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Abstract：
BACKGROUND: Remaining Plasmodium falciparum cases in Cambodia are concentrated in forested border areas and in remote populations who are hard to reach through passive case detection. A key approach to reach these populations is active case detection by mobile malaria workers (MMWs). However, this is operationally challenging because of changing movement patterns of the target population moving into less accessible areas. From January 2018 to December 2020, a tailored package of active case detection approaches was implemented in forested border areas of three provinces in north-eastern Cambodia to reach remote populations and support the elimination of falciparum malaria.
METHODS: Key elements of this project were to tailor approaches to local populations, use responsive monitoring systems, maintain operational flexibility, build strong relationships with local communities, and implement close supervision practices. MMWs were recruited from local communities. Proactive case detection approaches included mobile malaria posts positioned at frequented locations around and within forests, and locally informed outreach activities targeting more remote locations. Reactive case detection was conducted among co-travellers of confirmed cases. Testing for malaria was conducted independent of fever symptoms. Routine monitoring of programmatic data informed tactical adaptations, while supervision exercises ensured service quality.
RESULTS: Despite operational challenges, service delivery sites were able to maintain consistently high testing rates throughout the implementation period, with each of 45 sites testing a monthly average of 64 (SD 6) people in 2020. In 2020, project MMWs detected only 32 P. falciparum cases. Over the project period, the P. falciparum/P. vivax ratio steadily inversed. Including data from neighbouring health centres and village malaria workers, 45% (80,988/180,732) of all people tested and 39% (1280/3243) of P. falciparum cases detected in the area can be attributed to project MMWs. Remaining challenges of the last elimination phase include maintaining intensified elimination efforts, addressing the issue of detecting low parasitaemia cases and shifting focus to P. vivax malaria.
CONCLUSIONS: Reaching remote populations through active case detection should remain a key strategy to eliminate P. falciparum malaria. This case study presented a successful approach combining tailored proactive and reactive strategies that could be transferred to similar settings in other areas of the Greater Mekong Subregion.
METHODS: Key elements of this project were to tailor approaches to local populations, use responsive monitoring systems, maintain operational flexibility, build strong relationships with local communities, and implement close supervision practices. MMWs were recruited from local communities. Proactive case detection approaches included mobile malaria posts positioned at frequented locations around and within forests, and locally informed outreach activities targeting more remote locations. Reactive case detection was conducted among co-travellers of confirmed cases. Testing for malaria was conducted independent of fever symptoms. Routine monitoring of programmatic data informed tactical adaptations, while supervision exercises ensured service quality.
RESULTS: Despite operational challenges, service delivery sites were able to maintain consistently high testing rates throughout the implementation period, with each of 45 sites testing a monthly average of 64 (SD 6) people in 2020. In 2020, project MMWs detected only 32 P. falciparum cases. Over the project period, the P. falciparum/P. vivax ratio steadily inversed. Including data from neighbouring health centres and village malaria workers, 45% (80,988/180,732) of all people tested and 39% (1280/3243) of P. falciparum cases detected in the area can be attributed to project MMWs. Remaining challenges of the last elimination phase include maintaining intensified elimination efforts, addressing the issue of detecting low parasitaemia cases and shifting focus to P. vivax malaria.
CONCLUSIONS: Reaching remote populations through active case detection should remain a key strategy to eliminate P. falciparum malaria. This case study presented a successful approach combining tailored proactive and reactive strategies that could be transferred to similar settings in other areas of the Greater Mekong Subregion.
摘要：
背景：柬埔寨剩余的恶性疟原虫病例集中在森林边境地区和偏远人群中，这些人群很难通过被动病例检测获得。接触这些人群的一个关键方法是由移动疟疾工作人员(MMWs)主动检测病例。然而,这在操作上是具有挑战性的，因为改变了转移到较难进入地区的目标人群的移动模式。从2018年1月至2020年12月，在柬埔寨东北部三个省的森林边境地区实施了一套量身定制的主动病例检测方法，以覆盖偏远人群并支持消除恶性疟疾。
方法：该项目的关键要素是为当地人口量身定制方法，使用响应式监控系统，保持操作灵活性，与当地社区建立牢固的关系，实行严密监督。MMW是从当地社区招募的。积极的病例检测方法包括在森林周围和森林内经常出没的地方安置流动疟疾哨所，以及针对更偏远地点的当地知情外展活动。在确诊病例的共同旅行者中进行了反应性病例检测。疟疾检测独立于发热症状进行。对战术适应的方案数据进行例行监测，监督工作确保了服务质量。
结果：尽管存在运营挑战，服务交付站点能够在整个实施期间保持始终如一的高测试率，到2020年，45个站点中的每个站点每月平均测试64人(SD6)。2020年，MMW项目仅检测到32例恶性疟原虫病例。在项目期间，恶性疟原虫/P间日比稳定反转。包括来自邻近卫生中心和乡村疟疾工作者的数据,在该地区检测到的所有患者中有45％（80,988/180,732）和39％（1280/3243）的恶性疟原虫病例可归因于MMW项目。最后一个消除阶段的剩余挑战包括继续加大消除努力，解决检测低寄生虫血症病例和将重点转移到间日疟原虫的问题。
结论：通过主动病例检测达到偏远人群应仍然是消除恶性疟原虫疟疾的关键策略。本案例研究提出了一种成功的方法，结合了量身定制的主动和被动策略，可以将其转移到大湄公河次区域其他地区的类似环境中。
方法：该项目的关键要素是为当地人口量身定制方法，使用响应式监控系统，保持操作灵活性，与当地社区建立牢固的关系，实行严密监督。MMW是从当地社区招募的。积极的病例检测方法包括在森林周围和森林内经常出没的地方安置流动疟疾哨所，以及针对更偏远地点的当地知情外展活动。在确诊病例的共同旅行者中进行了反应性病例检测。疟疾检测独立于发热症状进行。对战术适应的方案数据进行例行监测，监督工作确保了服务质量。
结果：尽管存在运营挑战，服务交付站点能够在整个实施期间保持始终如一的高测试率，到2020年，45个站点中的每个站点每月平均测试64人(SD6)。2020年，MMW项目仅检测到32例恶性疟原虫病例。在项目期间，恶性疟原虫/P间日比稳定反转。包括来自邻近卫生中心和乡村疟疾工作者的数据,在该地区检测到的所有患者中有45％（80,988/180,732）和39％（1280/3243）的恶性疟原虫病例可归因于MMW项目。最后一个消除阶段的剩余挑战包括继续加大消除努力，解决检测低寄生虫血症病例和将重点转移到间日疟原虫的问题。
结论：通过主动病例检测达到偏远人群应仍然是消除恶性疟原虫疟疾的关键策略。本案例研究提出了一种成功的方法，结合了量身定制的主动和被动策略，可以将其转移到大湄公河次区域其他地区的类似环境中。
