title: Challenges to malaria surveillance following elimination of indigenous transmission: findings from a hospital-based study in rural Sri Lanka.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo 08, Sri Lanka ferndeep@gmail.com.
authors.forename: Sumadhya Deepika
authors.initials: SD
authors.lastname: Fernando
authors.affiliation: Department of Public Health, University of Oxford, Oxford, UK.
authors.forename: Samafilan
authors.initials: S
authors.lastname: Ainan
authors.affiliation: Anti Malaria Campaign, Colombo, Sri Lanka.
authors.forename: Risintha Gayan
authors.initials: RG
authors.lastname: Premaratne
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka.
authors.forename: Chaturaka
authors.initials: C
authors.lastname: Rodrigo
authors.affiliation: Regional Malaria Office, Anuradhapura, Sri Lanka.
authors.forename: S R
authors.initials: SR
authors.lastname: Jayanetti
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka.
authors.forename: Senaka
authors.initials: S
authors.lastname: Rajapakse
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000209:etiology; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006761:Hospitals; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000517:prevention & control / Q000635:transmission; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D062486:Public Health Surveillance / Q000379:methods*; D013188:Sri Lanka / Q000453:epidemiology
keywords: Malaria; Sri Lanka; Transmission