Surveillance to achieve malaria elimination in eastern Myanmar: a 7-year observational study

Abstract

Background: The collection and utilization of surveillance data is essential in monitoring progress towards achieving malaria elimination, in the timely response to increases in malaria case numbers and in the assessment of programme functioning. This paper describes the surveillance activities used by the malaria elimination task force (METF) programme which operates in eastern Myanmar, and provides an analysis of data collected from weekly surveillance, case investigations, and monitoring and evaluation of programme performance.

Methods: This retrospective analysis was conducted using data collected from a network of 1250 malaria posts operational between 2014 and 2021. To investigate changes in data completeness, malaria post performance, malaria case numbers, and the demographic details of malaria cases, summary statistics were used to compare data collected over space and time.

Results: In the first 3 years of the METF programme, improvements in data transmission routes resulted in a 18.9% reduction in late reporting, allowing for near real-time analysis of data collected at the malaria posts. In 2020, travel restrictions were in place across Karen State in response to COVID-19, and from February 2021 the military coup in Myanmar resulted in widescale population displacement. However, over that period there has been no decline in malaria post attendance, and the majority of consultations continue to occur within 48 h of fever onset. Case investigations found that 43.8% of cases travelled away from their resident village in the 3 weeks prior to diagnosis and 36.3% reported never using a bed net whilst sleeping in their resident village, which increased to 72.2% when sleeping away from their resident village. Malaria post assessments performed in 82.3% of the METF malaria posts found malaria posts generally performed to a high standard.

Conclusions: Surveillance data collected by the METF programme demonstrate that despite significant changes in the context in which the programme operates, malaria posts have remained accessible and continue to provide early diagnosis and treatment contributing to an 89.3% decrease in Plasmodium falciparum incidence between 2014 and 2021.

Fig. 1

The complete malaria post network operated by the METF programme in four townships of Karen State, Myanmar. Each point represents a malaria post (coloured by year of opening), operated by a trained malaria post worker delivering free, uninterrupted access to diagnosis and treatment. Coordination of the programme and analysis of data is carried out in Mae Sot, Thailand (black triangle). Map generated using ArcGIS Pro version 2.5

Fig. 2

Timeline of the METF programme and surveillance activities. After the commencement of the METF programme in 2014 various targeted surveillance and performance assessments were conducted to maintain and assess the malaria post network performance

Fig. 3

Average monthly rate of RDTs and malaria incidence by date and township. Average monthly rapid diagnostic testing rate (RDT—purple line) with 95% confidence intervals (purple area), and average monthly P. falciparum (green line) and P. vivax (orange line) incidence rates at the METF malaria posts

Fig. 4

Number of A P. falciparum cases investigated, and B monitoring and evaluation visits per malaria post. All individuals diagnosed with P. falciparum that could be contacted were investigated in Hlaingbwe, Kawkareik, and Myawaddy from 2017, and in Hpapun from 2019. Monitoring and evaluation visits were conducted between 2017 and 2021 to assess malaria post performance based on predefined performance indicators. Maps generated using ArcGIS Pro version 2.5