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Reactive case detection for malaria elimination: real-life experience from an ongoing program in Swaziland
Hugh J W Sturrock1, Joe M Novotny, Simon Kunene
1Global Health Group, University of California San Francisco, San Francisco, California, USA. SturrockH@globalhealth.ucsf.edu
Plos One
|May 24, 2013
Summary
Reactive case detection (RACD) in Swaziland identified more malaria cases than passive surveillance alone. Optimal screening requires rapid response and high coverage near index cases, as a 1 km radius is often impractical.
Area of Science:
- Epidemiology
- Public Health
- Vector Control
Background:
- Malaria elimination requires identifying asymptomatic or untreated infections.
- Reactive case detection (RACD) screens contacts of detected malaria cases.
- Defining optimal RACD screening parameters is crucial for effectiveness.
Purpose of the Study:
- To evaluate the impact of screening radius and other factors on case detection during RACD in Swaziland.
- To assess household coverage achieved by RACD using satellite imagery.
- To inform optimal strategies for malaria case detection in resource-limited settings.
Main Methods:
- Analysis of RACD data from Swaziland (December 2009 - June 2012).
- Statistical evaluation of screening radius, time to RACD, and insecticide spraying on case detection probability.
- Satellite imagery used to assess household coverage during RACD.
Main Results:
- RACD identified 74 additional malaria cases beyond passive surveillance.
- Higher odds of case detection within the index household (OR 13) and within one week of index case presentation (OR 8.7).
- Insecticide spraying of index households reduced detection odds (OR 0.11); a 1 km radius showed impractical coverage.
Conclusions:
- RACD is valuable for detecting malaria cases missed by passive surveillance.
- Timeliness of RACD and proximity to index cases significantly improve detection rates.
- Optimizing RACD in Swaziland necessitates improved coverage, rapid implementation, and consideration of insecticide spraying status, potentially requiring a radius smaller than 1 km.
