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Chang W, Cohen J, Wang DQ, Abdulla S, Mahende MK, Gavana T, Scott V, Msuya HM, Mwanyika-Sando M, Njau RJA, Lu SN, Temu S, Masanja H, Anthony W, Aregawi W M, Sunder N, Kun T, Bruxvoort K, Kitau J, Kihwele F, Chila G, Michael M, Castro M, Menzies NA, Kim S, Ning X, Zhou XN, Chaki P, Mlacha YP. Impact of 1,7-malaria reactive community-based testing and response (1,7-mRCTR) approach on malaria prevalence in Tanzania. Infect Dis Poverty 2023; 12:116. [PMID: 38105258 PMCID: PMC10726614 DOI: 10.1186/s40249-023-01166-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Progress in malaria control has stalled in recent years and innovative surveillance and response approaches are needed to accelerate malaria control and elimination efforts in endemic areas of Africa. Building on a previous China-UK-Tanzania pilot study on malaria control, this study aimed to assess the impact of the 1,7-malaria Reactive Community-Based Testing and Response (1,7-mRCTR) approach implemented over two years in three districts of Tanzania. METHODS The 1,7-mRCTR approach provides community-based malaria testing via rapid diagnostic tests and treatment in villages with the highest burden of malaria incidence based on surveillance data from health facilities. We used a difference-in-differences quasi-experimental design with linear probability models and two waves of cross-sectional household surveys to assess the impact of 1,7-mRCTR on malaria prevalence. We conducted sensitivity analyses to assess the robustness of our results, examined how intervention effects varied in subgroups, and explored alternative explanations for the observed results. RESULTS Between October 2019 and September 2021, 244,771 community-based malaria rapid tests were completed in intervention areas, and each intervention village received an average of 3.85 rounds of 1-7mRCTR. Malaria prevalence declined from 27.4% at baseline to 11.7% at endline in the intervention areas and from 26.0% to 16.0% in the control areas. 1,7-mRCTR was associated with a 4.5-percentage-point decrease in malaria prevalence (95% confidence interval: - 0.067, - 0.023), equivalent to a 17% reduction from the baseline. In Rufiji, a district characterized by lower prevalence and where larviciding was additionally provided, 1,7-mRCTR was associated with a 63.9% decline in malaria prevalence. CONCLUSIONS The 1,7-mRCTR approach reduced malaria prevalence. Despite implementation interruptions due to the COVID-19 pandemic and supply chain challenges, the study provided novel evidence on the effectiveness of community-based reactive approaches in moderate- to high-endemicity areas and demonstrated the potential of South-South cooperation in tackling global health challenges.
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Affiliation(s)
- Wei Chang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jessica Cohen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Duo-Quan Wang
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, People's Republic of China
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Chinese Center for Tropical Diseases Research, Shanghai, People's Republic of China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, People's Republic of China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, People's Republic of China
| | - Salim Abdulla
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Muhidin Kassim Mahende
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Tegemeo Gavana
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Valerie Scott
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hajirani M Msuya
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | | | - Ritha John A Njau
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Shen-Ning Lu
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, People's Republic of China
- Chinese Center for Tropical Diseases Research, Shanghai, People's Republic of China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, People's Republic of China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, People's Republic of China
| | - Silas Temu
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Honorati Masanja
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | | | - Maru Aregawi W
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | | | - Tang Kun
- Vanke School of Public Health, Tsinghua University, Beijing, People's Republic of China
| | - Katia Bruxvoort
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jovin Kitau
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Fadhila Kihwele
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Godlove Chila
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Mihayo Michael
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Marcia Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sein Kim
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiao Ning
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, People's Republic of China
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Chinese Center for Tropical Diseases Research, Shanghai, People's Republic of China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, People's Republic of China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, People's Republic of China
| | - Xiao-Nong Zhou
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, People's Republic of China
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Chinese Center for Tropical Diseases Research, Shanghai, People's Republic of China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, People's Republic of China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, People's Republic of China
| | - Prosper Chaki
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
- The Pan-African Mosquito Control Association (PAMCA), KEMRI Headquarters, Mbagathi Road, Nairobi, 54840-00200, Kenya
| | - Yeromin P Mlacha
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania.
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Mlacha YP, Wang D, Chaki PP, Gavana T, Zhou Z, Michael MG, Khatib R, Chila G, Msuya HM, Chaki E, Makungu C, Lin K, Tambo E, Rumisha SF, Mkude S, Mahende MK, Chacky F, Vounatsou P, Tanner M, Masanja H, Aregawi M, Hertzmark E, Xiao N, Abdulla S, Zhou XN. Effectiveness of the innovative 1,7-malaria reactive community-based testing and response (1, 7-mRCTR) approach on malaria burden reduction in Southeastern Tanzania. Malar J 2020; 19:292. [PMID: 32799857 PMCID: PMC7429894 DOI: 10.1186/s12936-020-03363-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In 2015, a China-UK-Tanzania tripartite pilot project was implemented in southeastern Tanzania to explore a new model for reducing malaria burden and possibly scaling-out the approach into other malaria-endemic countries. The 1,7-malaria Reactive Community-based Testing and Response (1,7-mRCTR) which is a locally-tailored approach for reporting febrile malaria cases in endemic villages was developed to stop transmission and Plasmodium life-cycle. The (1,7-mRCTR) utilizes existing health facility data and locally trained community health workers to conduct community-level testing and treatment. METHODS The pilot project was implemented from September 2015 to June 2018 in Rufiji District, southern Tanzania. The study took place in four wards, two with low incidence and two with a higher incidence. One ward of each type was selected for each of the control and intervention arms. The control wards implemented the existing Ministry of Health programmes. The 1,7-mRCTR activities implemented in the intervention arm included community testing and treatment of malaria infection. Malaria case-to-suspect ratios at health facilities (HF) were aggregated by villages, weekly to identify the village with the highest ratio. Community-based mobile test stations (cMTS) were used for conducting mass testing and treatment. Baseline (pre) and endline (post) household surveys were done in the control and intervention wards to assess the change in malaria prevalence measured by the interaction term of 'time' (post vs pre) and arm in a logistic model. A secondary analysis also studied the malaria incidence reported at the HFs during the intervention. RESULTS Overall the 85 rounds of 1,7-mRCTR conducted in the intervention wards significantly reduced the odds of malaria infection by 66% (adjusted OR 0.34, 95% CI 0.26,0.44, p < 0001) beyond the effect of the standard programmes. Malaria prevalence in the intervention wards declined by 81% (from 26% (95% CI 23.7, 7.8), at baseline to 4.9% (95% CI 4.0, 5.9) at endline). In villages receiving the 1,7-mRCTR, the short-term case ratio decreased by over 15.7% (95% CI - 33, 6) compared to baseline. CONCLUSION The 1,7-mRCTR approach significantly reduced the malaria burden in the areas of high transmission in rural southern Tanzania. This locally tailored approach could accelerate malaria control and elimination efforts. The results provide the impetus for further evaluation of the effectiveness and scaling up of this approach in other high malaria burden countries in Africa, including Tanzania.
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Affiliation(s)
- Yeromin P Mlacha
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Duoquan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Prosper P Chaki
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania.
| | - Tegemeo Gavana
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Zhengbin Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Mihayo G Michael
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Rashid Khatib
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Godlove Chila
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Hajirani M Msuya
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Exavery Chaki
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Christina Makungu
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Kangming Lin
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Ernest Tambo
- Higher Institute of Health Sciences, Université des Montagnes, Bangangté, BP 208, Cameroon
| | - Susan F Rumisha
- National Institute for Medical Research (NIMR), P.O. Box 9653, Dar es Salaam, Tanzania
| | - Sigsbert Mkude
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Muhidin K Mahende
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Frank Chacky
- National Malaria Control, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Honorati Masanja
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Maru Aregawi
- The Global Malaria Programme (GMP), World Health Organization, Geneva, Switzerland
| | - Ellen Hertzmark
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ning Xiao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Salim Abdulla
- Ifakara Health Institute, P. O. Box 78378, Kiko Avenue, Mikocheni, Dar es Salaam, Tanzania
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Road, Shanghai, 200025, People's Republic of China
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