National Vector Borne Disease Control Programme, Government of Odisha, Bhubaneswar, India.
Indian Institute of Public Health, Bhubaneswar, India.
PLoS One. 2019 Jan 2;14(1):e0208943. doi: 10.1371/journal.pone.0208943. eCollection 2019.
In 2013, the Comprehensive Case Management Programme (CCMP) was initiated to assess the impact of universal access to diagnosis and treatment and improved surveillance on malaria transmission in different settings in Odisha state, India.
Pairs of intervention and control sub-districts (blocks), matched on malaria incidence were selected in four districts with different transmission intensities. CCMP activities included training and supervision, ensuring no stock-outs of malaria tests and drugs, analysing verified surveillance data, stratifying areas based on risk factors, and appointing alternative providers to underserved areas. Composite risk scores were calculated for each sub-centre using principal component analysis. Post-pre changes (2013-2015 versus 2011-2012) for annual blood examination rates (ABER) and annual parasite incidence (API) across intervention and control groups were assessed using difference-in-difference (DID) estimates, adjusted for malaria transmission risk.
In the intervention sub-centres, the mean increase in ABER was 6.41 tests/sub-centre (95%CI 4.69, 8.14; p<0.01) and in API was 9.2 cases diagnosed/sub-centre (95%CI 5.18, 13.21; p<0.01). The control sub-centres reported lower increases in ABER (2.84 [95%CI 0.35, 5.34]; p<0.05) and API (3.68 [95%CI 0.45, 6.90]; p<0.05). The control-adjusted post-pre changes in API showed that 5.52 more cases (95%CI 0.34, 10.70; p<0.05) were diagnosed, and a 3.6 more cases (95%CI 0.58, 6.56; p<0.05) were tested per sub-centre in the intervention versus control areas. Larger differences in post-pre changes in API between intervention and control sub-centres were registered in the higher transmission-risk areas compared with the lower risk areas. All the changes were statistically significant.
Intensive intervention activities targeted at improved access to malaria diagnosis and treatment produced a substantial increase in blood examination and case notification, especially in inaccessible, hard-to-reach pockets. CCMP provides insights into how to achieve universal coverage of malaria services through a routine, state-run programme.
2013 年，开展了综合性病例管理规划（CCMP），以评估在印度奥里萨邦不同环境下普遍获得诊断和治疗以及加强监测对疟疾传播的影响。
在四个具有不同传播强度的地区，根据疟疾发病率选择了干预和对照分区（街区）。CCMP 活动包括培训和监督，确保疟疾检测和药物无库存短缺，分析经核实的监测数据，根据危险因素分层，指定替代提供者为服务不足地区提供服务。使用主成分分析为每个分区计算综合风险评分。使用差值（DID）估计值评估干预和对照组的年度血检率（ABER）和年度寄生虫发病率（API）的干预前后变化（2013-2015 年与 2011-2012 年），并根据疟疾传播风险进行调整。
在干预分区，ABER 平均增加 6.41 次/分区（95%CI 4.69，8.14；p<0.01），API 增加 9.2 例/分区（95%CI 5.18，13.21；p<0.01）。对照分区报告的 ABER（2.84 [95%CI 0.35，5.34]；p<0.05）和 API（3.68 [95%CI 0.45，6.90]；p<0.05）增加较低。经对照调整后的 API 干预前后变化显示，干预区比对照区每分区多诊断出 5.52 例（95%CI 0.34，10.70；p<0.05），多检测 3.6 例（95%CI 0.58，6.56；p<0.05）。与低风险区相比，高传播风险区的干预和对照分区的 API 干预前后变化差异更大。所有变化均具有统计学意义。
针对改善疟疾诊断和治疗获取机会的强化干预活动使血检和病例报告大幅增加，特别是在难以到达的地区。CCMP 提供了如何通过常规的州立方案实现疟疾服务全覆盖的见解。
