Assessment of effectiveness of DAMaN: A malaria intervention program initiated by Government of Odisha, India

Abstract

India, a persistently significant contributor to the global malaria burden, rolled out several anti-malaria interventions at the national and state level to control and recently, to eliminate the disease. Odisha, the eastern Indian state with the highest malaria burden experienced substantial gains shown by various anti-malaria initiatives implemented under the National Vector-borne Disease Control Programme (NVBDCP). However, recalcitrant high-transmission "pockets" of malaria persist in hard-to-reach stretches of the state, characterised by limited access to routine malaria surveillance and the forested hilly topography favouring unbridled vector breeding. The prevalence of asymptomatic malaria in such pockets serves as perpetual malaria reservoir, thus hindering its elimination. Therefore, a project with the acronym DAMaN was initiated since 2017 by state NVBDCP, targeting locally identified high endemic 'pockets' in 23 districts. DAMaN comprised biennial mass screening and treatment, provisioning of long-lasting insecticidal net (LLIN) and behavioural change communication. Subsequently, to inform policy, assessment of DAMaN was conceived that aims to estimate the coverage of the various components of the project; the prevalence of malaria, even at sub-patent level especially among pregnant/lactating women and children; and its impact on malaria incidence. A survey of DAMaN beneficiaries will measure coverage; and knowledge and practices related to LLIN; along with collection of blood specimens from a probability sample. A multi-stage stratified clustered sample of 2228 households (~33% having pregnant/lactating women) will be selected from 6 DAMaN districts. Routine DAMaN project data (2017-2018) and NVBDCP data (2013-2018) will be extracted. Rapid Diagnostic Test, Polymerase Chain Reaction and blood smear microscopy will be conducted to detect malarial parasitemia. In addition to measuring DAMaN's coverage and malarial prevalence in DAMaN pockets, its impact will be estimated using pre-post differences and Interrupted Time Series analysis using 2017 as the "inflection" point. The assessment may help to validate the unique strategies employed by DAMaN.

What India can learn from globally successful malaria elimination programmes

“…One of the programmes, the Comprehensive Case Management Plan (CCMP), has been adopted by the government of Odisha as the Durgama Anchalare Malaria Nirakarana (DAMaN) programme for mitigation of malaria in inaccessible areas and has contributed to a remarkable decline in malaria. Biannual screening of malaria in mass surveys and subsequent treatment has been adopted as a programme strategy in this state’s malaria plan 41…”

The effectiveness of malaria camps as part of the Durgama Anchalare Malaria Nirakaran (DAMaN) program in Odisha, India: study protocol for a cluster-assigned quasi-experimental study

“…During the writing of this manuscript, the study protocol of a complementary project 'DAMaN Assessment' was published by colleagues at the Indian Council of Medical Research/Regional Medical Research Centre, Bhubaneswar, India [61].…”

The Impact, Emerging Needs, and New Research Questions Arising from 12 Years of the Center for the Study of Complex Malaria in India

“… 10 In 2017, the Malaria Control Program (MCP) of the Odisha State Government rolled out a large-scale public health initiative called “Durgama Anchalare Malaria Nirakarana (DAMaN)” (“Malaria Elimination in Hard-to-Reach Remote Areas”) in 23 high malaria-endemic districts that targeted approximately 1 million people in 7,000 villages. 11 The three cornerstones of DAMaN are: 1) Mass Screening and Treatment (MSAT) during “Malaria Camps” using a bivalent RDT followed by treatment of RDT-positive cases regardless of fever status; 2) increasing use and distribution of LLINs and IRS; and 3) community education through plays and public health advertisements. Promisingly, implementation of DAMaN has coincided with a drastic reduction of malaria in Odisha.…”