Challenges to malaria surveillance following elimination of indigenous transmission: findings from a hospital-based study in rural Sri Lanka.

INTRODUCTION: Sri Lanka has eliminated local transmission of malaria. Assessing physician preparedness for early case detection is important, in order to prevent re-establishment of local transmission. METHODS: Adherence to malaria screening practices in patients admitted with fever to 12 hospitals in a previously malaria endemic district was evaluated using a cross sectional survey. In addition, knowledge and attitudes among doctors on current malaria surveillance practices and treatment recommendations was assessed. RESULTS: Of 403 fever patients, 150 warranted screening for malaria under the criteria defined by the Anti Malaria Campaign (AMC), with 93 of them having fever for over 7 days. Of these eligible patients, 12.6% (19/150) were investigated by doctors (including 3 persons with fever over 7 days), 14.6% (22/150) by laboratory staff and 72.6% (109/150) by the research team. The majority of doctors were not familiar with the treatment guidelines for malaria (76.5%, 75/98). CONCLUSIONS: Mandatory continuous medical education programmes need to continue to ensure that malaria remains on the differential diagnosis of a fever patient, especially in patients with fever over 7 days. It is essential to publicize the availability of free-of-charge malaria diagnostic facilities, and to ensure that proper notification procedures are followed when a malaria patient is diagnosed.

Educating the security forces, a high risk group in malaria elimination efforts: an example from Sri Lanka.

BACKGROUND: The security forces are a high risk group for malaria transmission in Sri Lanka. Interrupting transmission and maintaining surveillance in this group is an important component of elimination efforts. The objective of the study was to develop a prototype educational programme on malaria for security forces serving in endemic areas. METHODS: An interactive seminar was designed to deliver the required knowledge. The content was on current status, transmission, signs and symptoms and the role of security personnel in identification and prevention of malaria. Each seminar was preceded by a pre-test and followed by a post test to assess the improvement of knowledge. RESULTS: Fifty seminars were held in eight districts over 2 months with 2301 security forces personnel participating. Pre seminar knowledge on malaria was significantly better in the medical corps, those who had completed secondary education and in the Army compared to other security forces (p<0.001). Participation in the seminar resulted in an improvement in all domains tested as shown by test scores in post seminar assessment (p<0.001). CONCLUSIONS: Conducting a formal educational programme is an effective strategy to improve awareness on malaria amongst security forces personnel who are a high risk group for re-introduction of malaria into the country.