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Jongdeepaisal M, Khonputsa P, Prasert O, Maneenate S, Sirimatayanant M, Sopa P, Saisong A, Charoensup I, Kamsri T, Tipmontree R, Sudathip P, Liverani M, Maude RJ, Pell C. Expanding the roles of malaria post workers in Thailand: A qualitative study of stakeholder perspectives. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003670. [PMID: 39288113 PMCID: PMC11407649 DOI: 10.1371/journal.pgph.0003670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024]
Abstract
In Thailand, since the 2000s, malaria post (MP) workers have been tasked with promptly detecting and treating all malaria cases to prevent onward transmission in the communities. Expanding their roles to provide health services beyond malaria has been proposed as a strategy to sustain their activities until elimination is reached. This article examines the perspectives of stakeholders on community-based malaria care to assess prospects for expanding the role of MPs. The study incorporated in-depth interviews (IDIs) and focus group discussions (FGDs). In forested communities and local health facilities in northeast Thailand bordering Lao PDR and Cambodia, where malaria transmission is low, IDIs were conducted with 13 MPs and 23 community members. An additional 14 policymakers and implementers across the health sector in Thailand were interviewed. The respondents highlighted how in these border areas population groups most at risk of malaria, namely forest goers and migrants, are reluctant to visit public health facilities. In these areas, MP workers are well integrated in their communities and remain relevant although the communities no longer see malaria as spriority. Common conditions such as dengue, diabetes, insect bites, diarrhea, mental illness and substance abuse, were identified as local health concerns needing potential add-on services from MP workers. Although challenges in terms of training, supervision, and financing were raised, opportunities included additional funds from local administrative offices to maintain and integrate malaria activities with other health programmes. Changes to the roles of MPs should be adapted to changing local needs, some of which were identified in this study, should avoid duplication and potential tensions with other local health programmes, and need to build on the capacity of the community and primary care system. These enabling factors are worthy of consideration by any malaria programmes looking into maintaining their village malaria workers in the Greater Mekong Subregion.
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Affiliation(s)
- Monnaphat Jongdeepaisal
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Panarasri Khonputsa
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Orathai Prasert
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Supitsara Maneenate
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Massaya Sirimatayanant
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paradorn Sopa
- Ubon Ratchathani Provincial Health Office, Ubon Ratchathani, Thailand
| | | | | | - Tanong Kamsri
- Ubon Ratchathani Provincial Health Office, Ubon Ratchathani, Thailand
- Phibun Mangsahan Hospital, Phibun, Ubon Ratchathani, Thailand
| | - Rungrawee Tipmontree
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Prayuth Sudathip
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Marco Liverani
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Richard J Maude
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- The Open University, Milton Keynes, United Kingdom
| | - Christopher Pell
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
- Department of Global Health, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
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Srimokla O, Pan-Ngum W, Khamsiriwatchara A, Padungtod C, Tipmontree R, Choosri N, Saralamba S. Early warning systems for malaria outbreaks in Thailand: an anomaly detection approach. Malar J 2024; 23:11. [PMID: 38191421 PMCID: PMC10775623 DOI: 10.1186/s12936-024-04837-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Malaria continues to pose a significant health threat. Rapid identification of malaria infections and the deployment of active surveillance tools are crucial for achieving malaria elimination in regions where malaria is endemic, such as certain areas of Thailand. In this study, an anomaly detection system is introduced as an early warning mechanism for potential malaria outbreaks in countries like Thailand. METHODS Unsupervised clustering-based, and time series-based anomaly detection algorithms are developed and compared to identify abnormal malaria activity in Thailand. Additionally, a user interface tailored for anomaly detection is designed, enabling the Thai malaria surveillance team to utilize these algorithms and visualize regions exhibiting unusual malaria patterns. RESULTS Nine distinct anomaly detection algorithms we developed. Their efficacy in pinpointing verified outbreaks was assessed using malaria case data from Thailand spanning 2012 to 2022. The historical average threshold-based anomaly detection method triggered three times fewer alerts, while correctly identifying the same number of verified outbreaks when compared to the current method used in Thailand. A limitation of this analysis is the small number of verified outbreaks; further consultation with the Division of Vector Borne Disease could help identify more verified outbreaks. The developed dashboard, designed specifically for anomaly detection, allows disease surveillance professionals to easily identify and visualize unusual malaria activity at a provincial level across Thailand. CONCLUSION An enhanced early warning system is proposed to bolster malaria elimination efforts for countries with a similar malaria profile to Thailand. The developed anomaly detection algorithms, after thorough comparison, have been optimized for integration with the current malaria surveillance infrastructure. An anomaly detection dashboard for Thailand is built and supports early detection of abnormal malaria activity. In summary, the proposed early warning system enhances the identification process for provinces at risk of outbreaks and offers easy integration with Thailand's established malaria surveillance framework.
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Affiliation(s)
- Oraya Srimokla
- Nuffield Department of Medicine, University of Oxford, Broad St, Oxford, OX13AZ, UK
| | - Wirichada Pan-Ngum
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Ratchawithi Rd, Bangkok, 10400, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Ratchawithi Rd, Bangkok, 10400, Thailand
| | - Amnat Khamsiriwatchara
- Center of Excellence for Biomedical and Public Health Informatics, Faculty of Tropical Medicine, Mahidol University, Ratchawithi Rd, Bangkok, 10400, Thailand
| | - Chantana Padungtod
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Talat Kwan, Bangkok, Nonthaburi, 11000, Thailand
| | - Rungrawee Tipmontree
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Talat Kwan, Bangkok, Nonthaburi, 11000, Thailand
| | - Noppon Choosri
- College of Arts, Media and Technology, Chiang Mai University, Sukhothai 5 Alley, Mueang Chiang Mai, Chiang Mai, 50200, Thailand
| | - Sompob Saralamba
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Ratchawithi Rd, Bangkok, 10400, Thailand.
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Fornace KM, Drakeley CJ, Lindblade KA, Jelip J, Ahmed K. Zoonotic malaria requires new policy approaches to malaria elimination. Nat Commun 2023; 14:5750. [PMID: 37717079 PMCID: PMC10505154 DOI: 10.1038/s41467-023-41546-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023] Open
Abstract
WHO guidelines for classification of malaria elimination in a country require that the risk of human infection from zoonotic, as well as nonzoonotic, malaria parasites is negligible. In this Comment, the authors discuss the implications of this policy for countries, such as Malaysia, with no recent reported nonzoonotic cases but ongoing zoonotic transmission.
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Affiliation(s)
- Kimberly M Fornace
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK.
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Chris J Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Kamruddin Ahmed
- Borneo Medical and Health Research Centre, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
- Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
- Research Center for Global and Local Infectious Diseases, Oita University, Oita, Japan
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Prempree P, Bisanzio D, Sudathip P, Kanjanasuwan J, Powell I, Gopinath D, Suttiwong C, Pinyajeerapat N, Poortinga A, Sintasath D, Shah JA. Environmental Factors Linked to Reporting of Active Malaria Foci in Thailand. Trop Med Infect Dis 2023; 8:tropicalmed8030179. [PMID: 36977180 PMCID: PMC10051531 DOI: 10.3390/tropicalmed8030179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/22/2023] Open
Abstract
Thailand has made substantial progress towards malaria elimination, with 46 of the country’s 77 provinces declared malaria-free as part of the subnational verification program. Nonetheless, these areas remain vulnerable to the reintroduction of malaria parasites and the reestablishment of indigenous transmission. As such, prevention of reestablishment (POR) planning is of increasing concern to ensure timely response to increasing cases. A thorough understanding of both the risk of parasite importation and receptivity for transmission is essential for successful POR planning. Routine geolocated case- and foci-level epidemiological and case-level demographic data were extracted from Thailand’s national malaria information system for all active foci from October 2012 to September 2020. A spatial analysis examined environmental and climate factors associated with the remaining active foci. A logistic regression model collated surveillance data with remote sensing data to investigate associations with the probability of having reported an indigenous case within the previous year. Active foci are highly concentrated along international borders, particularly Thailand’s western border with Myanmar. Although there is heterogeneity in the habitats surrounding active foci, land covered by tropical forest and plantation was significantly higher for active foci than other foci. The regression results showed that tropical forest, plantations, forest disturbance, distance from international borders, historical foci classification, percentage of males, and percentage of short-term residents were associated with the high probability of reporting indigenous cases. These results confirm that Thailand’s emphasis on border areas and forest-going populations is well placed. The results suggest that environmental factors alone are not driving malaria transmission in Thailand; rather, other factors, including demographics and behaviors that intersect with exophagic vectors, may also be contributors. However, these factors are syndemic, so human activities in areas covered by tropical forests and plantations may result in malaria importation and, potentially, local transmission, in foci that had previously been cleared. These factors should be addressed in POR planning.
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Affiliation(s)
- Preecha Prempree
- Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand;
| | - Donal Bisanzio
- Inform Asia—USAID’s Health Research Program, RTI International, Bangkok 10330, Thailand; (D.B.); (I.P.)
| | - Prayuth Sudathip
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand; (P.S.); (J.K.); (C.S.)
| | - Jerdsuda Kanjanasuwan
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand; (P.S.); (J.K.); (C.S.)
| | - Isabel Powell
- Inform Asia—USAID’s Health Research Program, RTI International, Bangkok 10330, Thailand; (D.B.); (I.P.)
| | | | - Chalita Suttiwong
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand; (P.S.); (J.K.); (C.S.)
| | - Niparueradee Pinyajeerapat
- U.S. President’s Malaria Initiative, United States Agency for International Development (USAID), Regional Development Mission for Asia, Bangkok 10330, Thailand; (N.P.); (D.S.)
| | - Ate Poortinga
- The SERVIR-Mekong Project, Asian Disaster Preparedness Center, Bangkok 10400, Thailand;
| | - David Sintasath
- U.S. President’s Malaria Initiative, United States Agency for International Development (USAID), Regional Development Mission for Asia, Bangkok 10330, Thailand; (N.P.); (D.S.)
| | - Jui A. Shah
- Inform Asia—USAID’s Health Research Program, RTI International, Bangkok 10330, Thailand; (D.B.); (I.P.)
- Correspondence: ; Tel.: +66-(0)98-275-8210
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