Malaria Elimination Demonstration Project (MEDP), India
The goal of MEDP was to demonstrate successful elimination of malaria from 1233 villages of Mandla district (India) and use the lessons learnt for eliminating malaria from rest of the country. The MEDP employed field-tested and proven principles for malaria elimination with context specific modifications. The following strategies were included:
- Active surveillance and case management: based on the T4 strategy, which is 'Track' by fever, 'Test', 'Treat', and 'Track' for completion of treatment. In addition, several rounds of Mass Testing and Treatment (MTaT) were conducted to identify and treat the asymptomatic reservoir of infection in the community.
- Vector control: provision of Long-Lasting Insecticidal Nets (LLINs), Indoor Residual Spray (IRS) and minor engineering.
- Information, Education and Communication (IEC) and Behaviour Change Communication (BCC).
- Capacity building.
[All the above components had robust in-built monitoring and evaluation systems]
- Identify collateral benefits on other vector-borne diseases, such as dengue.
- Demonstrate benefits of intersectoral and team work approach.
- Propose cost and time effective strategy for malaria elimination and business plan for elimination initiative to the rest of the state.
MEDP is a first-of-its-kind Public-Private-Partnership between the Indian Council of Medical Research (ICMR), Government of Madhya Pradesh (GoMP), and the Foundation for Disease Elimination and Control of India (FDEC-India). The Mandla district of Madhya Pradesh was chosen for this project, because it provided various complexities of demographics (forest malaria, hard to reach malaria-infected communities, rural malaria, urban malaria and tribal malaria) and epidemiology (both species of malaria parasites).
This project has revealed about 91% reduction of indigenous cases of malaria during the period from June 2017 to May 2020, through case management and vector control strategies. A total 357,143 febrile cases were screened, out of which 0.19% were found positive for the presence of malaria parasites. Mass screening revealed 0.18% positivity in Sep-Oct 2018, followed by 0.06% in June 2019, and 0.03% in December 2019, and these were mostly asymptomatic cases in the community. This project has demonstrated that field programmes backed by adequate technical, management, operational, and financial controls with robust monitoring are needed for achieving malaria elimination.
Surveillance and case management: The project included 235 trained Village Malaria Workers (VMWs), each one responsible of door-to-door active surveillance in 6–8 villages. Each household was visited within an interval of 7–14 days. VMWs used the T4 strategy, where they tracked and identified fever cases; tested using a bivalent Rapid Diagnostic Test (RDT) kit for P. falciparum and P. vivax; treated the positive cases using anti-malarials; and tracked the case for successful completion of treatment regimen. In addition, passive surveillance was conducted through Accredited Social and Health Activists (ASHAs), who are the village-based health staff of the state government and are trained in malaria diagnosis and treatment.
MTaT: In 2018 mass screening was conducted in the hard-to-reach areas, high burden areas (> 5 API), moderate burden areas (1–4.99 API), and low burden areas (0–1 API), targeting a total of 38,248 population. In June 2019, MTaT was carried out only in high and low malaria endemic areas targeting a sample size of 6200 and 8500 population, respectively. In December 2019 , another round was carried out in 50 houses surrounding the cryptic cases diagnosed and 8467 population was screened.
Vector Control: IRS with alphacypermethrin 5% was done twice in a year. LLINs were distributed in 2017 and 2019 by the state in areas with API > 5 and API >2, respectively (monitored by MEDP staff for post-distribution usage).
IEC/BCC: MEDP developed materials consisting of calendars, flipbooks, job-aids, posters, and booths, using feedback from the community. Activities were performed in middle schools, community markets (haat bazaars) and as part of regular door-to-door fever surveillance.
Capacity building: Needs-assessment on malaria knowledge and practices of ASHAs was undertaken by the project. MEDP was invited to participate in the trainings of 1000 + ASHAs of the district.