Malaria case investigation with reactive focal testing and treatment: operational feasibility and lessons learned from low and moderate transmission areas in Amhara Region, Ethiopia

• Published in: Malaria Journal
• Main Authors: Pooja Bansil, Asnakew K. Yeshiwondim, Caterina Guinovart, Belendia Serda, Callie Scott, Berhane H. Tesfay, Adem Agmas, Belay Bezabih, Melkamu T. Zeleke, Girma S. Guesses, Asmamaw L. Ayenew, Worku M. Workie, Duncan Earle, Rick W. Steketee, Asefaw Getachew
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2018
• Subjects: Malaria; Surveillance; Elimination; Case Investigation; Ethiopia; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-018-2587-8; https://doaj.org/article/36bd95d6b4da4a79b786e8df1f305e09

Abstract Background When malaria transmission is very low, investigation of passively detected malaria cases and reactive focal testing and treatment (FTAT) in the case and neighbouring households can identify and contain the source and spread of infections. Methods Case investigation with reactive FTAT for malaria was implemented in 10 villages in Amhara Region, Ethiopia during the 2014/2015 malaria transmission season. Intervention villages were purposively selected based on the incidence of passively detected Plasmodium falciparum and mixed infections (P. falciparum and Plasmodium vivax) during the 2013 transmission season. A passively detected P. falciparum or mixed index case triggered an investigation that targeted the index case household and the closest 10 neighbouring households in a 100-m radius. All consenting household members received a rapid diagnostic test (RDT) and RDT-positive individuals received artemether–lumefantrine (P. falciparum, mixed) or chloroquine (P. vivax). Results From October 2014 to February 2015, 407 P. falciparum or mixed index cases (approximately 6.5 per 1000 population) were passively detected. Of these, 220 (54.1%) were investigated, of which 87.3% were male, 61.8% were age 20–39 years [median age: 27 years (range 1–90)], and 58.6% spent ≥ 1 night away from home in the past month (ranging from 0.0 to 94.1% by village). Among the 4077 residents in the 914 households investigated, 3243 (79.5%) received an RDT and 127 (3.9%) were RDT-positive (2.2% P. falciparum, 0.5% P. vivax, 1.2% mixed). Three epidemiological patterns were found. In six villages, there were almost no cases, with less than 10 index and secondary cases. In three villages, most index cases had a history of travel (> 62%), but there were a small number of secondary cases (< 10). Lastly, in one village none of the index cases had a history of recent travel and there was a large number of secondary cases (n = 105). Conclusions Three types of malaria transmission patterns were observed: (1) low importation ...