Regional Malaria Elimination Initiative, Inter-American Development Bank, DC, Washington, USA.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Malar J. 2021 Apr 30;20(1):208. doi: 10.1186/s12936-021-03645-x.
In malaria elimination settings, available metrics for malaria surveillance have been insufficient to measure the performance of passive case detection adequately. An indicator for malaria suspected cases with malaria test (MSCT) is proposed to measure the rate of testing on persons presenting to health facilities who satisfy the definition of a suspected malaria case. This metric does not rely on prior knowledge of fever prevalence, seasonality, or external denominators, and can be used to compare detection rates in suspected cases within and between countries, including across settings with different levels of transmission.
To compute the MSCT, an operational definition for suspected malaria cases was established, including clinical and epidemiological criteria. In general, suspected cases included: (1) persons with fever detected in areas with active malaria transmission; (2) persons with fever identified in areas with no active transmission and travel history to, or residence in areas with active transmission (either national or international); and (3) persons presenting with fever, chills and sweating from any area. Data was collected from 9 countries: Belize, Colombia (in areas with active transmission), Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, and Panama (September-March 2020). A sample of eligible medical records for 2018 was selected from a sample of health facilities in each country. An algorithm was constructed to assess if a malaria test was ordered or performed for cases that met the suspected case definition.
A sample of 5873 suspected malaria cases was obtained from 239 health facilities. Except for Nicaragua and Colombia, malaria tests were requested in less than 10% of all cases. More cases were tested in areas with active transmission than areas without cases. Travel history was not systematically recorded in any country.
A statistically comparable, replicable, and standardized metric was proposed to measure suspected malaria cases with a test (microscopy or rapid diagnostic test) that enables assessing the performance of passive case detection. Cross-country findings have important implications for malaria and infectious disease surveillance, which should be promptly addressed as countries progress towards malaria elimination. Local and easy-to-implement tools could be implemented to assess and improve passive case detection.
在疟疾消除环境中，现有的疟疾监测指标不足以充分评估被动病例发现的效果。提出一种有疟疾检测的疟疾疑似病例指标（MSCT），用于衡量满足疟疾疑似病例定义的人到医疗机构就诊时的检测率。该指标不依赖于发热流行率、季节性或外部分母的先验知识，可用于比较国家内和国家间的疑似病例检测率，包括在具有不同传播水平的环境中进行比较。
为了计算 MSCT，确定了疟疾疑似病例的操作定义，包括临床和流行病学标准。一般来说，疑似病例包括：（1）在有疟疾传播的地区发现发热的人；（2）在无疟疾传播地区发现发热的人，且有疟疾传播地区的旅行史或居住史（国内或国际）；（3）来自任何地区发热、畏寒和出汗的人。数据来自 9 个国家：伯利兹、哥伦比亚（有疟疾传播地区）、哥斯达黎加、多米尼加共和国、萨尔瓦多、危地马拉、洪都拉斯、尼加拉瓜和巴拿马（2020 年 9 月至 3 月）。从每个国家的卫生机构样本中选择了 2018 年合格病历的样本。构建了一个算法来评估符合疑似病例定义的病例是否开了或做了疟疾检测。
从 239 个卫生机构获得了 5873 例疑似疟疾病例的样本。除了尼加拉瓜和哥伦比亚，不到 10%的病例都要求做了疟疾检测。在有疟疾传播的地区，检测的病例更多。旅行史在任何国家都没有系统记录。
提出了一种可衡量有检测（显微镜检查或快速诊断检测）的疑似疟疾病例的可比、可复制和标准化指标，可用于评估被动病例发现的效果。跨国界的发现对疟疾和传染病监测具有重要意义，随着各国向疟疾消除迈进，应及时解决这些问题。可以实施当地的、易于实施的工具来评估和改进被动病例发现。
