Operational research to inform a sub-national surveillance intervention for malaria elimination in Solomon Islands

Malaria Journal

Research

Karen Gray¹  Andrew Ebringer¹  L Losi²  Albino Bobogare²  Geoffrey Kenilorea³  Heidi Reid³  Archie Clements³  Marie-Louise Johnson³  Matthew O'Sullivan³  Maxine Whittaker³  Yuka Yamaguchi³  Rushika Wijesinghe³  Jo-An Atkinson³  Ivor Harris⁴  Qin Cheng⁴  Dennis Shanks⁴  Lisa Bain⁵  Andrew Vallely⁶ 

[1] Australian Army Malaria Institute, Brisbane, Australia;National Vector Borne Disease Control Program, Ministry of Health, Honiara, Solomon Islands;School of Population Health, University of Queensland, Brisbane, Australia;School of Population Health, University of Queensland, Brisbane, Australia;Australian Army Malaria Institute, Brisbane, Australia;School of Population Health, University of Queensland, Brisbane, Australia;Australian Army Malaria Institute, Brisbane, Australia;Malaria Drug Resistance and Chemotherapy, Queensland Institute of Medical Research, Brisbane, Australia;The Kirby Institute (formally the National Centre in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, Australia;

关键词: Malaria;    Malaria Transmission;    Solomon Island;    Malaria Elimination;    Passive Case Detection;   

DOI  :  10.1186/1475-2875-11-101

 received in 2012-01-25, accepted in 2012-03-30,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundSuccessful reduction of malaria transmission to very low levels has made Isabel Province, Solomon Islands, a target for early elimination by 2014. High malaria transmission in neighbouring provinces and the potential for local asymptomatic infections to cause malaria resurgence highlights the need for sub-national tailoring of surveillance interventions. This study contributes to a situational analysis of malaria in Isabel Province to inform an appropriate surveillance intervention.MethodsA mixed method study was carried out in Isabel Province in late 2009 and early 2010. The quantitative component was a population-based prevalence survey of 8,554 people from 129 villages, which were selected using a spatially stratified sampling approach to achieve uniform geographical coverage of populated areas. Diagnosis was initially based on Giemsa-stained blood slides followed by molecular analysis using polymerase chain reaction (PCR). Local perceptions and practices related to management of fever and treatment-seeking that would impact a surveillance intervention were also explored using qualitative research methods.ResultsApproximately 33% (8,554/26,221) of the population of Isabel Province participated in the survey. Only one subject was found to be infected with Plasmodium falciparum (Pf) (96 parasites/μL) using Giemsa-stained blood films, giving a prevalence of 0.01%. PCR analysis detected a further 13 cases, giving an estimated malaria prevalence of 0.51%. There was a wide geographical distribution of infected subjects. None reported having travelled outside Isabel Province in the previous three months suggesting low-level indigenous malaria transmission. The qualitative findings provide warning signs that the current community vigilance approach to surveillance will not be sufficient to achieve elimination. In addition, fever severity is being used by individuals as an indicator for malaria and a trigger for timely treatment-seeking and case reporting. In light of the finding of a low prevalence of parasitaemia, the current surveillance system may not be able to detect and prevent malaria resurgence.ConclusionAn adaption to the malERA surveillance framework is proposed and recommendations made for a tailored provincial-level surveillance intervention, which will be essential to achieve elimination, and to maintain this status while the rest of the country catches up.

【 授权许可】

CC BY   
© Atkinson et al; licensee BioMed Central Ltd. 2012