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Observational Study
. 2021 Sep 22;21(1):1725.
doi: 10.1186/s12889-021-11749-x.

Longitudinal trends in malaria testing rates in the face of elimination in eastern Myanmar: a 7-year observational study

Jade D Rae  1   2   3 , Jordi Landier  4 , Julie A Simpson  5 , Stéphane Proux  6 , Angela Devine  5   7 , Richard J Maude  8   9   10   11 , Aung Myint Thu  6 , Jacher Wiladphaingern  6 , Ladda Kajeechiwa  6 , May Myo Thwin  6 , Saw Win Tun  6 , François H Nosten  6   9
Affiliations
Observational Study

Longitudinal trends in malaria testing rates in the face of elimination in eastern Myanmar: a 7-year observational study

Jade D Rae et al. BMC Public Health. .

Abstract

Background: Providing at-risk communities with uninterrupted access to early diagnosis and treatment is a key component in reducing malaria transmission and achieving elimination. As programmes approach malaria elimination targets it is critical that each case is tested and treated early, which may present a challenge when the burden of malaria is reduced. In this paper we investigate whether malaria testing rates decline over time and assess the impacts of integrating malaria and non-malaria services on testing rates in the malaria elimination task force (METF) programme in the Kayin state of Myanmar.

Methods: A retrospective analysis was conducted using weekly collected data on testing rates from a network of more than 1200 malaria posts during the period from 2014 to 2020. To determine whether monthly testing rates changed over the years of programme operations, and whether integrating malaria and non-malaria services impacted these testing rates, we fitted negative binomial mixed-effects regression models to aggregate monthly data, accounting for malaria seasonal variation.

Results: In the first year of malaria post operation, testing rates declined, correlating with a decline in attendance by people from outside the malaria post catchment area, but then remained fairly constant (the Rate Ratio (RR) for 2nd versus 1st year open ranged from 0.68 to 0.84 across the four townships included in the analysis, the RR for 3rd to 6th year versus 1st year open were similar, ranging from 0.59-0.78). The implementation of a training programme, which was intended to expand the role of the malaria post workers, had minimal impact on testing rates up to 24 months after training was delivered (RR for integrated versus malaria-only services ranged from 1.00 to 1.07 across METF townships).

Conclusion: Despite the decline in malaria incidence from 2014 to 2020, there has been no decline in the malaria testing rate in the METF programme after the establishment of the complete malaria post network in 2016. While the integration of malaria posts with other health services provides benefits to the population, our evaluation questions the necessity of integrated services in maintaining malaria testing rates in areas approaching elimination of malaria.

Keywords: Community health worker; Elimination; Integrated health services; Malaria; P. falciparum; P. vivax; RDT; Testing rate.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The Malaria Elimination Task Force malaria post network in the Kayin State of Myanmar. Each red point corresponds to a malaria post operated by a malaria post worker, trained to deliver uninterrupted access to diagnosis and treatment of malaria. The Kayin State is divided into 4 townships: Hpapun, Hlaingbwe, Kawkareik, and Myawaddy. Map generated using ArcGIS version 2.5
Fig. 2
Fig. 2
Average monthly P. falciparum and P. vivax incidence at malaria posts by township. Monthly incidence of P. falciparum (green line), with 95% confidence intervals (green area) and P. vivax (orange line), with 95% confidence intervals (orange area) calculated at the malaria post level, averaged over township. Total number of malaria posts providing weekly reports shown in grey. Upper confidence interval for P. falciparum incidence rate in Hpapun capped at 40
Fig. 3
Fig. 3
Average monthly rate of RDTs, and malaria incidence by date and township. Average rapid diagnostic testing rate (RDT – purple line), with 95% confidence intervals (purple area), and average P. falciparum (green line) and P. vivax (orange line) incidence rates in the METF malaria posts by date. Upper confidence interval for RDT rate in Hpapun capped at 300
Fig. 4
Fig. 4
Average monthly rate of RDTs, and malaria incidence by malaria post time open. Average rapid diagnostic testing rate (RDT – purple line), with 95% confidence intervals (purple area), and average P. falciparum (green line) and P. vivax (orange line) incidence rates in the METF malaria posts by years open
Fig. 5
Fig. 5
Average monthly rate of RDTs in malaria posts that received integrated community health worker training. Average rapid diagnostic testing rate (RDT – purple line), with 95% confidence intervals (purple area) before and after training was delivered (red line) by months since training
See this image and copyright information in PMC

References

    1. Battle KE, Lucas TCD, Nguyen M, Howes RE, Nandi AK, Twohig KA, Pfeffer DA, Cameron E, Rao PC, Casey D, Gibson HS, Rozier JA, Dalrymple U, Keddie SH, Collins EL, Harris JR, Guerra CA, Thorn MP, Bisanzio D, Fullman N, Huynh CK, Kulikoff X, Kutz MJ, Lopez AD, Mokdad AH, Naghavi M, Nguyen G, Shackelford KA, Vos T, Wang H, Lim SS, Murray CJL, Price RN, Baird JK, Smith DL, Bhatt S, Weiss DJ, Hay SI, Gething PW. Mapping the global endemicity and clinical burden of plasmodium vivax, 2000-17: a spatial and temporal modelling study. Lancet. 2019;394(10195):332–343. doi: 10.1016/S0140-6736(19)31096-7. - DOI - PMC - PubMed
    1. Weiss DJ, Lucas TCD, Nguyen M, Nandi AK, Bisanzio D, Battle KE, Cameron E, Twohig KA, Pfeffer DA, Rozier JA, Gibson HS, Rao PC, Casey D, Bertozzi-Villa A, Collins EL, Dalrymple U, Gray N, Harris JR, Howes RE, Kang SY, Keddie SH, May D, Rumisha S, Thorn MP, Barber R, Fullman N, Huynh CK, Kulikoff X, Kutz MJ, Lopez AD, Mokdad AH, Naghavi M, Nguyen G, Shackelford KA, Vos T, Wang H, Smith DL, Lim SS, Murray CJL, Bhatt S, Hay SI, Gething PW. Mapping the global prevalence, incidence, and mortality of plasmodium falciparum, 2000-17: a spatial and temporal modelling study. Lancet. 2019;394(10195):322–331. doi: 10.1016/S0140-6736(19)31097-9. - DOI - PMC - PubMed
    1. WHO. World Malaria Report. 2020. https://www.who.int/publications/i/item/9789240015791. Accessed 11 Jan 2021.
    1. Maltha J, Gillet P, Jacobs J. Malaria rapid diagnostic tests in endemic settings. Clin Microbiol Infect. 2013;19(5):399–407. doi: 10.1111/1469-0691.12151. - DOI - PubMed
    1. Rogier E, Hamre KES, Joseph V, Plucinski MM, Presume J, Romilus I, Mondelus G, Elisme T, van den Hoogen L, Lemoine JF, Drakeley C, Ashton RA, Chang MA, Existe A, Boncy J, Stresman G, Druetz T, Eisele TP. Conventional and high-sensitivity malaria rapid diagnostic test performance in 2 transmission settings: Haiti 2017. J Infect Dis. 2019;221:786–795. doi: 10.1093/infdis/jiz525. - DOI - PMC - PubMed

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