Prospects and strategies for malaria elimination in the Greater Mekong Sub-region: a qualitative study.
Elimination strategies
Governance
Health systems
Malaria control
Malaria elimination
Policy
Surveillance and response
Targeted approach
Journal
Malaria journal
ISSN: 1475-2875
Titre abrégé: Malar J
Pays: England
ID NLM: 101139802
Informations de publication
Date de publication:
20 Jun 2019
20 Jun 2019
Historique:
received:
23
03
2019
accepted:
09
06
2019
entrez:
22
6
2019
pubmed:
22
6
2019
medline:
5
11
2019
Statut:
epublish
Résumé
As malaria elimination becomes a goal in malaria-endemic nations, questions of feasibility become critical. This article explores the potential challenges associated with this goal and future strategies for malaria elimination in the Greater Mekong Sub-region. Thirty-two semi-structured interviews were conducted with policy makers (n = 17) and principal investigators (n = 15) selected based on their involvement in malaria prevention, control and elimination in the GMS. Interviews were audio-recorded and transcribed for qualitative content (thematic) analysis using QSR NVivo. All respondents described current malaria control and elimination strategies, such as case detection and management, prevention and strengthening of surveillance systems as critical and of equal priority. Aware of the emergence of multi-drug resistance in the GMS, researchers and policy makers outlined the need for additional elimination tools. As opposed to a centralized strategy, more targeted and tailored approaches to elimination were recommended. These included targeting endemic areas, consideration for local epidemiology and malaria species, and strengthening the peripheral health system. A decline in malaria transmission could lead to complacency amongst funders and policy makers resulting in a reduction or discontinuation of support for malaria elimination. Strong commitment of policymakers combined with strict monitoring and supervision by funders were considered pivotal to successful elimination programmes. Against a backdrop of increasing anti-malarial resistance and decreasing choices of anti-malarial regimens, policy makers and researchers stressed the urgency of finding new malaria elimination strategies. There was consensus that multi-pronged strategies and approaches are needed, that no single potential tool/strategy can be appropriate to all settings. Hence there is a need to customize malaria control and elimination strategies based on the better surveillance data.
Sections du résumé
BACKGROUND
BACKGROUND
As malaria elimination becomes a goal in malaria-endemic nations, questions of feasibility become critical. This article explores the potential challenges associated with this goal and future strategies for malaria elimination in the Greater Mekong Sub-region.
METHODS
METHODS
Thirty-two semi-structured interviews were conducted with policy makers (n = 17) and principal investigators (n = 15) selected based on their involvement in malaria prevention, control and elimination in the GMS. Interviews were audio-recorded and transcribed for qualitative content (thematic) analysis using QSR NVivo.
RESULTS
RESULTS
All respondents described current malaria control and elimination strategies, such as case detection and management, prevention and strengthening of surveillance systems as critical and of equal priority. Aware of the emergence of multi-drug resistance in the GMS, researchers and policy makers outlined the need for additional elimination tools. As opposed to a centralized strategy, more targeted and tailored approaches to elimination were recommended. These included targeting endemic areas, consideration for local epidemiology and malaria species, and strengthening the peripheral health system. A decline in malaria transmission could lead to complacency amongst funders and policy makers resulting in a reduction or discontinuation of support for malaria elimination. Strong commitment of policymakers combined with strict monitoring and supervision by funders were considered pivotal to successful elimination programmes.
CONCLUSION
CONCLUSIONS
Against a backdrop of increasing anti-malarial resistance and decreasing choices of anti-malarial regimens, policy makers and researchers stressed the urgency of finding new malaria elimination strategies. There was consensus that multi-pronged strategies and approaches are needed, that no single potential tool/strategy can be appropriate to all settings. Hence there is a need to customize malaria control and elimination strategies based on the better surveillance data.
Identifiants
pubmed: 31221145
doi: 10.1186/s12936-019-2835-6
pii: 10.1186/s12936-019-2835-6
pmc: PMC6585139
doi:
Substances chimiques
Antimalarials
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
203Subventions
Organisme : Wellcome Trust
ID : 101148/Z/13/Z
Pays : United Kingdom
Organisme : Bill and Melinda Gates Foundation
ID : BMGF OPP1081420
Références
Lancet. 2000 Nov 4;356(9241):1560-4
pubmed: 11075770
Trop Med Int Health. 2004 Dec;9(12):1241-6
pubmed: 15598255
Trans R Soc Trop Med Hyg. 2006 Nov;100(11):1019-24
pubmed: 16765399
Malar J. 2008 Dec 11;7 Suppl 1:S1
pubmed: 19091033
Acta Trop. 2010 Jun;114(3):177-83
pubmed: 20132788
Nat Rev Microbiol. 2010 Apr;8(4):272-80
pubmed: 20208550
Acta Trop. 2012 Mar;121(3):227-39
pubmed: 21382335
Malar J. 2011 Aug 04;10:225
pubmed: 21816085
Malar J. 2012 Jul 28;11:246
pubmed: 22839432
Adv Parasitol. 2012;80:301-41
pubmed: 23199491
Lancet. 2013 Sep 7;382(9895):900-11
pubmed: 23594387
PLoS One. 2013 Jul 23;8(7):e69516
pubmed: 23936033
Malar J. 2013 Oct 11;12:363
pubmed: 24119916
Cochrane Database Syst Rev. 2013 Dec 09;(12):CD008846
pubmed: 24318836
Malar J. 2014 Jun 02;13:209
pubmed: 24888370
N Engl J Med. 2014 Jul 31;371(5):411-23
pubmed: 25075834
BMJ. 2015 Feb 25;350:h602
pubmed: 25716700
Expert Rev Anti Infect Ther. 2015 Jun;13(6):715-30
pubmed: 25831482
Am J Trop Med Hyg. 2015 Jun;92(6 Suppl):95-104
pubmed: 25897062
Am J Trop Med Hyg. 2015 Jul;93(1):125-134
pubmed: 26013371
BMC Med. 2015 Jul 25;13:167
pubmed: 26208740
Bull World Health Organ. 2015 Dec 1;93(12):862-6
pubmed: 26668438
Lancet. 2015 Nov 7;386(10006):1811
pubmed: 26843297
Malar J. 2016 Feb 24;15:117
pubmed: 26911803
PLoS Biol. 2016 Mar 02;14(3):e1002380
pubmed: 26934361
Malar J. 2016 Mar 24;15:181
pubmed: 27013512
Science. 2016 Apr 22;352(6284):398-402, 404-5
pubmed: 27102459
Malar J. 2016 May 20;15(1):282
pubmed: 27206729
Malar J. 2016 May 27;15(1):296
pubmed: 27234446
Malar J. 2016 Jun 01;15:302
pubmed: 27251199
Malar J. 2016 Sep 27;15(1):494
pubmed: 27677694
Malar J. 2016 Oct 21;15(1):518
pubmed: 27769285
Malar J. 2016 Nov 2;15(1):523
pubmed: 27806717
Lancet Infect Dis. 2017 May;17(5):491-497
pubmed: 28161569
Malar J. 2017 Feb 14;16(1):75
pubmed: 28196536
Parasit Vectors. 2017 Mar 31;10(1):165
pubmed: 28359289
Glob Health Action. 2017;10(1):1271594
pubmed: 28452652
Malar J. 2017 May 23;16(1):214
pubmed: 28535765
Malar J. 2017 Aug 1;16(1):308
pubmed: 28764792
Glob Health Action. 2017;10(1):1366136
pubmed: 28914184
Malar J. 2017 Oct 23;16(1):424
pubmed: 29061133
Wellcome Open Res. 2017 Sep 6;2:81
pubmed: 29062913
Malar J. 2017 Nov 28;16(1):483
pubmed: 29183370
PLoS Negl Trop Dis. 2017 Dec 20;11(12):e0006148
pubmed: 29261647
Malar J. 2018 Jan 9;17(1):15
pubmed: 29316932
Clin Infect Dis. 2018 Aug 31;67(6):817-826
pubmed: 29522113
Lancet. 2018 May 12;391(10133):1916-1926
pubmed: 29703425
Drugs. 2018 Jun;78(9):861-879
pubmed: 29802605
Malar J. 2018 Jun 1;17(1):218
pubmed: 29859089
Lancet. 2018 Jun 16;391(10138):2415-2416
pubmed: 29916383
Malar J. 2018 Jun 20;17(1):242
pubmed: 29925375
Malar J. 2018 Jun 22;17(1):243
pubmed: 29929514
Malar J. 2018 Jul 11;17(1):260
pubmed: 29996831
Am J Trop Med Hyg. 2018 Sep;99(3):680-687
pubmed: 30014810
Trop Med Health. 2018 Aug 2;46:28
pubmed: 30123042
Clin Infect Dis. 2019 Mar 5;68(6):1066-1067
pubmed: 30219841
Malar J. 2018 Nov 3;17(1):405
pubmed: 30390647
Int Health. 2019 May 1;11(3):166-176
pubmed: 30395228
PLoS One. 2018 Dec 11;13(12):e0208912
pubmed: 30533024
Malar J. 2019 Feb 1;18(1):32
pubmed: 30709399
PLoS Med. 2019 Feb 15;16(2):e1002745
pubmed: 30768615
J Infect Dis. 2019 Mar 18;:null
pubmed: 30882150
PLoS One. 2019 Mar 25;14(3):e0214280
pubmed: 30908523
BMC Health Serv Res. 2019 Apr 24;19(1):252
pubmed: 31018855