Development and evaluation of a spatial decision support system for malaria elimination in Bhutan

Abstract

BackgroundBhutan has reduced its malaria incidence significantly in the last 5 years, and is aiming for malaria elimination by 2016. To assist with the management of the Bhutanese malaria elimination programme a spatial decision support system (SDSS) was developed. The current study aims to describe SDSS development and evaluate SDSS utility and acceptability through informant interviews.MethodsThe SDSS was developed based on the open-source Quantum geographical information system (QGIS) and piloted to support the distribution of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) in the two sub-districts of Samdrup Jongkhar District. It was subsequently used to support reactive case detection (RACD) in the two sub-districts of Samdrup Jongkhar and two additional sub-districts in Sarpang District. Interviews were conducted to ascertain perceptions on utility and acceptability of 11 informants using the SDSS, including programme and district managers, and field workers.ResultsA total of 1502 households with a population of 7165 were enumerated in the four sub-districts, and a total of 3491 LLINs were distributed with one LLIN per 1.7 persons. A total of 279 households representing 728 residents were involved with RACD. Informants considered that the SDSS was an improvement on previous methods for organizing LLIN distribution, IRS and RACD, and could be easily integrated into routine malaria and other vector-borne disease surveillance systems. Informants identified some challenges at the programme and field level, including the need for more skilled personnel to manage the SDSS, and more training to improve the effectiveness of SDSS implementation and use of hardware.ConclusionsThe SDSS was well accepted and informants expected its use to be extended to other malaria reporting districts and other vector-borne diseases. Challenges associated with efficient SDSS use included adequate skills and knowledge, access to training and support, and availability of hardware including computers and global positioning system receivers.

What Do Users Really Need? Participatory Development of Decision Support Tools for Environmental Management Based on Outcomes

“…These have been included because there are many spatial decision support applications built around these platforms, see e.g., for ArcMap [19,54] and for QGIS [55,56], but unfortunately, we found both of these to be poorly adapted to touchscreen environments, both in terms of operation (sluggish and buggy) and in terms of the user interface (tiny buttons, missing right mouse button functionality). The 3D Community Viz Public Participation GIS plugin for ArcMap was unusable on our touch table.…”

Ending Malaria Transmission in the Asia Pacific Malaria Elimination Network (APMEN) Countries: Challenges and the Way Forward

“…Malaria control in border areas is often difficult for being heavily forested, mountainous and inaccessible terrain, and unregulated population movements across the borders [103,104]. Open porous international borders allow unchecked movement of people [105][106][107][108][109][110][111]. Such cross-border migration is likely to derail the malaria control activities of the neighbouring countries and risk introduction of drugresistant parasites [112].…”

“…In recent years, spatial decision support systems (SDSSs) have been increasingly used in malaria elimination programmes in some countries of Asia-Pacific region to support planning, monitoring and evaluation, including Vanuatu, Solomon Islands and Bhutan [110,165]. SDSSs have also been employed for other vector-borne disease control programmes such as dengue in Thailand and Singapore [166][167][168].…”

“…Framework of spatial decision support system for malaria control and prevention with potential use in other vector borne diseases. (GIS geographical information system, PDA personnel digital assistant, GPS global positioning system, SDSS spatial decision support system, GR geographic reconnaissance, LLIN long-lasting insecticidal net, IRS indoor residual spraying, PCD passive case detection, RACD active case detection, JE Japanese encephalitis) (Wangdi et al [110]).…”

“…Passive case detection (PCD) could capture imported cases and allow interventions that would prevent resurgence in the presence of robust health system [175]. However, in areas with high transmission intensities in APMEN countries [70,176], and unchecked migration across borders [103][104][105][106][107][108][109][110][111], there is likely to be significant transmission even in low transmission settings. Therefore, imported infections must be prevented through border screening, regional and cross-border initiatives and dialogue, proactive case detection, and treatment in high-risk population groups and travellers preventing resurgence of the disease [177].…”