Monitoring and evaluation of intervals from onset of fever to diagnosis before “1-3-7” approach in malaria elimination: a retrospective study in Shanxi Province, China from 2013 to 2018

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Abstract

Background

China’s 1-3-7 approach was extensively implemented to monitor the timeframe of case reporting, case investigation and foci response in the malaria elimination. However, activities before diagnosis and reporting (before ‘1’) would counteract the efficiency of 1-3-7 approach but few data have evaluated this issue. This study aims to evaluate the timelines between onset of fever and diagnosis at healthcare facilities in Shanxi Province.

Methods

Routine data were extracted from IDIRMS and NMISM database from 2013 to 2018. Time intervals between onset of fever and healthcare-seeking and between healthcare-seeking and diagnosis were calculated. Each of the documented malaria cases was geo-coded and paired to the county-level layers of polygon.

Results

A total of 90 cases were reported in 2013–2018 in Shanxi Province, and 73% of cases reported at provincial health facilities. All malaria cases were imported from Africa (90%) and Southeast Asia (10%) especially around the Chinese Spring Festival (n = 46, 51%). The median days between fever and healthcare-seeking and between healthcare-seeking and diagnosis of malaria were 3 and 2, respectively.

Conclusions

The current “1-3-7” approach is well executed in Shanxi Province, but delays intervals observed in case finding before 1-3-7 approach occurred in all levels of facilities in Shanxi Province, which imply that more efforts are highlighted for timely case finding. Health education should be provided for improving awareness of healthcare-seeking, and various technical training aiming at the physicians should be carried out to improve diagnosis of malaria.

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Most cited references 36

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Communicating and Monitoring Surveillance and Response Activities for Malaria Elimination: China's “1-3-7” Strategy

Jun Cao, Hugh Sturrock, Chris Cotter … (2014)

Qi Gao and colleagues describe China's 1-3-7 strategy for eliminating malaria: reporting of malaria cases within one day, their confirmation and investigation within three days, and the appropriate public health response to prevent further transmission within seven days.

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Ready for malaria elimination: zero indigenous case reported in the People’s Republic of China

Jun Feng, Li Li Zhang, Fang Huang … (2018)

Background Malaria was once one of the most serious public health problems in China. However, the disease burden has sharply declined and epidemic areas have shrunk after the implementation of an integrated malaria control and elimination strategy, especially since 2000. In this review, the lessons were distilled from the Chinese national malaria elimination programme and further efforts to mitigate the challenges of malaria resurgence are being discussed. Methods A retrospective evaluation was performed to assess the changes in malaria epidemic patterns from 1950 to 2017 at national level. The malaria data before 2004 were collected from paper-based annual reports. After 2004, each of the different cases from the Infectious Diseases Information Reporting Management System (IDIRMS) was closely examined and scrutinized. An additional documenting system, the National Information Management System for Malaria, established in 2012 to document the interventions of three parasitic diseases, was also examined to complete the missing data from IDIRMS. Results From 1950 to 2017, the occurrence of indigenous malaria has been steeply reduced, and malaria-epidemic regions have substantially shrunk, especially after the launch of the national malaria elimination programme. There were approximately 30 million malaria cases annually before 1949 with a mortality rate of 1%. A total of 5999 indigenous cases were documented from 2010 to 2016, with a drastic reduction of 99% over the 6 years (2010, n = 4262; 2016, n = 3). There were indigenous cases reported in 303 counties from 18 provinces in 2010, but only 3 indigenous cases were reported in 2 provinces nationwide in 2016. While in 2017, for the first time, zero indigenous case was reported in China, and only 7 of imported cases were in individuals who died of Plasmodium falciparum infection. Conclusion Malaria elimination in China is a country-led and country-owned endeavour. The country-own efforts were a clear national elimination strategy, supported by two systems, namely a case-based surveillance and response system and reference laboratory system. The country-led efforts were regional and inter-sectoral collaboration as well as sustained monitoring and evaluation. However, there are still some challenges, such as the maintenance of non-transmission status, the implementation of a qualified verification and assessment system, and the management of imported cases in border areas, through regional cooperation. The findings from this review can probably help improving malaria surveillance systems in China, but also in other elimination countries. Electronic supplementary material The online version of this article (10.1186/s12936-018-2444-9) contains supplementary material, which is available to authorized users.

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China’s 1-3-7 surveillance and response strategy for malaria elimination: Is case reporting, investigation and foci response happening according to plan?

Shui-Sen Zhou, Shao-Sen Zhang, Li-Li Zhang … (2015)

Background The China’s 1-3-7 strategy was initiated and extensively adopted in different types of counties (geographic regions) for reporting of malaria cases within 1 day, their confirmation and investigation within 3 days, and the appropriate public health response to prevent further transmission within 7 days. Assessing the level of compliance to the 1-3-7 strategy at the county level is a first step towards determining whether the surveillance and response strategy is happening according to plan. This study assessed if the time-bound targets of the 1-3-7 strategy were being sustained over time. Such information would be useful to improve implementation of the 1-3-7 strategy in China. Methods This cross-sectional study involved country-wide programmatic data for the period January 1st 2013 to June 30th 2014. Data variables were extracted from the national malaria information system and included socio-demographic information, type of county, date of diagnosis, date of reporting, date of case investigation, case classification (indigenous, or imported, or unknown), focus investigation, date of reactive case detection (RACD), and date of indoor residual spraying (IRS). Summary statistics and proportions were used and comparisons between groups were assessed using the chi-square test. Level of significance was set at a P-value ≤ 0.05. Results Of a total of 5,688 malaria cases from 731 counties, there were 55 (1 %) indigenous cases (only in Type 1 and Type 2 counties) and 5,633 (99 %) imported cases from all types of counties. There was no delay in reporting malaria cases by type of county. In terms of case investigation, 97.5 % cases were investigated within 3 days with the proportion of delays (1.5 %) in type 2 counties, being significantly lower than type 1 counties (4.1 %). Regarding active foci, 96.4 % were treated by RACD and/or IRS. Conclusions The performance of 1-3-7 strategy was encouraging but identified some challenges that if addressed can further improve implementation. Electronic supplementary material The online version of this article (doi:10.1186/s40249-015-0089-2) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Ping Tie: sxtieping@163.com

Journal

Journal ID (nlm-ta): Malar J

Journal ID (iso-abbrev): Malar. J

Title: Malaria Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-2875

Publication date (Electronic): 12 July 2019

Publication date PMC-release: 12 July 2019

Publication date Collection: 2019

Volume: 18

Electronic Location Identifier: 235

Affiliations

[1 ]Shanxi Center for Disease Control and Prevention, Taiyuan, 030012 China

[2 ]ISNI 0000 0000 8803 2373, GRID grid.198530.6, National Institute of Parasitic Diseases, , Chinese Center for Disease Control and Prevention, ; Shanghai, 200025 China

[3 ]Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Mandalay, 05021 Myanmar

[4 ]ISNI 0000 0000 8803 2373, GRID grid.198530.6, National Institute for Viral Disease Control and Prevention, , Chinese Center for Disease Control and Prevention, ; Beijing, 102206 China

Article

Publisher ID: 2865

DOI: 10.1186/s12936-019-2865-0

PMC ID: 6626373

PubMed ID: 31299985

SO-VID: ba612dad-d33c-4f2c-9565-678952296ee3

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 25 March 2019

Date accepted : 3 July 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100012165, Key Technologies Research and Development Program;

Award ID: 2018ZX10101002-004

Award Recipient : Jun Feng

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: malaria,shanxi,case diagnosis,elimination

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: malaria, shanxi, case diagnosis, elimination

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Monitoring and evaluation of intervals from onset of fever to diagnosis before “1-3-7” approach in malaria elimination: a retrospective study in Shanxi Province, China from 2013 to 2018

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Most cited references 36

Communicating and Monitoring Surveillance and Response Activities for Malaria Elimination: China's “1-3-7” Strategy

Ready for malaria elimination: zero indigenous case reported in the People’s Republic of China

China’s 1-3-7 surveillance and response strategy for malaria elimination: Is case reporting, investigation and foci response happening according to plan?

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