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Bansil P, Yeshiwondim AK, Guinovart C, Serda B, Scott C, Tesfay BH, Agmas A, Bezabih B, Zeleke MT, Guesses GS, Ayenew AL, Workie WM, Earle D, Steketee RW, Getachew A. Malaria case investigation with reactive focal testing and treatment: operational feasibility and lessons learned from low and moderate transmission areas in Amhara Region, Ethiopia. Malar J 2018; 17:449. [PMID: 30514307 PMCID: PMC6278130 DOI: 10.1186/s12936-018-2587-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/06/2018] [Accepted: 11/22/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND When malaria transmission is very low, investigation of passively detected malaria cases and reactive focal testing and treatment (FTAT) in the case and neighbouring households can identify and contain the source and spread of infections. METHODS Case investigation with reactive FTAT for malaria was implemented in 10 villages in Amhara Region, Ethiopia during the 2014/2015 malaria transmission season. Intervention villages were purposively selected based on the incidence of passively detected Plasmodium falciparum and mixed infections (P. falciparum and Plasmodium vivax) during the 2013 transmission season. A passively detected P. falciparum or mixed index case triggered an investigation that targeted the index case household and the closest 10 neighbouring households in a 100-m radius. All consenting household members received a rapid diagnostic test (RDT) and RDT-positive individuals received artemether-lumefantrine (P. falciparum, mixed) or chloroquine (P. vivax). RESULTS From October 2014 to February 2015, 407 P. falciparum or mixed index cases (approximately 6.5 per 1000 population) were passively detected. Of these, 220 (54.1%) were investigated, of which 87.3% were male, 61.8% were age 20-39 years [median age: 27 years (range 1-90)], and 58.6% spent ≥ 1 night away from home in the past month (ranging from 0.0 to 94.1% by village). Among the 4077 residents in the 914 households investigated, 3243 (79.5%) received an RDT and 127 (3.9%) were RDT-positive (2.2% P. falciparum, 0.5% P. vivax, 1.2% mixed). Three epidemiological patterns were found. In six villages, there were almost no cases, with less than 10 index and secondary cases. In three villages, most index cases had a history of travel (> 62%), but there were a small number of secondary cases (< 10). Lastly, in one village none of the index cases had a history of recent travel and there was a large number of secondary cases (n = 105). CONCLUSIONS Three types of malaria transmission patterns were observed: (1) low importation and low local transmission; (2) high importation and low local transmission; and, (3) low importation and high local transmission. To achieve malaria elimination in Amhara Region, intervention strategies targeting these different patterns of transmission and population movement are required.
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Affiliation(s)
- Pooja Bansil
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA.
| | - Asnakew K Yeshiwondim
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Addis Ababa, Ethiopia
| | - Caterina Guinovart
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Belendia Serda
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Addis Ababa, Ethiopia
| | - Callie Scott
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Berhane H Tesfay
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Addis Ababa, Ethiopia
| | - Adem Agmas
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Addis Ababa, Ethiopia
| | - Belay Bezabih
- Amhara National Regional State Health Bureau, Bahir Dar, Ethiopia
| | - Melkamu T Zeleke
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Addis Ababa, Ethiopia
| | - Girma S Guesses
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Addis Ababa, Ethiopia
| | - Asmamaw L Ayenew
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Addis Ababa, Ethiopia
| | - Worku M Workie
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Addis Ababa, Ethiopia
| | - Duncan Earle
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Rick W Steketee
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Asefaw Getachew
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Addis Ababa, Ethiopia
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Scott CA, Yeshiwondim AK, Serda B, Guinovart C, Tesfay BH, Agmas A, Zeleke MT, Guesses GS, Ayenew AL, Workie WM, Steketee RW, Earle D, Bezabih B, Getachew A. Mass testing and treatment for malaria in low transmission areas in Amhara Region, Ethiopia. Malar J 2016; 15:305. [PMID: 27255330 PMCID: PMC4890322 DOI: 10.1186/s12936-016-1333-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 01/08/2016] [Accepted: 05/10/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In areas with ongoing malaria transmission, strategies to clear parasites from populations can reduce infection and transmission. The objective of this paper was to describe a malaria mass testing and treatment (MTAT) intervention implemented in six kebeles (villages) in Amhara Region, Ethiopia, at the beginning of the 2014 transmission season. METHODS Intervention kebeles were selected based on incidence of passively detected Plasmodium falciparum and mixed (P. falciparum and P. vivax) malaria cases during the 2013 malaria transmission season. All households in intervention kebeles were targeted; consenting residents received a rapid diagnostic test (RDT) and RDT-positive individuals received artemether-lumefantrine for P. falciparum/mixed infections or chloroquine for P. vivax. Data were collected on MTAT participation, sociodemographic characteristics, malaria risk factors, and RDT positivity. RESULTS Of 9162 households targeted, 7974 (87.0 %) participated in the MTAT. Among the 35,389 residents of these households, 30,712 (86.8 %) received an RDT. RDT-positivity was 1.4 % (0.3 % P. vivax, 0.7 % P. falciparum, 0.3 % mixed), ranging from 0.3 to 5.1 % by kebele; 39.4 % of RDT-positive individuals were febrile, 28.5 % resided in the same household with another RDT-positive individual, 23.0 % were not protected by vector control interventions [mosquito net or indoor residual spray (IRS)], and 7.1 % had travel history. For individuals under 10 years of age, the odds of being RDT-positive was significantly higher for those with fever, recent use of anti-malarial drugs or residing in the same household with another RDT-positive individual; 59.0 % of RDT-positive individuals had at least one of these risk factors. For individuals 10 years of age and older, the odds of being RDT positive was significantly higher for those with reported travel, fever, recent use of anti-malarial drugs, no use of vector control, and those residing in the same household as another RDT-positive individual; 71.2 % of RDT-positive individuals had at least one of these risk factors. CONCLUSIONS In the Ethiopia setting, an MTAT intervention is operationally feasible and can be conducted with high coverage. RDT-positivity is low and varies widely by kebele. While several risk factors are significantly associated with RDT-positivity, there are still many RDT-positive individuals who do not have any of these risk factors. Strategies that target populations for testing and treatment based on these risk factors alone are likely to leave many infections undetected.
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Affiliation(s)
- Callie A Scott
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Asnakew K Yeshiwondim
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Belendia Serda
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Caterina Guinovart
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA.
| | - Berhane H Tesfay
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Adem Agmas
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Melkamu T Zeleke
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Girma S Guesses
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Asmamaw L Ayenew
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Worku M Workie
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
| | - Richard W Steketee
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
| | - Duncan Earle
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Stand #16806, Trinity Park, Alick Nkhata Road, Mass Media Area, Lusaka, 10101, Zambia
| | - Belay Bezabih
- Amhara National Regional State Health Bureau, P.O. Box 495, Bahir Dar, Ethiopia
| | - Asefaw Getachew
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia
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