Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot
Abstract Background Panama is one of eight countries in Mesoamerica that aims to eliminate malaria by 2022. Malaria is concentrated in indigenous and remote regions like Guna Yala, a politically autonomous region where access to health services is limited and cases are predominately detected through...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | Malaria Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12936-022-04318-z |
| _version_ | 1811249871107129344 |
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| author | Darlene Bhavnani Bernardo García Espinosa Madeline Baird Nicholas Presley Arnaud Le Menach Christina Bradley Marcela Outten Oscar González |
| author_facet | Darlene Bhavnani Bernardo García Espinosa Madeline Baird Nicholas Presley Arnaud Le Menach Christina Bradley Marcela Outten Oscar González |
| author_sort | Darlene Bhavnani |
| collection | DOAJ |
| description | Abstract Background Panama is one of eight countries in Mesoamerica that aims to eliminate malaria by 2022. Malaria is concentrated in indigenous and remote regions like Guna Yala, a politically autonomous region where access to health services is limited and cases are predominately detected through intermittent active surveillance. To improve routine access to care, a joint effort was made by Guna Yala authorities and the Ministry of Health to pilot a network of community health workers (CHWs) equipped with rapid diagnostic tests and treatment. The impact of this pilot is described. Methods Access to care was measured using the proportion of villages targeted by the effort with active CHWs. Epidemiological impact was evaluated through standard surveillance and case management measures. Tests for differences in proportions or rates were used to compare measures prior to (October 2014-September 2016) and during the pilot (October 2016-September 2018). Results An active CHW was placed in 39 (95%) of 41 target communities. During the pilot, CHWs detected 61% of all reported cases from the region. Test positivity in the population tested by CHWs (22%) was higher than in those tested through active surveillance, both before (3.8%) and during the pilot (2.9%). From the pre-pilot to the pilot period, annual blood examination rates decreased (9.8 per 100 vs. 8.0 per 100), test positivity increased (4.2% to 8.5%, Χ2 = 126.3, p < 0.001) and reported incidence increased (4.1 cases per 1000 to 6.9 cases per 1000 [Incidence Rate Ratio = 1.83, 95% CI 1.52, 2.21]). The percent of cases tested on the day of symptom onset increased from 8 to 27% and those treated on the day of their test increased from 26 to 84%. Conclusions The CHW network allowed for replacement of routine active surveillance with strong passive case detection leading to more targeted and timely testing and treatment. The higher test positivity among those tested by CHWs compared to active surveillance suggests that they detected cases in a high-risk population that had not previously benefited from access to diagnosis and treatment. Surveillance data acquired through this CHW network can be used to better target active case detection to populations at highest risk. |
| first_indexed | 2024-04-12T15:55:06Z |
| format | Article |
| id | doaj.art-7830a835c1154387968edc59466af647 |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-04-12T15:55:06Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-7830a835c1154387968edc59466af6472022-12-22T03:26:24ZengBMCMalaria Journal1475-28752022-10-0121111110.1186/s12936-022-04318-zMalaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilotDarlene Bhavnani0Bernardo García Espinosa1Madeline Baird2Nicholas Presley3Arnaud Le Menach4Christina Bradley5Marcela Outten6Oscar González7Clinton Health Access InitiativeClinton Health Access InitiativeClinton Health Access InitiativeClinton Health Access InitiativeClinton Health Access InitiativeClinton Health Access InitiativeMinisterio de Salud de PanamaMinisterio de Salud de PanamaAbstract Background Panama is one of eight countries in Mesoamerica that aims to eliminate malaria by 2022. Malaria is concentrated in indigenous and remote regions like Guna Yala, a politically autonomous region where access to health services is limited and cases are predominately detected through intermittent active surveillance. To improve routine access to care, a joint effort was made by Guna Yala authorities and the Ministry of Health to pilot a network of community health workers (CHWs) equipped with rapid diagnostic tests and treatment. The impact of this pilot is described. Methods Access to care was measured using the proportion of villages targeted by the effort with active CHWs. Epidemiological impact was evaluated through standard surveillance and case management measures. Tests for differences in proportions or rates were used to compare measures prior to (October 2014-September 2016) and during the pilot (October 2016-September 2018). Results An active CHW was placed in 39 (95%) of 41 target communities. During the pilot, CHWs detected 61% of all reported cases from the region. Test positivity in the population tested by CHWs (22%) was higher than in those tested through active surveillance, both before (3.8%) and during the pilot (2.9%). From the pre-pilot to the pilot period, annual blood examination rates decreased (9.8 per 100 vs. 8.0 per 100), test positivity increased (4.2% to 8.5%, Χ2 = 126.3, p < 0.001) and reported incidence increased (4.1 cases per 1000 to 6.9 cases per 1000 [Incidence Rate Ratio = 1.83, 95% CI 1.52, 2.21]). The percent of cases tested on the day of symptom onset increased from 8 to 27% and those treated on the day of their test increased from 26 to 84%. Conclusions The CHW network allowed for replacement of routine active surveillance with strong passive case detection leading to more targeted and timely testing and treatment. The higher test positivity among those tested by CHWs compared to active surveillance suggests that they detected cases in a high-risk population that had not previously benefited from access to diagnosis and treatment. Surveillance data acquired through this CHW network can be used to better target active case detection to populations at highest risk.https://doi.org/10.1186/s12936-022-04318-zMalariaCommunity health workerRapid diagnostic testSurveillanceCase managementPlasmodium vivax |
| spellingShingle | Darlene Bhavnani Bernardo García Espinosa Madeline Baird Nicholas Presley Arnaud Le Menach Christina Bradley Marcela Outten Oscar González Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot Malaria Journal Malaria Community health worker Rapid diagnostic test Surveillance Case management Plasmodium vivax |
| title | Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot |
| title_full | Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot |
| title_fullStr | Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot |
| title_full_unstemmed | Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot |
| title_short | Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot |
| title_sort | malaria surveillance and case management in remote and indigenous communities of panama results from a community based health worker pilot |
| topic | Malaria Community health worker Rapid diagnostic test Surveillance Case management Plasmodium vivax |
| url | https://doi.org/10.1186/s12936-022-04318-z |
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