Elements of effective community engagement: lessons from a targeted malaria elimination study in Lao PDR (Laos)

Adhikari, Bipin; Pell, Christopher; Phommasone, Koukeo; Soundala, Xayaphone; Kommarasy, Palingnaphone; Pongvongsa, Tiengkham; Henriques, Gisela; Day, Nicholas P. J.; Mayxay, Mayfong; Cheah, Phaik Yeong

doi:10.1080/16549716.2017.1366136

Cited by 97 publications

(198 citation statements)

References 29 publications

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“…MDA integrated with other approaches such as distribution of LLINs and strengthening community based health services and health workers, can accelerate malaria elimination ( [16][17][18][19]. MDA as an approach has shown mixed results in the history of malaria elimination [8,10,20] and depends upon i) the targeted region's epidemiology of malaria or transmission intensity; ii) geographical characteristics of the malaria endemic regions (islands where mobility of population is minimal have cleared malaria, such as Aneityum, Taiwan); iii) coverage of such an approach with effective community engagement [21,22]; and the challenges could be resistance to antimalarials [19,[23][24][25] as well as lack of support from local authorities.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

Cheng

Okyere

Enos

et al. 2019

Preprint

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Background: Global efforts to scale-up malaria control interventions are gaining steam. These include the use of Long-Lasting Insecticide Nets, Intermittent Preventive Treatment and Test, Treat and Track (T3) using ACTs. Intermittent preventive treatment of children (IPTc) in Ghana has demonstrated a parasite load reduction of 90%. However, unanswered questions include – whether mass treatment of population sub-groups such as IPTc could be scaled-up to whole populations as in mass testing, treatment and tracking (MTTT)? What is needed to implement MTTT at scale? Can MTTT reduce asymptomatic parasitaemia levels in children under 15? And whether MTTT of populations complemented by community-based management of malaria (CBMm) using volunteers could be an effective strategy for malaria control at a lower cost. Methods: A population of 5,000 asymptomatic individuals in seven communities in the Pakro sub-district of Ghana participated in this study. A register was developed for each community following a census. MTTT engaged trained community-based health volunteers (CBHVs) who conducted house-to-house testing using RDTs every four months and treated positive cases with ACTs. Between interventions, CBMm was done on symptomatic cases. Results: MTTT Coverage was 98.8% in July 2017 and 79.3% in July 2018. Of those tested, asymptomatic infection with malaria parasites reduced from 1,795 (36.3%) in July 2017 to 1,303 (32.9%) in July 2018. Implementing MTTT significantly averted asymptomatic parasitaemia by 24% from July 2017 to July 2018 after adjusting for age, ITN use and temperature (OR=0.76, CI=0.67, 0.85 p ≤ 0.001). In comparison, treatment of symptomatic patients at the Health Centre reduced parasitaemia by 9% over the same period which was however, not statistically significant (OR=0.91, CI=0.67, 1.38 p = 0.672). A total of 223 (5.1%) cases were averted in children under 15 years (X² = 9.7, p < 0.002). An important observation was a decrease in hospital attendance, which negatively affected the internally generated funds (IGF) scheme of the participating health facilities. Conclusion: This study has demonstrated that implementing MTTT was feasible and could reduce prevalence of malaria asymptomatic parasitaemia in children under 15 years of age. Furthermore, the use of CBHVs could ensure high coverage at lower cost.

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Section: Introductionmentioning

confidence: 99%

Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

Cheng

Okyere

Enos

et al. 2019

Preprint

View full text Add to dashboard Cite

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“…Without the buy-in of the target population the coverage of mass drug administration can lead to disappointment has been trialled and evaluated. Health education, drama performance, and incentives (for individuals and communities) appear to have been successful, suggesting that the engagement modalities have to be adapted to the requirements of each community [46][47][48][49][50][51][52].…”

Section: Mass Drug Administrationmentioning

confidence: 99%

Tools to accelerate falciparum malaria elimination in Cambodia: a meeting report

Lek

Callery

Nguon

et al. 2020

Malar J

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Cambodia targets malaria elimination by 2025. Rapid elimination will depend on successfully identifying and clearing malaria foci linked to forests. Expanding and maintaining universal access to early diagnosis and effective treatment remains the key to malaria control and ultimately malaria elimination in the Greater Mekong Subregion (GMS) in the foreseeable future. Mass Drug Administration (MDA) holds some promise in the rapid reduction of Plasmodium falciparum infections, but requires considerable investment of resources and time to mobilize the target communities. Furthermore, the most practical drug regimen for MDA in the GMS-three rounds of DHA/piperaquine-has lost some of its efficacy. Mass screening and treatment benefits asymptomatic P. falciparum carriers by clearing chronic infections, but in its current form holds little promise for malaria elimination. Hopes that "highly sensitive" diagnostic tests would provide substantial advances in screen and treat programmes have been shown to be misplaced. To reduce the burden on P. falciparum and Plasmodium vivax infections in people working in forested areas novel approaches to the use of malaria prophylaxis in forest workers should be explored. During an October 2019 workshop in Phnom Penh researchers and policymakers reviewed evidence of acceptability, feasibility and effectiveness of interventions to target malaria foci and interrupt P. falciparum transmission and discussed operational requirements and conditions for programmatic implementation.

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Section: Introductionmentioning

confidence: 99%

Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

Cheng

Okyere

Enos

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Global efforts to scale-up malaria control interventions are gaining steam. These include the use of Long-Lasting Insecticide Nets, Indoor Residual Spraying, Intermittent Preventive Treatment and Test, Treat and Track. Despite these, the drive for malaria elimination is far from being realistic in endemic communities in Africa. This is partly due to the fact that asymptomatic parasite carriage, not specifically targeted by most interventions, remains the bedrock that fuels transmission. This has led to mass testing, treatment and tracking (MTTT) as an alternative strategy to target asymptomatic individuals. We report the impact of MTTT on the prevalence of asymptomatic malaria parasitaemia over a one-year period in Ghana, hypothesizing that implementing MTTT could reduce the rate of asymptomatic parasitaemia. Methods: A population of about 5,000 individuals in seven communities in the Pakro sub-district of Ghana participated in this study. A register was developed for each community following a census. MTTT engaged trained community-based health volunteers who conducted house-to-house testing using RDTs every four months and treated positive cases with Artemisinin–based Combination Therapy. Between interventions, community-based management of malaria was implemented for symptomatic cases. Results: MTTT Coverage was 98.8% in July 2017 and 79.3% in July 2018. Of those tested, asymptomatic infection with malaria parasites reduced from 36.3% (1,795/4941) in July 2017 to 32.9% (1,303/3966) in July 2018 (p=0.001). Prevalence of asymptomatic parasitaemia among children under 15 years declined from 52.6% (1,043/1984) in July 2017 to 47.5% (820/1,728) in July 2018 (p=0.002). Implementing MTTT significantly reduced asymptomatic parasitaemia by 24% from July 2017 to July 2018 after adjusting for age, ITN use and axillary temperature (OR=0.76, CI=0.67, 0.85 p≤0.001). Conclusion: This study has demonstrated that implementing MTTT is feasible and could reduce the prevalence of asymptomatic malaria parasitaemia in children under 15 years of age. Furthermore, the use of community-based health volunteers could ensure high coverage at lower cost of implementation.

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Elements of effective community engagement: lessons from a targeted malaria elimination study in Lao PDR (Laos)

Cited by 97 publications

References 29 publications

Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

Tools to accelerate falciparum malaria elimination in Cambodia: a meeting report

Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

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