Inter-sectoral approaches for the prevention and control of malaria among the mobile and migrant populations: a scoping review

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malaria 82 Title: Malaria JournalInter-sectoral approaches for the prevention and control of malaria among the mobile and migrant populations: a scoping reviewCho NaingMaxine A. WhittakerMarcel TannerPublication
malaria 870 this review. Numerous stakeholders were identified as involved in the intersectoral actions to defeat malaria amongst MMPs. Almost all studies discussed the involvement of Ministry of Health/Public Health (MOH/MOPH).
malaria 1231 personal protective measures (40.5%), followed by the intervention of early diagnoses and treatment of malaria (33.3%), the surveillance and response activities (13.9%) and the behaviour change communication (8.3%).
malaria 1723 showed some evidence that the intersectoral collaborations contributed to improvement in knowledge about malaria , initiation and promotion of bed nets utilization, increased access to diagnosis and treatment in a
malaria 1891 access to diagnosis and treatment in a surveillance context and contributed towards a reduction in malaria transmission. Overall, a high proportion of the targeted MMPs was equipped with correct knowledge about
malaria 2003 transmission. Overall, a high proportion of the targeted MMPs was equipped with correct knowledge about malaria transmission (70%, 95% CI 57–83%). Interventions targeting the use of bed nets utilization were two
malaria 2141 57–83%). Interventions targeting the use of bed nets utilization were two times more likely to reduce malaria incidence amongst the targeted MMPs (summary OR 2.01, 95% CI 1.43–2.6) than the non-users. The various
malaria 2548 that interventions supported by the multiple stakeholders had a significant impact on the reduction of malaria transmission amongst the targeted MMPs. Well-designed studies from different countries are recommended
malaria 3050 users.BackgroundThe ultimate goal of the Global Technical Malaria Strategy 2016–2030 is to eliminate malaria from at least 35 countries by 2030 [[1], [2]]. In 2016, 91 countries reported on the indigenous malaria
malaria 3154 malaria from at least 35 countries by 2030 [[1], [2]]. In 2016, 91 countries reported on the indigenous malaria cases. Among these, 15 countries carried 80% of the global malaria burden [[3]]. In some of the pre-elimination
malaria 3221 countries reported on the indigenous malaria cases. Among these, 15 countries carried 80% of the global malaria burden [[3]]. In some of the pre-elimination countries, malaria is now limited to remote, forested areas,
malaria 3285 countries carried 80% of the global malaria burden [[3]]. In some of the pre-elimination countries, malaria is now limited to remote, forested areas, and often malaria cases are largely found in mobile and migrant
malaria 3345 some of the pre-elimination countries, malaria is now limited to remote, forested areas, and often malaria cases are largely found in mobile and migrant populations (MMPs) [[4]]. The link between malaria transmission
malaria 3442 often malaria cases are largely found in mobile and migrant populations (MMPs) [[4]]. The link between malaria transmission and human population movement (HPM) has been acknowledged many years ago [[5]]. Historically,
malaria 3659 has been noted that the failure to consider HPM has been one factor contributing to the failure of malaria eradication campaigns in the 1950s and the 1960s [[6]–[9]].As transmission declines due to concerted
malaria 3781 campaigns in the 1950s and the 1960s [[6]–[9]].As transmission declines due to concerted efforts of malaria control, it often becomes increasingly focal [[10]] or found as pockets of transmission [[11]]. Control
malaria 4047 reservoirs, deploying resources with increasing granularity [[10]] to populations who are at high risk of malaria transmission. This often includes MMPs. Numerous studies have reported that MMPs face many obstacles
malaria 4478 migrant-inclusive health policies, among others [[12]–[14]]. In the context of achieving and sustaining malaria elimination, there is a need to have health services that are used by MMPs and this requires specific
malaria 4684 specific service-delivery because they move into and through multiple localities that may have different malaria transmission levels and risks [[13]].Efforts should be directed towards implementation of integrated
malaria 4968 non-health sectors [[12]]. However, there are limited and mixed evidences about the success of intersectoral malaria -focussed activities and HPM. For instance, some studies reported there was no clear linkages between
malaria 5174 between the health sectors and other sectoral ministries [[14]], while other studies showed reduction of malaria incidence through intersectoral activities [[15]]. Additionally, descriptions of successful intersectoral
malaria 5302 intersectoral activities [[15]]. Additionally, descriptions of successful intersectoral approaches to malaria in general, and in particular for MMPs are limited. Intersectoral interventions (activities/actions)
malaria 5415 general, and in particular for MMPs are limited. Intersectoral interventions (activities/actions) for malaria in this review refers to the inclusion of several sectors in addition to the health sector when designing
malaria 5732 the research question: What sectors are addressing and implementing intervention(s) targeted towards malaria control of the MMPs?The objectives were to:Identify what intersectoral actions have been taken and how
malaria 6394 guideline [[17]] (Additional file 1). A conceptual framework for intersectoral activities addressing malaria and HPM is provided (Fig. 1). The framework identified three main domains that can contribute to the
malaria 6520 provided (Fig. 1). The framework identified three main domains that can contribute to the consequences of malaria interventions targeted towards the HPM. The domains included are the antecedents, the health problems
malaria 6907 populations have encountered multiple health problems. However, the focus of this study is primarily on malaria . The key factors that are involved in the implementation of interventions are also described. The two
malaria 7585 response, (ii) test and treat, (iii) vector control and (iv) PPE/HE, in accordance with the global malaria control strategy. All these three domains are sequentially linked which contribute to the consequences
malaria 8030 achievements of the sectors involved.Fig. 1A conceptual framework for intersectoral activities addressing malaria and human population movementStudy searchThe relevant studies were searched in the health-related databases,
malaria 8263 Medline, Embase, ProQuest, Global Health, and Google Scholar. Keywords used in the search included: malaria , Plasmodium falciparum, Plasmodium vivax, migrants, migration, hard-to-reach, marginalised, multisectoral,
malaria 8577 as appropriate. The search was extended to the WHO websites for Roll Back Malaria Partnership to end malaria (RBM) documents, the international agency websites including International Organization for Migration
malaria 9057 population, concepts and context in the PCC format [[18]].Population (P)Studies with participants having malaria and categorized as MMP, were included regardless of age, gender and their legal status. As theories
malaria 9256 theories and definitions of migration are diverse [[11]] and migration is not a definitive risk for malaria [[19]], the MMP in this review is defined in the context of malaria, rather than general definition
malaria 9324 migration is not a definitive risk for malaria [[19]], the MMP in this review is defined in the context of malaria , rather than general definition of MMP. In the present study MMPs are defined as “individuals who
malaria 10188 population movement (HPM) [[22]].Concepts (C)All interventions targeting to the prevention or control of malaria were included. The interventions were summarized into five categories; (i) surveillance and response
malaria 10522 control.Contents (C)Published and unpublished epidemiologic studies were considered, assessing interventions for malaria control, case studies (publications that describe implementation of interventions), position papers
malaria 10832 the description of actual or proposed interventions) with a focus on intersectoral collaboration for malaria control among MMPs. The following outcomes of intersectoral interventions targeted at MMPs were considered.Interventions
malaria 11037 considered.Interventions thatBenefited participants (levels of knowledge, attitudes and practices of malaria control),Demonstrated positive behaviour changes with significant reduction in malaria incidence,Had
malaria 11124 practices of malaria control),Demonstrated positive behaviour changes with significant reduction in malaria incidence,Had increased detection of asymptomatic malaria cases,Demonstrated intersectoral coordination
malaria 11182 behaviour changes with significant reduction in malaria incidence,Had increased detection of asymptomatic malaria cases,Demonstrated intersectoral coordination (qualitatively or quantitatively).The search was limited
malaria 11611 that were primarily concerned with other issues rather than intersectoral collaboration to address malaria amongst MMPs were excluded.Data extractionSeveral steps were involved in data extraction in the present
malaria 17900 [[47]].Fig. 3Distribution of study countriesStakeholders involvedThe list of stakeholders in the intersectoral actions for malaria control among MMPs is presented in Additional file 3. A variety of stakeholders, such as MOH/MOPH, other
malaria 18201 and local NGOs, and faith-based organizations, were identified for intersectoral actions to defeat malaria amongst MMPs. Almost all studies discussed the involvement of MOH/MOPH, except two studies from Myanmar
malaria 19546 protective measures (PPM) (40.5%), followed by the intervention of early diagnosis and treatment of malaria (33.3%), the surveillance and response activities (13.9%) and the behaviour change communication (BCC)
malaria 19765 (8.3%).Lessons learnedTable 2 presents the summary of lessons learned on the intersectoral involvement for malaria control/elimination amongst MMPs. Almost all studies described the success factors for the intervention
malaria 20028 description on which a particular agency/sector was involved and how they collaborated with each other in malaria control/elimination activities. Only three studies explicitly provided details on factors contributing
malaria 20980 funding” [28, p. 11].Table 2Description of lessons learned from the intersectoral involvement for malaria control targeted to the mobile and migrant populationsStudy, yearCountryLessons learned (success)Zhang,
malaria 22301 ITNs in migrant workersCanavati, 2016 [[43]]CambodiaTargeted community was satisfied with the mobile malaria workers’ servicesLessons learned (challenges) Wai, 2014 [[36]]MyanmarNeed to improve mechanisms of
malaria 22975 language barrier in multilingual ethnic groups Ly, 2017 [[53]]Cambodia~ 10% of participants treated for malaria did not have a confirmed diagnosis Ly, 2017 [[53]]; Obol, 2013 [[33]]; Charchuk, 2016 [[44]]Cambodia;
malaria 23767 [[36]]MyanmarA gap in willingness to buy ITNs/LLINs and affordability Canavati, 2016 [[43]]Short stay of mobile malaria workers;Low utilization of mobile malaria workers Carrara, 2006 [[23]]Thailand2-day artesunate regimen
malaria 23809 affordability Canavati, 2016 [[43]]Short stay of mobile malaria workers;Low utilization of mobile malaria workers Carrara, 2006 [[23]]Thailand2-day artesunate regimen given, not a standard 3-day regimen MOH,
malaria 24027 Malaysia, 2015 [[38]]MalaysiaUndocumented migrant workers are a challenging group to access/trace for the malaria elimination intervention Qayum, 2012 [[31]]PakistanLimited distribution of ITNs;No worn out bed nets
malaria 25133 countries was identified, that provided details on the proportion of MMPs with the correct knowledge about malaria as a mosquito borne disease [[27], [31], [32], [37], [39], [41], [43], [53]]. Overall, a pooled estimate
malaria 25351 70% (95% CI 57–83%), indicating a high proportion of the targeted MMPs had correct knowledge about malaria transmission (Fig. 4). There was a substantial variation within study heterogeneity, and the estimates
malaria 25925 State, Mon State, Bago region and Tanintharyi region of Myanmar [[39]] had correct knowledge about malaria transmission. This implied that there might be variations in modes of delivery of health education (HE)
malaria 26121 education (HE) messages.Fig. 4Proportion of the mobile and migrant populations who correctly know malaria as a mosquito-borne disease. Effect size (ES) indicates proportion. Each included study is represented
malaria 28500 resultsInterestingly, the paradoxical phenomenon of a high proportion of MMPs with knowledge about malaria transmission, but with a low proportion of net utilization was found in a study from Cambodia [[53]],
malaria 29961 width of the diamond, the less reliable the pooled resultsAmong the studies that measured an outcome of malaria case reduction, five studies (with six datasets) provided data with comparable reporting methods [[15],
malaria 30280 no-intervention. An intervention for utilization of ITNs/LLINs was two times more likely to reduce malaria incidence amongst the targeted MMPs (summary OR 2.01, 95% CI 1.43–2.6) (Fig. 7). Amongst MMPs in
malaria 30536 the habit of (always) sleeping under a bed net at night were likely to have a threefold reduction in malaria incidence compared to those who did not reported this behaviour (OR 3.2, 95% CI 2.9–3.7) [[15]]. Only
malaria 30777 Myanmar-Thailand borders provided data on outcome of early detection and treatment. It showed a 12% increase in malaria cases in the non-intervention groups compared to those MMPs under intervention (OR 1.12, 95% CI 1.09–1.16)
malaria 32352 included in the current review, a common finding in these studies was the high levels of asymptomatic malaria . The detection of asymptomatic malaria was through active case detection (ACD) and reactive case detection
malaria 32391 finding in these studies was the high levels of asymptomatic malaria. The detection of asymptomatic malaria was through active case detection (ACD) and reactive case detection (RCD) activities among MMPs. One
malaria 32693 It showed that RDTs and microscopy (used for surveillance) did not identify all the people who had malaria parasites [[46]]. Compared to PCR, the RDT sensitivity was very low (16%, 95% CI 9.9–27.7%) as was
malaria 33013 or with microscopy (100%, 95% CI 98.8–100%). This would mean that 84% and 82% of humans carrying malaria parasites would have been missed by using only microscopy or only RDT, respectively. Several stakeholders,
malaria 33810 seventeen countries. This is the first systematic review which assessed intersectoral collaboration for malaria control targeted to MMPs in pre-elimination or elimination phases. “Intersectoral action is a strategy
malaria 34651 agencies, NGOs, private sectors, employers of concern had been supporting the various interventions for malaria control/elimination targeted to these high risk populations;Although limited details were provided in
malaria 34909 some evidence that the intersectoral collaborations contributed to the improvement in knowledge about malaria . This also initiated and promoted bed net utilization; increased access to diagnosis and treatment interventions
malaria 35069 utilization; increased access to diagnosis and treatment interventions and contributed towards a reduction in malaria incidence.The need for more detailed description of partnershipsIntersectoral collaboration to address
malaria 35632 robust analysis of the contribution of these intersectoral actions made towards achieving the targeted malaria control outcome. This was because these studies were designed to address their specific objectives,
malaria 36024 to MMPs.Although there was paucity of data, evidence was found that interventions targeted towards malaria in IDP camps/amongst MMPs could reduce malaria incidence/prevalence significantly in comparison to the
malaria 36071 evidence was found that interventions targeted towards malaria in IDP camps/amongst MMPs could reduce malaria incidence/prevalence significantly in comparison to the surrounding villages or those villages without
malaria 37491 analysis confirmed this assertion by revealing the geographical variations in the level of knowledge about malaria transmission or net utilization. This difference was possibly related to type of interventions for MMPs.
malaria 37830 positive behaviours appropriate to their settings.The proportion of people equipped with knowledge about malaria transmission through the bite of (infective female) mosquitoes was higher, but the net utilization rates
malaria 38423 means of protection in order to support people to convert their knowledge and supportive attitudes into malaria control practice. Moreover, other aspects of a supportive environment such as community and health services
malaria 39342 phase, all instances of detected parasitaemia (including gametocytaemia only) are considered as ‘ malaria case’ as they might lead to onward transmission, regardless of the presence or absence of clinical
malaria 39499 transmission, regardless of the presence or absence of clinical symptoms [[59]]. Hence, it is crucial to expand malaria intervention strategies in IDP camps to local surrounding villages in the border area [[22]]. The malaria
malaria 39605 malaria intervention strategies in IDP camps to local surrounding villages in the border area [[22]]. The malaria control strategy in the critical period of pre/elimination phase in the areas of MMPs should be an “all
malaria 40646 they have limited employment opportunities [[58]]. More detailed consideration of sustainability of malaria control interventions among various sub-populations of MMPs is required to achieve the targets of elimination
malaria 41353 (e.g. ITN distribution or BCC activities). It is likely that countries have developed strategies for malaria control activities with MMPs through intersectoral actions that have not been published and are, therefore,
malaria 41960 inherent in the included studies; the individual characteristics of MMPs, migration patterns, level of malaria endemicity in their localities, the presence of co-infections/co-morbid conditions, and coverage of
malaria 42078 in their localities, the presence of co-infections/co-morbid conditions, and coverage of effective malaria interventions. Due to inadequate data, stratified analyses based on all these influencing factors were
malaria 42359 design.Public health implicationsUniversal health coverage must be the goal for all people at risk of malaria including MMPs. Control of malaria and effective treatment was problematic since it was difficult for
malaria 42394 implicationsUniversal health coverage must be the goal for all people at risk of malaria including MMPs. Control of malaria and effective treatment was problematic since it was difficult for routine health sector activities,
malaria 43099 healthcare services could be maximized through improved knowledge and supportive attitudes towards malaria control supported by effective BCC that were linked to improve provision of required “tools” for
malaria 43863 interventions and services through a network of village health workers and community volunteers to strengthen malaria prevention and control measures might be particularly useful for the MMPs who have limited access to
malaria 44134 suggest that interventions supported by multiple stakeholders have a significant impact on reduction of malaria transmission in the targeted MMPs. It is important to realize that intersectoral action is a key strategy
malaria 44603 ministries, private medical sectors and implementing NGOs is urgently needed to enhance the outcome of malaria control and elimination efforts targeting these often neglected and underserved populations. Well-designed
malaria 45068 Excluded studies and the reasons for exclusion.Additional file 3. List of the stakeholders involved for malaria control among mobile and migrant populations.Additional file 4. Intersectoral involvement in the malaria
malaria 45173 malaria control among mobile and migrant populations.Additional file 4. Intersectoral involvement in the malaria intervention activities targeted to the mobile and migrant populations

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