title: Evaluation of community-based systems for the surveillance of day three-positive Plasmodium falciparum cases in Western Cambodia.
abstract: BACKGROUND
  Delayed clearance of Plasmodium falciparum parasites is used as an operational indicator of potential artemisinin resistance. Effective community-based systems to detect P. falciparum cases remaining positive 72 hours after initiating treatment would be valuable for guiding case follow-up in areas of known resistance risk and for detecting areas of emerging resistance.
  
  
  METHODS
  Systems incorporating existing networks of village malaria workers (VMWs) to monitor day three-positive P. falciparum cases were piloted in three provinces in western Cambodia. Quantitative and qualitative data were used to evaluate the wider feasibility and sustainability of community-based surveillance of day three-positive P. falciparum cases.
  
  
  RESULTS
  Of 294 day-3 blood slides obtained across all sites (from 297 day-0 positives), 63 were positive for P. falciparum, an overall day-3 positivity rate of 21%. There were significant variations in the systems implemented by different partners. Full engagement of VMWs and health centre staff is critical. VMWs are responsible for a range of individual tasks including preparing blood slides on day-0, completing forms, administering directly observed therapy (DOT) on days 0-2, obtaining follow-up slides on day-3 and transporting slides and paperwork to their supervising health centre. When suitably motivated, unsalaried VMWs are willing and able to produce good quality blood smears and achieve very high rates of DOT and day-3 follow-up.
  
  
  CONCLUSIONS
  Community-based surveillance of day-3 P. falciparum cases is feasible, but highly intensive, and as such needs strong and continuous support, particularly supervision and training. The purpose and role of community-based day-3 surveillance should be assessed in the light of resource requirements; scaling-up would need to be systematic and targeted, based on clearly defined epidemiological criteria. To be truly comprehensive, the system would need to be extended beyond VMWs to other public and private health providers.
authors: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. jonathan.cox@lshtm.ac.uk.
authors: Jonathan
authors: J
authors: Cox
authors: Lek
authors: L
authors: Dy Soley
authors: Tol
authors: T
authors: Bunkea
authors: Siv
authors: S
authors: Sovannaroth
authors: Kheang
authors: K
authors: Soy Ty
authors: Song
authors: S
authors: Ngak
authors: Steven
authors: S
authors: Bjorge
authors: Pascal
authors: P
authors: Ringwald
authors: Steven
authors: S
authors: Mellor
authors: David
authors: D
authors: Sintasath
authors: Sylvia
authors: S
authors: Meek
mesh_terms: D037621:Artemisinins / Q000494:pharmacology* / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002160:Cambodia / Q000453:epidemiology; D016000:Cluster Analysis; D003150:Community Health Workers / Q000191:economics / Q000193:education / Q000523:psychology; D055812:Community-Based Participatory Research / Q000191:economics; D015897:Comorbidity; D004351:Drug Resistance; D005240:Feasibility Studies; D006282:Health Personnel / Q000191:economics; D006792:House Calls / Q000191:economics; D006801:Humans; D007407:Interviews as Topic; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology*; D016780:Malaria, Vivax / Q000453:epidemiology; D008853:Microscopy / Q000295:instrumentation / Q000379:methods; D018512:Parasitemia / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology*; D010274:Parasitology / Q000379:methods; D010865:Pilot Projects; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000302:isolation & purification; D011159:Population Surveillance / Q000379:methods*; D015397:Program Evaluation; D036301:Qualitative Research; D060926:Remuneration; D013048:Specimen Handling / Q000191:economics; D013997:Time Factors; D014186:Transportation / Q000191:economics
chemical_list: D037621:Artemisinins; C031327:artemisinin