1. Choosing interventions to eliminate forest malaria: preliminary results of two operational research studies inside Cambodian forests
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Mark Debackere, Amber Kunkel, Jean-Olivier Guintran, Sarun Im, Sophea, Jean Popovici, Dom Peov, Saorin Kim, Patrice Piola, Sreynet Srun, Amélie Vantaux, Chea Nguon, Srean Chhim, Phanith Kong, Nimol Khim, Benoit Witkowski, Unité d'Épidémiologie et de Santé Publique [Phnom Penh], Institut Pasteur du Cambodge, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), National Center for Parasitology, Entomology and Malaria Control [Phnom Penh, Cambodia] (CNM), Malaria Molecular Epidemiology (MMEU), Partners for Development [Phnom Penh, Cambodia], Partners For Development [Silver Spring, MD] (PFD), Malaria Consortium [Phnom Penh, Cambodge], World Health Organization [Phnom Penh] (WHO), Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), These studies were funded by the French Initiative 5%: 'Blocking Malaria Transmission in Forest Vulnerable Populations through Forest Malaria Workers: A Key for Malaria Elimination in Cambodia'. Grant Code: 17SANIN205 and the Regional Artemisinin-resistance Initiative—Regional Component Package 2—Operational Research: Effectiveness of forest-based malaria control interventions in large forests of Cambodia. Grant code: QSE-M-UNOPS. AK was supported by the Pasteur Foundation (US)., Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), Malaria Molecular Epidemiology, Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université (HESAM)-HESAM Université (HESAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), and HESAM Université (HESAM)-HESAM Université (HESAM)
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MESH: Disease Eradication ,Plasmodium vivax ,Rapid diagnostic test ,Forests ,Greater mekong subregion ,0302 clinical medicine ,MESH: Risk Factors ,Risk Factors ,Prevalence ,Mass Screening ,MESH: Animals ,030212 general & internal medicine ,Malaria, Falciparum ,Forestgoers ,education.field_of_study ,MESH: Operations Research ,biology ,MESH: Malaria, Falciparum ,MESH: Forests ,3. Good health ,Infectious Diseases ,MESH: Mosquito Vectors ,Female ,Mass screening and treatment ,Cambodia ,medicine.medical_specialty ,Operations Research ,lcsh:Arctic medicine. Tropical medicine ,lcsh:RC955-962 ,MESH: Malaria ,030231 tropical medicine ,Population ,Plasmodium falciparum ,Mosquito Vectors ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,Forest-goers ,Asian People ,Environmental health ,parasitic diseases ,medicine ,Malaria, Vivax ,Animals ,Humans ,lcsh:RC109-216 ,MESH: Mass Screening ,Forest ,Disease Eradication ,education ,MESH: Prevalence ,Mass screening ,MESH: Humans ,business.industry ,MESH: Cambodia ,Public health ,Research ,MESH: Malaria, Vivax ,15. Life on land ,medicine.disease ,biology.organism_classification ,Malaria ,Culicidae ,Tropical medicine ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Parasitology ,MESH: Asians ,MESH: Culicidae ,business ,MESH: Female - Abstract
Background Rapid elimination of Plasmodium falciparum malaria in Cambodia is a goal with both national and international significance. Transmission of malaria in Cambodia is limited to forest environments, and the main population at risk consists of forest-goers who rely on forest products for income or sustenance. The ideal interventions to eliminate malaria from this population are unknown. Methods In two forested regions of Cambodia, forest-goers were trained to become forest malaria workers (FMWs). In one region, FMWs performed mass screening and treatment, focal screening and treatment, and passive case detection inside the forest. In the other region, FMWs played an observational role for the first year, to inform the choice of intervention for the second year. In both forests, FMWs collected blood samples and questionnaire data from all forest-goers they encountered. Mosquito collections were performed in each forest. Results Malaria prevalence by PCR was high in the forest, with 2.3–5.0% positive for P. falciparum and 14.6–25.0% positive for Plasmodium vivax among forest-goers in each study site. In vectors, malaria prevalence ranged from 2.1% to 9.6%, but no P. falciparum was observed. Results showed poor performance of mass screening and treatment, with sensitivity of rapid diagnostic tests equal to 9.1% (95% CI 1.1%, 29.2%) for P. falciparum and 4.4% (95% CI 1.6%, 9.2%) for P. vivax. Malaria infections were observed in all demographics and throughout the studied forests, with no clear risk factors emerging. Conclusions Malaria prevalence remains high among Cambodian forest-goers, but performance of rapid diagnostic tests is poor. More adapted strategies to this population, such as intermittent preventive treatment of forest goers, should be considered.
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- 2020