Targeting populations at higher risk for malaria: a survey of national malaria elimination programmes in the Asia Pacific

Abstract

BackgroundSignificant progress has been made in reducing the malaria burden in the Asia Pacific region, which is aggressively pursuing a 2030 regional elimination goal. Moving from malaria control to elimination requires National Malaria Control Programmes (NMCPs) to target interventions at populations at higher risk, who are often not reached by health services, highly mobile and difficult to test, treat, and track with routine measures, and if undiagnosed, can maintain parasite reservoirs and contribute to ongoing transmission.MethodsA qualitative, free-text questionnaire was developed and disseminated among 17 of the 18 partner countries of the Asia Pacific Malaria Elimination Network (APMEN).ResultsAll 14 countries that responded to the survey identified key populations at higher risk of malaria in their respective countries. Thirteen countries engage in the dissemination of malaria-related Information, Education, and Communication (IEC) materials. Eight countries engage in diagnostic screening, including of mobile and migrant workers, military staff, and/or overseas workers. Ten countries reported distributing or recommending the use of long-lasting insecticide-treated nets (LLINs) among populations at higher risk with fewer countries engaging in other prevention measures such as indoor residual spraying (IRS) (two countries), spatial repellents (four countries), chemoprophylaxis (five countries), and mass drug administration (MDA) (three countries). Though not specifically tailored to populations at higher risk, 11 countries reported using mass blood surveys as a surveillance tool and ten countries map case data. Most NMCPs lack a monitoring and evaluation structure.ConclusionCountries in the Asia Pacific have identified populations at higher risk and targeted interventions to these groups but there is limited information on the effectiveness of these interventions. Platforms like APMEN offer the opportunity for the sharing of protocols and lessons learned related to finding, targeting and successfully clearing malaria from populations at higher risk. The sharing of programme data across borders may further strengthen national and regional efforts to eliminate malaria. This exchange of real-life experience is invaluable to NMCPs when scarce scientific evidence on the topic exists to aid decision-making and can further support NMCPs to develop strategies that will deliver a malaria-free Asia Pacific by 2030.

Defining Malaria Risks Among Forest Workers in Aceh, Indonesia: A Formative Assessment

“…Their treatment-seeking behaviours provide insights for the Indonesian malaria programme, as the country prepares for malaria elimination in 2030. Globally, as national malaria programs seek to address suspected high-risk groups with which they have little previous familiarity, rapid, formative assessment studies such as this one are an increasingly relevant rst step to crafting effective elimination strategies [8,15], as they have been in the HIV context [17][18][19].…”

“…Mean age of male forest workers was 32 years (range 18 to 56), whilst mean age of other KIs was 37 years (range 19 to 73) with a male to female ratio of 1.8 to 1. Forty-one individuals (34 males and 7 females) contacted declined to participate due to work activities in the forest (17), immediate family matters (11), uncontactable (8), and unwell (5) on the assigned day of group discussions. plantations and up to one month at plantations located deeper in the forest, in part to work and in part to guard their crops from animals.…”

Malaria epidemiology in central Myanmar: identification of a multi-species asymptomatic reservoir of infection

“…Forest work is an established risk factor for malaria transmission [37]. Plasmodium knowlesi is particularly associated with forest malaria, due to the outdoor biting habits of P. knowlesi vectors and the natural primate reservoirs living in forests [38].…”

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

“…Cross-border movement of populations impacts the maintenance of 'hotspots' of high transmission along international borders [77,94,97,108,137,[197][198][199][200], and spread of drug-resistance seen along the international border of Thailand and Cambodia [201]. Then, cross-border initiatives should be initiated through sharing of programme data including insecticide resistance, blood testing at the border areas, and treatment of symptomatic cases [177,[202][203][204][205][206][207][208]. Such successful cross-border case studies in the region have led to significant reduction in malaria burden in the study areas [209].…”