Malaria elimination: the rationale for Reactive Case Detection

By Pierre Bush, PhD Moderator | 10 Jan, 2017

Dear Colleagues,
The malaria elimination campaign comprises many important steps: one of them is the reactive case detection (RCD) which helps the Community Health Workers, and public health employees to detect active cases that are in their areas and treat them promptly.
A study from Zambia (Larsen et al., 2017) emphasizes that the location is the most important element in order to be effective in RCD. Whereas van Eijk et al. (2016) question the value of RCD all together. What is your opinion?

Abstract

Background
Decreasing malaria transmission leads to increasing heterogeneity with increased risk in both hot spots (locations) and hot pops (certain demographics). In Southern Province, Zambia, reactive case detection has formed a part of malaria surveillance and elimination efforts since 2011. Various factors may be associated with finding malaria infections during case investigations, including the demographics of the incident case and environmental characteristics of the location of the incident case.

Methods
Community health worker registries were used to determine what factors were associated with finding a malaria infection during reactive case detection.

Results
Location was a more powerful predictor of finding malaria infections during case investigations than the demographics of the incident case. After accounting for environmental characteristics, no demographics around the incident case were associated with finding malaria infections during case investigations. Various time-invariant measures of the environment, such as median enhanced vegetation index, the topographic position index, the convergence index, and the topographical wetness index, were all associated as expected with increased probability of finding a malaria infection during case investigations.

Conclusions
These results suggest that targeting the locations highly at risk of malaria transmission is of importance in elimination settings.