]
Abstract
Monitoring malaria prevalence in humans, as well as vector populations, for the presence of Plasmodium, is an integral component of effective malaria control, and eventually, elimination. In the field of human diagnostics, a major challenge is the ability to define, precisely, the causative agent of fever, thereby differentiating among several candidate (also non-malaria) febrile diseases. This requires genetic-based pathogen identification and multiplexed analysis, which, in combination, are hardly provided by the current gold standard diagnostic tools. In the field of vectors, an essential component of control programs is the detection of Plasmodium species within its mosquito vectors, particularly in the salivary glands, where the infective sporozoites reside. In addition, the identification of species composition and insecticide resistance alleles within vector populations is a primary task in routine monitoring activities, aiming to support control efforts. In this context, the use of converging diagnostics is highly desirable for providing comprehensive information, including differential fever diagnosis in humans, and mosquito species composition, infection status, and resistance to insecticides of vectors. Nevertheless, the two fields of human diagnostics and vector control are rarely combined, both at the diagnostic and at the data management end, resulting in fragmented data and mis- or non-communication between various stakeholders. To this direction, molecular technologies, their integration in automated platforms, and the co-assessment of data from multiple diagnostic sources through information and communication technologies are possible pathways towards a unified human vector approach.
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Affiliation(s)
- Konstantinos Mitsakakis
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany.
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany.
| | - Sebastian Hin
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany.
| | - Pie Müller
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box, 4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland.
| | - Nadja Wipf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box, 4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland.
| | - Edward Thomsen
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
| | - Michael Coleman
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
| | - Roland Zengerle
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany.
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany.
| | - John Vontas
- Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, 70013 Heraklion, Greece.
- Pesticide Science Laboratory, Department of Crop Science, Agricultural University of Athens, 11855 Athens, Greece.
| | - Konstantinos Mavridis
- Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, 70013 Heraklion, Greece.
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Cotter C, Sudathip P, Herdiana H, Cao Y, Liu Y, Luo A, Ranasinghe N, Bennett A, Cao J, Gosling RD. Piloting a programme tool to evaluate malaria case investigation and reactive case detection activities: results from 3 settings in the Asia Pacific. Malar J 2017; 16:347. [PMID: 28830519 PMCID: PMC5568298 DOI: 10.1186/s12936-017-1991-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Case investigation and reactive case detection (RACD) activities are widely-used in low transmission settings to determine the suspected origin of infection and identify and treat malaria infections nearby to the index patient household. Case investigation and RACD activities are time and resource intensive, include methodologies that vary across eliminating settings, and have no standardized metrics or tools available to monitor and evaluate them. METHODS In response to this gap, a simple programme tool was developed for monitoring and evaluating (M&E) RACD activities and piloted by national malaria programmes. During the development phase, four modules of the RACD M&E tool were created to assess and evaluate key case investigation and RACD activities and costs. A pilot phase was then carried out by programme implementers between 2013 and 2015, during which malaria surveillance teams in three different settings (China, Indonesia, Thailand) piloted the tool over a period of 3 months each. This study describes summary results of the pilots and feasibility and impact of the tool on programmes. RESULTS All three study areas implemented the RACD M&E tool modules, and pilot users reported the tool and evaluation process were helpful to identify gaps in RACD programme activities. In the 45 health facilities evaluated, 71.8% (97/135; min 35.3-max 100.0%) of the proper notification and reporting forms and 20.0% (27/135; min 0.0-max 100.0%) of standard operating procedures (SOPs) were available to support malaria elimination activities. The tool highlighted gaps in reporting key data indicators on the completeness for malaria case reporting (98.8%; min 93.3-max 100.0%), case investigations (65.6%; min 61.8-max 78.4%) and RACD activities (70.0%; min 64.7-max 100.0%). Evaluation of the SOPs showed that knowledge and practices of malaria personnel varied within and between study areas. Average monthly costs for conducting case investigation and RACD activities showed variation between study areas (min USD $844.80-max USD $2038.00) for the malaria personnel, commodities, services and other costs required to carry out the activities. CONCLUSION The RACD M&E tool was implemented in the three pilot areas, identifying key gaps that led to impacts on programme decision making. Study findings support the need for routine M&E of malaria case reporting, case investigation and RACD activities. Scale-up of the RACD M&E tool in malaria-eliminating settings will contribute to improved programme performance to the high level that is required to reach elimination.
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Affiliation(s)
- Chris Cotter
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), 550 16th Street, 3rd floor, San Francisco, CA, 94158, USA. .,Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
| | - Prayuth Sudathip
- Department of Disease Control, Bureau of Vector Borne Diseases, Ministry of Public Health, Nonthaburi, Thailand
| | - Herdiana Herdiana
- Paritrana Asia Foundation, Jakarta, Indonesia.,United Nations Children's Fund (UNICEF), Aceh Field Office, Banda Aceh, Indonesia
| | - Yuanyuan Cao
- Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, Jiangsu, People's Republic of China
| | - Yaobao Liu
- Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, Jiangsu, People's Republic of China
| | - Alex Luo
- Global Health Sciences, University of California, San Francisco (UCSF), San Francisco, USA
| | | | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), 550 16th Street, 3rd floor, San Francisco, CA, 94158, USA.,Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco (UCSF), San Francisco, USA
| | - Jun Cao
- Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, Jiangsu, People's Republic of China
| | - Roly D Gosling
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco (UCSF), 550 16th Street, 3rd floor, San Francisco, CA, 94158, USA.,Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco (UCSF), San Francisco, USA
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Rosewell A, Makita L, Muscatello D, John LN, Bieb S, Hutton R, Ramamurthy S, Shearman P. Health information system strengthening and malaria elimination in Papua New Guinea. Malar J 2017; 16:278. [PMID: 28679421 PMCID: PMC5499047 DOI: 10.1186/s12936-017-1910-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/26/2017] [Indexed: 11/17/2022] Open
Abstract
Background The objective of the study was to describe an m-health initiative to strengthen malaria surveillance in a 184-health facility, multi-province, project aimed at strengthening the National Health Information System (NHIS) in a country with fragmented malaria surveillance, striving towards enhanced control, pre-elimination. Methods A remote-loading mobile application and secure online platform for health professionals was created to interface with the new system (eNHIS). A case-based malaria testing register was developed and integrated geo-coded households, villages and health facilities. A malaria programme management dashboard was created, with village-level malaria mapping tools, and statistical algorithms to identify malaria outbreaks. Results Since its inception in 2015, 160,750 malaria testing records, including village of residence, have been reported to the eNHIS. These case-based, geo-coded malaria data are 100% complete, with a median data entry delay of 9 days from the date of testing. The system maps malaria to the village level in near real-time as well as the availability of treatment and diagnostics to health facility level. Data aggregation, analysis, outbreak detection, and reporting are automated. Conclusions The study demonstrates that using mobile technologies and GIS in the capture and reporting of NHIS data in Papua New Guinea provides timely, high quality, geo-coded, case-based malaria data required for malaria elimination. The health systems strengthening approach of integrating malaria information management into the eNHIS optimizes sustainability and provides enormous flexibility to cater for future malaria programme needs.
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Affiliation(s)
- Alexander Rosewell
- PNG Remote Sensing Centre, PO Box 1733, Waterfront, Konedobu, Port Moresby, Papua New Guinea. .,School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, Australia.
| | - Leo Makita
- National Department of Health, Port Moresby, Papua New Guinea
| | - David Muscatello
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, Australia
| | | | - Sibauk Bieb
- National Department of Health, Port Moresby, Papua New Guinea
| | | | - Sundar Ramamurthy
- PNG Remote Sensing Centre, PO Box 1733, Waterfront, Konedobu, Port Moresby, Papua New Guinea
| | - Phil Shearman
- PNG Remote Sensing Centre, PO Box 1733, Waterfront, Konedobu, Port Moresby, Papua New Guinea.,School of Botany and Zoology, The Australian National University, Linnaeus Way, Canberra, 0200, Australia
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Fu C, Lopes S, Mellor S, Aryal S, Sovannaroth S, Roca-Feltrer A. Experiences From Developing and Upgrading a Web-Based Surveillance System for Malaria Elimination in Cambodia. JMIR Public Health Surveill 2017; 3:e30. [PMID: 28615155 PMCID: PMC5489705 DOI: 10.2196/publichealth.6942] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/01/2017] [Accepted: 03/29/2017] [Indexed: 11/18/2022] Open
Abstract
Strengthening the surveillance component is key toward achieving country-wide malaria elimination in Cambodia. A Web-based upgraded malaria information system (MIS) was deemed to essentially act as the central component for surveillance strengthening. New functionality (eg, data visualization) and operational (eg, data quality) attributes of the system received particular attention. However, building from the lessons learned in previous systems’ developments, other aspects unique to Cambodia were considered to be equally important; for instance, feasibility issues, particularly at the field level (eg, user acceptability at various health levels), and sustainability needs (eg, long-term system flexibility). The Cambodian process of identifying the essential changes and critical attributes for this new information system can provide a model for other countries at various stages of the disease control and elimination continuum. Sharing these experiences not only facilitates the establishment of “best practices” but also accelerates global and regional malaria elimination efforts. In this article, Cambodia’s experience in developing and upgrading its MIS to remain responsive to country-specific needs demonstrates the necessity for considering functionality, operationalization, feasibility, and sustainability of an information system in the context of malaria elimination.
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Affiliation(s)
| | | | | | - Siddhi Aryal
- Malaria Consortium Asia Regional OfficeBangkokThailand
| | - Siv Sovannaroth
- The National Center for Parasitology, Entomology and Malaria ControlPhnom PenhCambodia
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Mercado CEG, Ekapirat N, Dondorp AM, Maude RJ. An assessment of national surveillance systems for malaria elimination in the Asia Pacific. Malar J 2017; 16:127. [PMID: 28327180 PMCID: PMC5361802 DOI: 10.1186/s12936-017-1774-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/13/2017] [Indexed: 11/29/2022] Open
Abstract
Background Heads of Government from Asia and the Pacific have committed to a malaria-free region by 2030. In 2015, the total number of confirmed cases reported to the World Health Organization by 22 Asia Pacific countries was 2,461,025. However, this was likely a gross underestimate due in part to incidence data not being available from the wide variety of known sources. There is a recognized need for an accurate picture of malaria over time and space to support the goal of elimination. A survey was conducted to gain a deeper understanding of the collection of malaria incidence data for surveillance by National Malaria Control Programmes in 22 countries identified by the Asia Pacific Leaders Malaria Alliance. Methods In 2015–2016, a short questionnaire on malaria surveillance was distributed to 22 country National Malaria Control Programmes (NMCP) in the Asia Pacific. It collected country-specific information about the extent of inclusion of the range of possible sources of malaria incidence data and the role of the private sector in malaria treatment. The findings were used to produce recommendations for the regional heads of government on improving malaria surveillance to inform regional efforts towards malaria elimination. Results A survey response was received from all 22 target countries. Most of the malaria incidence data collected by NMCPs originated from government health facilities, while many did not collect comprehensive data from mobile and migrant populations, the private sector or the military. All data from village health workers were included by 10/20 countries and some by 5/20. Other sources of data included by some countries were plantations, police and other security forces, sentinel surveillance sites, research or academic institutions, private laboratories and other government ministries. Malaria was treated in private health facilities in 19/21 countries, while anti-malarials were available in private pharmacies in 16/21 and private shops in 6/21. Most countries use primarily paper-based reporting. Conclusions Most collected malaria incidence data in the Asia Pacific is from government health facilities while data from a wide variety of other known sources are often not included in national surveillance databases. In particular, there needs to be a concerted regional effort to support inclusion of data on mobile and migrant populations and the private sector. There should also be an emphasis on electronic reporting and data harmonization across organizations. This will provide a more accurate and up to date picture of the true burden and distribution of malaria and will be of great assistance in helping realize the goal of malaria elimination in the Asia Pacific by 2030.
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Affiliation(s)
- Chris Erwin G Mercado
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nattwut Ekapirat
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Arjen M Dondorp
- 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, University of Oxford, Oxford, UK
| | - Richard J Maude
- 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, University of Oxford, Oxford, UK. .,Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA.
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Folegatti PM, Siqueira AM, Monteiro WM, Lacerda MVG, Drakeley CJ, Braga ÉM. A systematic review on malaria sero-epidemiology studies in the Brazilian Amazon: insights into immunological markers for exposure and protection. Malar J 2017; 16:107. [PMID: 28270152 PMCID: PMC5341168 DOI: 10.1186/s12936-017-1762-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/28/2017] [Indexed: 01/11/2023] Open
Abstract
Background Considerable success in reducing malaria incidence and mortality has been achieved in Brazil, leading to discussions over the possibility of moving towards elimination. However, more than reporting and counting clinical cases, elimination will require the use of efficient tools and strategies for measuring transmission dynamics and detecting the infectious reservoir as the primary indicators of interest for surveillance and evaluation. Because acquisition and maintenance of anti-malarial antibodies depend on parasite exposure, seroprevalence rates could be used as a reliable tool for assessing malaria endemicity and an adjunct measure for monitoring transmission in a rapid and cost-effective manner. Methods This systematic review synthesizes the existing literature on seroprevalence of malaria in the Brazilian Amazon Basin. Different study designs (cross-sectional surveys and longitudinal studies) with reported serological results in well-defined Brazilian populations were considered. Medline (via PubMed), EMBASE and LILACS databases were screened and the articles were included per established selection criteria. Data extraction was performed by two authors and a modified critical appraisal tool was applied to assess the quality and completeness of cross-sectional studies regarding defined variables of interest. Results From 220 single records identified, 23 studies were included in this systematic review for the qualitative synthesis. Five studies reported serology results on Plasmodium falciparum, 14 papers assessed Plasmodium vivax and four articles reported results on both Plasmodium species. Considerable heterogeneity among the evaluated malarial antigens, including sporozoite and blood stage antigens, was observed. The majority of recent studies analysed IgG responses against P. vivax antigens reflecting the species distribution pattern in Brazil over the last decades. Most of the published papers were cross-sectional surveys (73.9%) and only six cohort studies were included in this review. Three studies pointed to an association between antibodies against circumsporozoite protein of both P. falciparum and P. vivax and malaria exposure. Furthermore, five out 13 cross-sectional studies evidenced a positive association between IgG antibodies to the conserved 19-kDa C-terminal region of the merozoite surface protein 1 of P. vivax (PvMSP119) and malaria exposure. Conclusions This systematic review identifies potential biomarkers of P. falciparum and P. vivax exposure in areas with variable and unstable malaria transmission in Brazil. However, this study highlights the need for standardization of further studies to provide an ideal monitoring tool to evaluate trends in malaria transmission and the effectiveness of malaria intervention programmes in Brazil. Moreover, the score-based weighted tool developed and used in this study still requires further validation.
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Affiliation(s)
- Pedro M Folegatti
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - André M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Wuelton M Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Marcus Vinícius G Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Instituto de Pesquisas Leônidas e Maria Deane, Manaus, Amazonas, Brazil
| | - Chris J Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Érika M Braga
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Departamento de Parasitologia, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil.
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Merkord CL, Liu Y, Mihretie A, Gebrehiwot T, Awoke W, Bayabil E, Henebry GM, Kassa GT, Lake M, Wimberly MC. Integrating malaria surveillance with climate data for outbreak detection and forecasting: the EPIDEMIA system. Malar J 2017; 16:89. [PMID: 28231803 PMCID: PMC5324298 DOI: 10.1186/s12936-017-1735-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/11/2017] [Indexed: 11/19/2022] Open
Abstract
Background Early indication of an emerging malaria epidemic can provide an opportunity for proactive interventions. Challenges to the identification of nascent malaria epidemics include obtaining recent epidemiological surveillance data, spatially and temporally harmonizing this information with timely data on environmental precursors, applying models for early detection and early warning, and communicating results to public health officials. Automated web-based informatics systems can provide a solution to these problems, but their implementation in real-world settings has been limited. Methods The Epidemic Prognosis Incorporating Disease and Environmental Monitoring for Integrated Assessment (EPIDEMIA) computer system was designed and implemented to integrate disease surveillance with environmental monitoring in support of operational malaria forecasting in the Amhara region of Ethiopia. A co-design workshop was held with computer scientists, epidemiological modelers, and public health partners to develop an initial list of system requirements. Subsequent updates to the system were based on feedback obtained from system evaluation workshops and assessments conducted by a steering committee of users in the public health sector. Results The system integrated epidemiological data uploaded weekly by the Amhara Regional Health Bureau with remotely-sensed environmental data freely available from online archives. Environmental data were acquired and processed automatically by the EASTWeb software program. Additional software was developed to implement a public health interface for data upload and download, harmonize the epidemiological and environmental data into a unified database, automatically update time series forecasting models, and generate formatted reports. Reporting features included district-level control charts and maps summarizing epidemiological indicators of emerging malaria outbreaks, environmental risk factors, and forecasts of future malaria risk. Conclusions Successful implementation and use of EPIDEMIA is an important step forward in the use of epidemiological and environmental informatics systems for malaria surveillance. Developing software to automate the workflow steps while remaining robust to continual changes in the input data streams was a key technical challenge. Continual stakeholder involvement throughout design, implementation, and operation has created a strong enabling environment that will facilitate the ongoing development, application, and testing of the system.
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Affiliation(s)
- Christopher L Merkord
- Geospatial Sciences Center of Excellence, South Dakota State University, Brookings, SD, USA
| | - Yi Liu
- Department of Electrical Engineering and Computer Science, South Dakota State University, Brookings, SD, USA
| | - Abere Mihretie
- Health, Development, and Anti-Malaria Association, Addis Ababa, Ethiopia
| | | | - Worku Awoke
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Estifanos Bayabil
- Health, Development, and Anti-Malaria Association, Addis Ababa, Ethiopia
| | - Geoffrey M Henebry
- Geospatial Sciences Center of Excellence, South Dakota State University, Brookings, SD, USA
| | | | - Mastewal Lake
- Amhara National Regional State Health Bureau, Bahir Dar, Ethiopia
| | - Michael C Wimberly
- Geospatial Sciences Center of Excellence, South Dakota State University, Brookings, SD, USA.
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Wang D, Cotter C, Sun X, Bennett A, Gosling RD, Xiao N. Adapting the local response for malaria elimination through evaluation of the 1-3-7 system performance in the China-Myanmar border region. Malar J 2017; 16:54. [PMID: 28137293 PMCID: PMC5282924 DOI: 10.1186/s12936-017-1707-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Assessing the essential components of ‘1-3-7’ strategy along the China–Myanmar border is critical to identify gaps and challenges to support evidence-based decision making. Methods A mixed-method retrospective study including quantitative and qualitative analysis of the 1-3-7 system components was conducted. Sampled counties were chosen based on malaria incidence from 1 January 2012 to 31 December 2014. Results All 260 confirmed malaria cases from sampled counties were reported within 1 day and had completed case investigations. 70.0% of all Reactive Case Detection (RACD) events were conducted and 90.1% of those were within 7 days. Only ten additional individuals were found malaria positive out of 3662 individuals tested (0.3%) by rapid diagnostic test during RACD events. Conclusions Key gaps were identified in case investigation and RACD activities in Yunnan Province border counties. This evidence supports improving the RACD (or “7”) response strategy in this setting. Given the challenges in this border region, it will be critical to adapt the RACD response to promote the malaria elimination along the China border. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1707-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duoquan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Pathology, World Health Organization Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, People's Republic of China
| | - Chris Cotter
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Xiaodong Sun
- Yunnan Institute of Parasitic Diseases, Puer, 665000, People's Republic of China
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Roly D Gosling
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Ning Xiao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Pathology, World Health Organization Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, People's Republic of China.
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Stresman G, Cameron A, Drakeley C. Freedom from Infection: Confirming Interruption of Malaria Transmission. Trends Parasitol 2017; 33:345-352. [PMID: 28108199 DOI: 10.1016/j.pt.2016.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/02/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
The global reductions in disease burden and the continued spread of drug and insecticide resistance make malaria elimination both viable and imperative, although this may be more easily achieved in some settings compared to others. Whilst the focus has been on optimal approaches to achieve elimination, less attention has been paid to how to measure the absence of malaria. Measuring the absence of transmission poses a specific challenge in that it involves proving a negative. The concept of freedom from infection, routinely used in veterinary epidemiology, can provide quantitative and reproducible estimates that, if infections were present above a predefined (low) threshold, they would be detected with a known uncertainty. Additionally, these methods are adaptable for both passively and actively collected data as well as combining information when multiple surveillance streams are available. Here we discuss the potential application of this approach to malaria.
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Affiliation(s)
- Gillian Stresman
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
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Liyanage H, Liaw ST, Di Iorio CT, Kuziemsky C, Schreiber R, Terry AL, de Lusignan S. Building a Privacy, Ethics, and Data Access Framework for Real World Computerised Medical Record System Data: A Delphi Study. Contribution of the Primary Health Care Informatics Working Group. Yearb Med Inform 2016:138-145. [PMID: 27830242 DOI: 10.15265/iy-2016-035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Privacy, ethics, and data access issues pose significant challenges to the timely delivery of health research. Whilst the fundamental drivers to ensure that data access is ethical and satisfies privacy requirements are similar, they are often dealt with in varying ways by different approval processes. OBJECTIVE To achieve a consensus across an international panel of health care and informatics professionals on an integrated set of privacy and ethics principles that could accelerate health data access in data-driven health research projects. METHOD A three-round consensus development process was used. In round one, we developed a baseline framework for privacy, ethics, and data access based on a review of existing literature in the health, informatics, and policy domains. This was further developed using a two-round Delphi consensus building process involving 20 experts who were members of the International Medical Informatics Association (IMIA) and European Federation of Medical Informatics (EFMI) Primary Health Care Informatics Working Groups. To achieve consensus we required an extended Delphi process. RESULTS The first round involved feedback on and development of the baseline framework. This consisted of four components: (1) ethical principles, (2) ethical guidance questions, (3) privacy and data access principles, and (4) privacy and data access guidance questions. Round two developed consensus in key areas of the revised framework, allowing the building of a newly, more detailed and descriptive framework. In the final round panel experts expressed their opinions, either as agreements or disagreements, on the ethics and privacy statements of the framework finding some of the previous round disagreements to be surprising in view of established ethical principles. CONCLUSION This study develops a framework for an integrated approach to ethics and privacy. Privacy breech risk should not be considered in isolation but instead balanced by potential ethical benefit.
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Affiliation(s)
| | | | | | | | | | | | - S de Lusignan
- Simon de Lusignan, Professor of Primary Care and Clinical Informatics, Department of Clinical & Experimental Medicine, University of Surrey, GUILDFORD, Surrey GU2 7XH, UK, E-mail:
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