Publication: Reactive case‑detection of malaria in Pailin Province, Western Cambodia: lessons from a year‑long evaluation in a pre‑elimination setting
Issued Date
2016
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eng
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Mahidol University
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Faculty of Environment and Resource Studies Mahidol University
Bibliographic Citation
Malaria Journal. Vol.15, (2016),132
Suggested Citation
John Hustedt, Canavati, Sara E., Chandary Rang, Ashton, Ruth A., Nimol Khim, Laura Berne, Saorin Kim, Siv Sovannaroth, Po Ly, Didier Ménard, Jonathan Cox, Sylvia Meek, Arantxa Roca‐Feltrer Reactive case‑detection of malaria in Pailin Province, Western Cambodia: lessons from a year‑long evaluation in a pre‑elimination setting. Malaria Journal. Vol.15, (2016),132. doi:10.1186/s12936-016-1191-z Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/3137
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Title
Reactive case‑detection of malaria in Pailin Province, Western Cambodia: lessons from a year‑long evaluation in a pre‑elimination setting
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Abstract
Background: As momentum towards malaria elimination grows, strategies are being developed for scale-up in
elimination settings. One prominent strategy, reactive case detection (RACD), involves screening and treating individuals
living in close proximity to passively detected, or “index” cases. This study aims to use RACD to quantify Plasmodium
parasitaemia in households of index cases, and identify risk factors for infection; these data could inform reactive
screening approaches and identify target risk groups.
Methods: This study was conducted in the Western Cambodian province of Pailin between May 2013 and March
2014 among 440 households. Index participants/index cases (n = 270) and surrounding households (n = 110) were
screened for Plasmodium infection with rapid diagnostic tests (RDT), microscopy and real-time polymerase chain
reaction (PCR). Participants were interviewed to identify risk factors. A comparison group of 60 randomly-selected
households was also screened, to compare infection levels of RACD and non-RACD households. In order to identify
potential risk factors that would inform screening approaches and identify risk groups, multivariate logistic regression
models were applied.
Results: Nine infections were identified in households of index cases (RACD approach) through RDT screening of
1898 individuals (seven Plasmodium vivax, two Plasmodium falciparum); seven were afebrile. Seventeen infections
were identified through PCR screening of 1596 individuals (15 P. vivax, and 22 % P. falciparum/P. vivax mixed infections).
In the control group, 25 P. falciparum infections were identified through PCR screening of 237 individuals, and
no P. vivax was found. Plasmodium falciparum infection was associated with fever (p = 0.013), being a member of a
control household (p ≤ 0.001), having a history of malaria infection (p = 0.041), and sleeping without a mosquito net
(p = 0.011). Significant predictors of P. vivax infection, as diagnosed by PCR, were fever (p = 0.058, borderline significant)
and history of malaria infection (p ≤ 0.001).
Conclusion: This study found that RACD identified very few secondary infections when targeting index and neighbouring
households for screening. The results suggest RACD is not appropriate, where exposure to malaria occurs
away from the community, and there is a high level of treatment-seeking from the private sector. Piloting RACD in a
range of transmission settings would help to identify the ideal environment for feasible and effective reactive screening
methods.