Innovation in malaria case detection

The paradox of malaria and many tropical diseases is that those most at-risk are also some of the least likely to access, or be able to access, health facilities. Active case detection, the screening of fever cases in the community itself, helps enable case management in such remote or inaccessible areas. But it’s also time and manpower intensive. Answering the questions of where to target, and whom to target is critical to making sure that effort will be worthwhile. In practice, the usual mechanical application of the strategy ensures that it will not be efficient.

So it’s beautiful to see an example of creative thinking. Last year in the infamous Jalpaiguri district of India, I met an unique, young block medical officer. Over some hot milk tea, the clean-shaven late 20s year old commented on how most of the cases at his primary health center labored in the dense jungle along the Bhutanese border. Living in secluded villages, many sought care only after prolonged illness and often arrived with severe complications. In fact,  he had described a well known phenomenon. From central India to throughout Southeast Asia stretches a vast epidemiological belt of  ‘forest malaria’. The ecotype is notorious for intense transmission due to the efficient mosquito species (A. fluviatilis, minimus, and dirus) particular to that habitat.

How did he respond? Simply, intensify active case detection in those areas. To his surprise, few of the blood smears collected turned up malaria parasites. Why?  Slides were collected during the day, exactly when most of the workers were away. Undeterred, the medical officer led his staff to the villages at dusk when workers were back from the bush. Travelling as late as 8 and 9pm by unlighted, broken roads, they again returned the following day to treat infected patients. He knew it to be unsustainable for the health workers themselves in the long run, ideally the villages could receive  a community health worker (ASHA) or later they could train community volunteers, but continued the practice for the rest of the high transmission season. It paid off. Inpatient admissions for severe malaria at the primary health center fell dramatically.

I was floored. Here he was young, new to the area, no special training in malaria, but already making a difference with the few resources at his disposal. It is the value of good management. Best of all it’s not a story about new technology or glossy strategy guides – just careful observation and dedication.




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