Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.
Indian Council of Medical Research, National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India.
Malar J. 2020 Nov 16;19(1):410. doi: 10.1186/s12936-020-03458-4.
In the past decade substantial reduction in malaria morbidity and mortality has been observed through well-implemented case management and vector control strategies. India has also achieved a significant reduction in malaria burden in 2018 and has committed to eliminate malaria by 2030. The Mandla Malaria Elimination Demonstration Project (MEDP) was started in 2017 in 1233 villages of District Mandla to demonstrate malaria elimination in a tribal district with hard-to-reach areas was possible using active and passive surveillance, case management, vector control, and targeted information, education and communication campaigns. An operational plan was developed to strengthen the existing surveillance and malaria elimination systems, through fortnightly active case detection to ensure that all cases including those that are introduced into the communities are rapidly identified and treated promptly. The plan also focused on the reduction of human-mosquito contact through the use of Long-Lasting Insecticial Nets (LLINs) and Indoor Residual Spray (IRS). The operational plan was modified in view of the present COVID-19 pandemic by creating systems of assistance for the local administration for COVID-related work while ensuring the operational integrity of malaria elimination efforts.
The use of MEDP study design and operational plan, with its built-in management control systems, has yielded significant (91%) reduction of indigenous cases of malaria during the period from June 2017 to May 2020. The malaria positivity rate was 0.33% in 2017-18, 0.13% in 2018-19, and 0.06% in 2019-20. Mass screening revealed 0.18% malaria positivity in September-October 2018, followed by 0.06% in June 2019, and 0.03% in December 2019, and these were mostly asymptomatic cases in the community. The project has been able to sustain the gains of the past three years during the ongoing COVID-19 pandemic.
This paper provides the study design and the operational plan for malaria elimination in a high-burden district of Central India, which presented difficulties of hard to reach areas, forest malaria, and complex epidemiology of urban and rural malaria. The lessons learned could be used for malaria elimination efforts in rest of the country and other parts of South Asia with comparable demography and epidemiology.
通过实施良好的病例管理和病媒控制策略，过去十年疟疾发病率和死亡率显著下降。印度在 2018 年也显著降低了疟疾负担，并承诺到 2030 年消除疟疾。曼德拉疟疾消除示范项目（MEDP）于 2017 年在曼德拉区的 1233 个村庄启动，旨在证明在一个难以到达的部落地区，通过主动和被动监测、病例管理、病媒控制和有针对性的信息、教育和宣传活动，疟疾消除是可行的。制定了一项行动计划，通过每两周进行一次主动病例发现，加强现有的监测和疟疾消除系统，以确保迅速发现所有病例，包括那些传入社区的病例，并及时进行治疗。该计划还侧重于通过使用长效驱虫蚊帐（LLINs）和室内滞留喷洒（IRS）减少人与蚊子的接触。根据目前的 COVID-19 大流行，制定了地方行政部门援助系统，以支持 COVID 相关工作，同时确保疟疾消除工作的运营完整性，对行动计划进行了修改。
使用 MEDP 研究设计和行动计划，以及其内置的管理控制系统，在 2017 年 6 月至 2020 年 5 月期间，疟疾本地病例显著减少（91%）。2017-18 年疟疾阳性率为 0.33%，2018-19 年为 0.13%，2019-20 年为 0.06%。大规模筛查显示 2018 年 9 月至 10 月疟疾阳性率为 0.18%，随后 2019 年 6 月为 0.06%，2019 年 12 月为 0.03%，这些都是社区中无症状的病例。在目前的 COVID-19 大流行期间，该项目能够维持过去三年的成果。
本文提供了在印度中部高负担地区消除疟疾的研究设计和行动计划，该地区存在难以到达地区、森林疟疾以及城市和农村疟疾复杂流行病学等困难。所吸取的经验教训可用于印度其他地区和其他具有类似人口统计学和流行病学特征的南亚地区的疟疾消除工作。
