Last Updated: 31/10/2025
ACROSS Study: APMEN health Care facility & community assessment to determine populations at Risk Of malaria and primaquine-induced haemolysiS
Objectives
Primary Objectives:
- To quantify the microscopic and sub microscopic prevalence of malaria.
- To determine the prevalence and spectrum of activity of G6PD deficiency in patients with and without malaria.
Secondary Objectives:
- To evaluate novel qualitative and quantitative diagnostics for the diagnosis of G6PD deficiency
- To evaluate performance of currently used malaria RDTs
- To evaluate ultra-sensitive diagnostics for the diagnosis of malaria
- To identify utility of serological or other survey tools for targeting interventions, and appropriate ways to use them
- To evaluate the perceptions and utility of novel diagnostics in healthcare providers
- To determine the local G6PD and CYP2D6 genotypes present in the local population
- To determine the local prevalence of anemia
- To quantify prevalence of parasite polymorphisms associated with antimalarial drug resistance
- To assess community understanding of P. vivax infection and radical cure
- To assess community perceptions of P. vivax infection and the concept of radical cure
- To assess health seeking behavior for P. vivax malaria at community level
- To assess acceptability of G6PD testing among health system stakeholders, health facility staff and local communities
- To review prescription behavior for radical cure among health facility staff
- To assess adherence to radical cure prescription at health facility level and adherence to radical cure treatment at community level.
Asia Pacific Malaria Elimination Network (APMEN), Singapore
PATH, United States
Institute of Tropical Medicine (ITM) Antwerp, Belgium
FIND, Switzerland
International Centre for Diarrheal Diseases Research, Bangladesh
Ministry of Health (MOH) Bhutan, Bhutan
National Institute of Parasitic Diseases (NIPD), Chinese Center for Disease Control and Prevention (China CDC), China
Medical College Kolkata (KMC), India
Eijkman Institute for Molecular Biology (EIMB), Indonesia
Tribhuvan University, Nepal
Aga Khan University, Pakistan
National Institute of Malaria, Parasitology and Entomology (NIMPE) Vietnam, Vietnam
In the Asia-Pacific region an increasing proportion of malaria is due to Plasmodium vivax since it is harder to eliminate than Plasmodium falciparum. P. vivax can form dormant liver stages that can relapse weeks to months after an initial infection. The only widely available drug to kill the liver stages is primaquine, but this can cause drug induced hemolysis in patients with a common enzyme deficiency known as Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency.
To promote the safe and effective use of primaquine radical cure for malaria, we need to have a better understanding of which populations are at greatest risk of malaria and know prevalence and variants of G6PD deficiency in these populations. In the last five years, great gains have been made in developing novel point-of-care diagnostics that can diagnose patients with P. vivax malaria and identify those with G6PD deficiency. The utility of these diagnostics in a clinical setting need to be explored both by quantitative and qualitative surveys. The aim of the ACROSS surveys is to provide a standardised approach to field testing so that a range of data can be gathered for each location, but can also be pooled for a comprehensive analysis.
Jun 2018
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