Choosing interventions to eliminate forest malaria: preliminary results of two operational research studies inside Cambodian forests.
Animals
Asian People
/ statistics & numerical data
Cambodia
/ epidemiology
Culicidae
/ parasitology
Disease Eradication
/ methods
Female
Forests
Humans
Malaria
/ blood
Malaria, Falciparum
/ epidemiology
Malaria, Vivax
/ epidemiology
Mass Screening
/ statistics & numerical data
Mosquito Vectors
/ parasitology
Operations Research
Prevalence
Risk Factors
Cambodia
Forest
Forest-goers
Greater mekong subregion
Malaria
Mass screening and treatment
Plasmodium falciparum
Plasmodium vivax
Rapid diagnostic test
Journal
Malaria journal
ISSN: 1475-2875
Titre abrégé: Malar J
Pays: England
ID NLM: 101139802
Informations de publication
Date de publication:
20 Jan 2021
20 Jan 2021
Historique:
received:
19
10
2020
accepted:
24
12
2020
entrez:
21
1
2021
pubmed:
22
1
2021
medline:
7
8
2021
Statut:
epublish
Résumé
Rapid elimination of Plasmodium falciparum malaria in Cambodia is a goal with both national and international significance. Transmission of malaria in Cambodia is limited to forest environments, and the main population at risk consists of forest-goers who rely on forest products for income or sustenance. The ideal interventions to eliminate malaria from this population are unknown. In two forested regions of Cambodia, forest-goers were trained to become forest malaria workers (FMWs). In one region, FMWs performed mass screening and treatment, focal screening and treatment, and passive case detection inside the forest. In the other region, FMWs played an observational role for the first year, to inform the choice of intervention for the second year. In both forests, FMWs collected blood samples and questionnaire data from all forest-goers they encountered. Mosquito collections were performed in each forest. Malaria prevalence by PCR was high in the forest, with 2.3-5.0% positive for P. falciparum and 14.6-25.0% positive for Plasmodium vivax among forest-goers in each study site. In vectors, malaria prevalence ranged from 2.1% to 9.6%, but no P. falciparum was observed. Results showed poor performance of mass screening and treatment, with sensitivity of rapid diagnostic tests equal to 9.1% (95% CI 1.1%, 29.2%) for P. falciparum and 4.4% (95% CI 1.6%, 9.2%) for P. vivax. Malaria infections were observed in all demographics and throughout the studied forests, with no clear risk factors emerging. Malaria prevalence remains high among Cambodian forest-goers, but performance of rapid diagnostic tests is poor. More adapted strategies to this population, such as intermittent preventive treatment of forest goers, should be considered.
Sections du résumé
BACKGROUND
BACKGROUND
Rapid elimination of Plasmodium falciparum malaria in Cambodia is a goal with both national and international significance. Transmission of malaria in Cambodia is limited to forest environments, and the main population at risk consists of forest-goers who rely on forest products for income or sustenance. The ideal interventions to eliminate malaria from this population are unknown.
METHODS
METHODS
In two forested regions of Cambodia, forest-goers were trained to become forest malaria workers (FMWs). In one region, FMWs performed mass screening and treatment, focal screening and treatment, and passive case detection inside the forest. In the other region, FMWs played an observational role for the first year, to inform the choice of intervention for the second year. In both forests, FMWs collected blood samples and questionnaire data from all forest-goers they encountered. Mosquito collections were performed in each forest.
RESULTS
RESULTS
Malaria prevalence by PCR was high in the forest, with 2.3-5.0% positive for P. falciparum and 14.6-25.0% positive for Plasmodium vivax among forest-goers in each study site. In vectors, malaria prevalence ranged from 2.1% to 9.6%, but no P. falciparum was observed. Results showed poor performance of mass screening and treatment, with sensitivity of rapid diagnostic tests equal to 9.1% (95% CI 1.1%, 29.2%) for P. falciparum and 4.4% (95% CI 1.6%, 9.2%) for P. vivax. Malaria infections were observed in all demographics and throughout the studied forests, with no clear risk factors emerging.
CONCLUSIONS
CONCLUSIONS
Malaria prevalence remains high among Cambodian forest-goers, but performance of rapid diagnostic tests is poor. More adapted strategies to this population, such as intermittent preventive treatment of forest goers, should be considered.
Identifiants
pubmed: 33472630
doi: 10.1186/s12936-020-03572-3
pii: 10.1186/s12936-020-03572-3
pmc: PMC7818569
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
51Subventions
Organisme : World Health Organization
ID : 001
Pays : International
Organisme : French Initiative 5%
ID : 17SANIN205
Organisme : Regional Artemisinin-resistance Initiative
ID : QSE-M-UNOPS
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