Improved access to early diagnosis and complete treatment of malaria in Odisha, India

Pradhan, Sreya; Pradhan, Mohan Kumar; Dutta, Ambarish; Shah, Naman K.; Joshi, Priyanka; Pradhan, Khageshwar; Sharma, S. K.; Daumerie, Penny Grewal; Banerji, Jaya; Duparc, Stephan; Mendis, Kamini; Murugasampillay, Shiva; Valecha, Neena; Anvikar, Anupkumar R.

doi:10.1371/journal.pone.0208943

Cited by 20 publications

(23 citation statements)

References 19 publications

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“…early diagnosis and complete treatment, vector control using LLIN/IRS/Larvivorous fishes, IEC/BCC, Mass Screening and Treatment (MSAT). Evidence shows that strengthening surveillance may control the malaria leading to elimination [ 8 , 33 – 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…In Odisha, an initiative to reduce asymptomatic reservoirs from the community was undertaken through the "Durgam Anchalare Malaria Nirakarana" (DAMaN) project [7]. The CCMP approach for early detection and treatment of malaria along with DAMaN initiative resulted in reducing the size of infectious reservoirs [8]. The strengthening of malaria case management system through community-based intervention has been also implemented in various countries for malaria control [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Demonstration of indigenous malaria elimination through Track-Test-Treat-Track (T4) strategy in a Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh

Bharti

Rajvanshi²,

Nisar³

et al. 2020

Malar J

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Background Many malaria endemic countries are heading towards malaria elimination through the use of case management and vector control strategies, which employ surveillance, improving access to early diagnosis, prompt treatment., and integrated vector control measures. There is a consensus that elimination of malaria is feasible when rapid detection and prompt treatment is combined with mosquito-human contact interruption in an efficient and sustainable manner at community levels. This paper describes results of an integrated case management and vector control strategy for reducing malaria cases in 1233 villages over 3 years in district Mandla, Madhya Pradesh, India. Methods The project enrolled the entire population (1,143,126) of Mandla district for fever surveillance followed by testing of febrile cases and treatment of positive subjects using T4 strategy, which is Track (by fever), Test (by RDTs), Treat (by ACT) and Track (for completion of treatment). In addition to the active and passive surveillance for detection and treatment of febrile cases, the project conducted mass screening and treatment to clear the asymptomatic reservoirs of infection. Febrile cases were also tested in the out-patient department of the District Hospital from June 2018 to September, 2018 and in a community-based medical camp from November 7 to 14, 2019. The project also used vector control measures for interrupting human-mosquito contact, and information, education and communication (IEC) campaigns to increase demand for malaria services at community level. Results This project has revealed about 91% reduction of indigenous cases of malaria during the period from June 2017 to May 2020, through case management and vector control strategies. A total 357,143 febrile cases were screened, out of which 0.19% were found positive for the presence of malaria parasites, with Plasmodium falciparum and Plasmodium vivax ratio of 62:38. The prevalence of malaria was higher in individuals > 15 years of age (69% cases). The positivity rate was 0.33% in 2017–18, 0.13% in 2018–19, and 0.06% in 2019–20. In all of the 3 years of the project, the peak transmission correlated with rains. Mass screening revealed 0.18% positivity in Sep-Oct 2018, followed by 0.06% in June 2019, and 0.03% in December 2019, and these were mostly asymptomatic cases in the community. Imported cases into the district were mostly contributed by the distant state of Telangana (51.13%). Fever patients tested for malaria parasites in the District Hospital and medical camp revealed zero cases. Conclusion Using the current intervention and prevention tools along with optimum utilization of human resources, a 91% reduction in indigenous cases of malaria was seen in the district in 3 years. The reduction was similar in the three high prevalence blocks of the district. These results reveal that malaria elimination is achievable in India within a stipulated time frame. The reduction of malaria at the community level was further validated when zero malaria cases were diagnosed during hospital and community-based studies in Mandla. Prompt detection and treatment of imported/migratory cases may have prevented outbreaks in the district. This project has demonstrated that field programmes backed by adequate technical, management, operational, and financial controls with robust monitoring are needed for achieving malaria elimination.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Demonstration of indigenous malaria elimination through Track-Test-Treat-Track (T4) strategy in a Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh

Bharti

Rajvanshi²,

Nisar³

et al. 2020

Malar J

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“…A feature that consistently stood out is that malaria control in large swathes of Odisha is operationally difficult, as significant portion of the land has hilly terrain, forest cover with poor communication facilities along with left-wing extremism; and a large section of the residents of these hard-to-reach areas are indigenous tribal people [7], who often live in widely scattered small hamlets. This historically has been rendering many such malaria endemic villages poor accessibility to malaria services [14].…”

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confidence: 99%

“…In 2013, the Comprehensive Case Management Project (CCMP), an operational research initiative, was started by NVBDCP, Odisha in collaboration with National Institute of Malaria Research, with support from Medicines for Malaria Venture and WHO [14]. CCMP showed that high endemic hard-to-reach villages had sub-optimal malaria surveillance, often displaying misleadingly low reporting of cases due to under-detection, and thus ultimately leading to persistence of malaria reservoir in those pockets.…”

Section: A1111111111 A1111111111 A1111111111 A1111111111 A1111111111mentioning

confidence: 99%

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

et al. 2020

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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.

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“…It can be a key factor in tribal populations and remote geographies in which most of the malaria exists in India and other LMICs. Detection by CHWs has been a big part of the success achieved in malaria-management by another Indian state, Odisha [36,37].…”

Section: Discussionmentioning

confidence: 99%

Coverage of community case management for malaria through CHWs: a quantitative assessment using primary household surveys of high-burden areas in Chhattisgarh state of India

Garg

Gurung

Dewangan

et al. 2020

Malar J

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Background: Community Case Management of Malaria (CCMM) has been implemented through community health workers (CHWs) in many countries. Existing studies have shown that CHWs can be viable means of implementing CCMM. However, not many studies have examined the coverage under large-scale CCMM programmes. India is a big contributor to global malaria burden. Chhattisgarh is a leading state in India in terms of malaria incidence and mortality. CCMM was implemented on a large scale through the 'mitanin' CHWs in rural Chhattisgarh from 2015. Under CCMM, 37,696 CHWs in 84 high-burden administrative blocks of the state were trained and equipped with rapid diagnostic tests (RDT), artemisinin-based combination therapy (ACT) and chloroquine. Methods: This descriptive quantitative study assesses coverage of CCMM in detection and treatment of Malaria over three rounds of household surveys-2015, 2016 and 2018. Household-interviews covered more than 15,000 individuals in each round, using multi-stage random sampling across the 84 blocks. The main objectives were to find out the coverage in identification and treatment of malaria and the share of CHWs in them. A 15-days recall was used to find out cases of fever and healthcare sought by them. Results: In 2018, 62% of febrile cases in rural population contacted CHWs. RDT, ACT and chloroquine were available with 96%, 80% and 95% of CHWs, respectively. From 2015 to 2018, the share of CHWs in testing of febrile cases increased from 34 to 70%, while it increased from 28 to 69% in treatment of malaria cases. CHWs performed better than other providers in treatment-completion and administered medication under direct observation to 72% of cases they treated. Conclusion: This study adds to one of the most crucial but relatively less reported area of CCMM programmes, i.e. the extent of coverage of the total febrile population by CHWs, which subsequently determines the actual coverage of case-management in malaria. Mitanin-CHWs achieved high coverage and treatment-completion rates that were rarely reported in context of large-scale CCMM elsewhere. Close to community, well-trained CHWs with sufficient supplies of rapid tests and anti-malarial drugs can play a key role in achieving the desired coverage in malaria-management.

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Improved access to early diagnosis and complete treatment of malaria in Odisha, India

Cited by 20 publications

References 19 publications

Demonstration of indigenous malaria elimination through Track-Test-Treat-Track (T4) strategy in a Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh

Demonstration of indigenous malaria elimination through Track-Test-Treat-Track (T4) strategy in a Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh

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

Coverage of community case management for malaria through CHWs: a quantitative assessment using primary household surveys of high-burden areas in Chhattisgarh state of India

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