Predictors of malaria rapid diagnostic test positivity in a high burden area of Paletwa Township, Chin State in Western Myanmar

Abstract

Background: Despite major reductions in malaria burden across Myanmar, clusters of the disease continue to persist in specific subregions. This study aimed to assess the predictors of test positivity among people living in Paletwa Township of Chin State, an area of persistently high malaria burden.

Methods: Four villages with the highest malaria incidence from Paletwa Township were purposively selected. The characteristics of 1045 subjects seeking malaria diagnosis from the four assigned village health volunteers from January to December, 2018 were retrospectively analyzed. Their household conditions and surroundings were also recorded using a checklist. Descriptive statistics and logistic regression models were applied to investigate potential associations between individual and household characteristics and malaria diagnosis.

Results: In 2017, the Paletwa township presented 20.9% positivity and an annual parasite index of 46.9 cases per 1000 people. Plasmodium falciparum was the predominant species and accounted for more than 80.0% of all infections. Among 1045 people presenting at a clinic with malaria symptoms, 31.1% were diagnosed with malaria. Predictors for test positivity included living in a hut [adjusted odds ratios (a OR): 2.3, 95% confidence intervals (CI): 1.2-4.6], owning farm animals (aOR: 1.7, 95% CI: 1.1-3.6), using non-septic type of toilets (aOR: 1.9, 95% CI: 1.1-8.4), presenting with fever (aOR: 1.9, 95% CI: 1.1-3.0), having a malaria episode within the last year (aOR: 2.9, 95% CI: 1.4-5.8), traveling outside the village in the previous 14 days (aOR: 4.5, 95% CI: 1.5-13.4), and not using bed nets (a OR: 3.4, 95% CI: 2.3-5.1). There were no statistically significant differences by age or gender in this present analysis.

Conclusions: The results from this study, including a high proportion of P. falciparum infections, little difference in age, sex, or occupation, suggest that malaria is a major burden for these study villages. Targeted health education campaigns should be introduced to strengthen synchronous diagnosis-seeking behaviors, tighten treatment adherence, receiving a diagnosis after traveling to endemic regions, and using bed nets properly. We suggest increased surveillance, early diagnosis, and treatment efforts to control the disease and then to consider the local elimination.

Keywords: Endemic area; Malaria; Myanmar; Risk; Trend.

Fig. 1

Map indicating study location in Paletwa Township, Chin State, Western Myanmar

Fig. 2

Township level malaria data for Paletwa: a Test positivity and b annual parasite incidence (2011–2017). c Plasmodium species proportions (2011–2017). Pf: Plasmodium falciparum; Pv: Plasmodium vivax

Fig. 3

Malaria cases in 2017 and 2018 in the four study villages (including total febrile patients, total confirmed cases, and test positivity)