The role of early detection and treatment in malaria elimination

Abstract

Falciparum malaria persists in hard-to-reach areas or demographic groups that are missed by conventional healthcare systems but could be reached by trained community members in a malaria post (MP). The main focus of a MP is to provide uninterrupted and rapid access to rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) too all inhabitants of a village. RDTs allow trained community members to perform malaria diagnosis accurately and prescribe appropriate treatment, reducing as much as possible any delay between the onset of fever and treatment. Early treatment with ACT and with a low-dose of primaquine prevents further transmission from human to mosquito. A functioning MP represents an essential component of any malaria elimination strategy. Implementing large-scale, high-coverage, community-based early diagnosis and treatment through MPs requires few technological innovations but relies on a very well structured organization able to train, supervise and supply MPs, to monitor activity and to perform strict malaria surveillance.

Fig. 1

Map of the region of Eastern Myanmar targeted for large scale deployment of community-based EDT by the Malaria Elimination Task Force (METF). Drug and multidrug-resistant falciparum malaria is a major threat in the Thailand-Myanmar border region. In the past drug-resistant malaria has emerged in this area, and other parts of Southeast Asia, and subsequently spread globally. Elimination of falciparum malaria in the region is the only solution to avoid a repeat of history with artemisinin resistance. With this goal in mind, the METF was set up in 2014 and targets over 1200 villages in Eastern Kayin State, Myanmar [18]. The high-level divisions (area, zone) are represented. Each zone corresponds to a territory under the responsibility of one health community-based organization

Fig. 2

Distribution of monthly costs in an METF-supported MP. Costs of METF MP are around US$160, similar to other programs in Myanmar [20]. The costs of training, transportation (supervision, supply, patient referrals), data transmission (smartphone and SMS) and management of the MP network (36 % of total), emphasize the necessary investment on constant availability of supplies, regular monitoring and weekly malaria surveillance in MP. Stock-outs, lack of refresher trainings and/or monitoring visits have been reported as major risks for losing the trust of the communities and demotivation of workers in other programs of malaria EDT [40, 41], and are a major threat to elimination programs (see also “Challenges” section)