Foundation for Disease Elimination and Control of India (FDEC India), Mumbai, Maharashtra, India.
Asia Pacific Leaders Malaria Alliance (APLMA), Singapore, Singapore.
Malar J. 2024 Oct 25;23(1):321. doi: 10.1186/s12936-024-05143-2.
In India, an increase in malaria cases by 21% (223,961 cases) has been reported between 2022 and 2023. Madhya Pradesh ranks 10th in malaria burden, with Mandla district selected for the Malaria Elimination Demonstration Project (MEDP) to demonstrate the feasibility of malaria elimination in a hard-to-reach, tribal-dominated, and hilly forested district. A Constant Contact Community-based Epidemiological Investigation (C3EI) was undertaken by continuous engagement with the community for real-time data collection, mapping of malaria cases, identification of risk factors, and monitoring of intervention outcomes designed to drive effective strategies for malaria elimination.
The study mapped 1,143,126 individuals from 248,825 households in the year 2017 in Mandla district for constant contact surveillance. Fortnightly household visits were conducted to inquire about febrile episodes, with on-spot diagnosis and treatment. Data collection was done using the SOCH mobile application, and analysis using R.
The constant contact household surveillance revealed that out of 956,795 individuals, 230,780 (24.12%) unique individuals reported one or more febrile episodes, with a total of 322,577 febrile episodes and 490 malaria episodes (RDT positive). Males had a higher risk of malaria infection than females (OR = 2.62; p < 0.0001). The cumulative incidence of malaria was highest among children aged 5-15 years and pregnant women. Multiple episodes of malaria infections were more common in adults over 30 years. The incidence of malaria per 100,000 persons gradually declined from 26.13 in 2018 to 11.18 in 2020, with the highest incidence during the monsoon season.
The C3EI presents a new strategy suitable for disease elimination programmes. Implementing C3EI-type longitudinal studies in elimination projects holds promise for generating data to expedite malaria elimination efforts because the unit of observation is a 'household'. Such a comprehensive approach allows identification in the gaps in case management for prompt interventions at the household-level.
在印度，2022 年至 2023 年期间，疟疾病例增加了 21%（223961 例）。中央邦在疟疾负担方面排名第 10 位，曼德拉区被选为消除疟疾示范项目（MEDP），以证明在一个难以到达、以部落为主、丘陵森林地区消除疟疾的可行性。通过与社区持续接触进行的持续接触社区基于流行病学调查（C3EI），实时收集数据、绘制疟疾病例图、确定风险因素，并监测旨在推动消除疟疾的有效战略的干预结果。
在曼德拉区，2017 年对 248825 户家庭的 1143126 人进行了持续接触监测。每两周进行一次家访，询问发热情况，进行现场诊断和治疗。使用 SOCH 移动应用程序进行数据收集，并使用 R 进行分析。
持续接触家庭监测显示，在 956795 人中，有 230780 名（24.12%）独特的个人报告了一次或多次发热，共有 322577 次发热和 490 次疟疾发作（RDT 阳性）。男性感染疟疾的风险高于女性（OR=2.62；p<0.0001）。5-15 岁儿童和孕妇的疟疾累积发病率最高。30 岁以上成年人的疟疾多次感染更为常见。疟疾发病率每 10 万人逐渐从 2018 年的 26.13 例下降到 2020 年的 11.18 例，季风季节发病率最高。
C3EI 提出了一种适合疾病消除计划的新策略。在消除项目中实施 C3EI 型纵向研究有望产生数据，以加快消除疟疾的努力，因为观察单位是“家庭”。这种全面的方法可以在家庭层面上发现病例管理中的差距，并及时进行干预。
