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Evaluating Thailand's malaria reactive surveillance and response strategies for malaria elimination: a mixed-method
Win Han Oo1,2, Wanlapa Roobsoong3, Nilar Aye Tun4
1Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia. winhan.oo@unimelb.edu.au.
Background:
Thailand aims to eliminate malaria in all provinces by 2030, where 37 out of 77 provinces have been verified as malaria-free by 2021. Thailand is accelerating its elimination activities and preventing re-establishment of malaria through implementation of the 1-3-7 reactive surveillance and response (RASR) strategy, which entails case notification within one day, case investigation within three days and case investigation survey within seven days after detecting an index malaria case. This study aimed to assess how this 1-3-7 malaria RASR strategy was implemented to understand how it may be optimised to achieve national malaria elimination goals.
Methods:
A cross-sectional mixed-method study was conducted in Tak, Songkhla and Yala provinces of Thailand between January and April 2023. Quantitative survey with purposively recruited malaria programme stakeholders (n = 33) and frontline malaria service providers (FMSPs) (n = 41), qualitative focus group discussions with malaria programme stakeholders, FMSPs and mobile migrant population, and individual in-depth interviews with malaria programme stakeholders were conducted face-to-face in Thai language. Quantitative and qualitative data were analysed descriptively and thematically.
Results:
About half of survey participants (40/74, 54.1%) perceived that malaria cases were notified within the specified one day timeframe. Almost all participants (73/74, 98.7%) reported that case investigation, focus investigation and response activities were conducted within the required timeframes, except in border areas where malaria burden was high. Despite every participant (74/74, 100.0%) being aware of and considering the 1-3-7 strategy as efficient, challenges such as limited human resources and budget, low levels of community participation, and difficult terrain and telecommunication were reported in performing RASR activities.
Conclusions:
The overall implementation of RASR activities was reported to be timely except for malaria case notification and focus response activities in border areas. Despite good acceptability towards RASR activities, the 1-3-7 strategy is not a one-size-fits-all approach; its feasibility for implementation depends on health system capacity and malaria incidence of the area. There are still several challenges to be addressed particularly for successful implementation of RASR activities for cross-border malaria.
