title: Malaria surveillance in low-transmission areas of Zambia using reactive case detection.
abstract: BACKGROUND
  Repeat national household surveys suggest highly variable malaria transmission and increasing coverage of high-impact malaria interventions throughout Zambia. Many areas of very low malaria transmission, especially across southern and central regions, are driving efforts towards sub-national elimination.
  
  
  METHODS
  Reactive case detection (RCD) is conducted in Southern Province and urban areas of Lusaka in connection with confirmed incident malaria cases presenting to a community health worker (CHW) or clinic and suspected of being the result of local transmission. CHWs travel to the household of the incident malaria case and screen individuals living in adjacent houses in urban Lusaka and within 140 m in Southern Province for malaria infection using a rapid diagnostic test, treating those testing positive with artemether-lumefantrine.
  
  
  CONCLUSIONS
  Reactive case detection improves access to health care and increases the capacity for the health system to identify malaria infections. The system is useful for targeting malaria interventions, and was instrumental for guiding focal indoor residual spraying in Lusaka during the 2014/2015 spray season. Variations to maximize impact of the current RCD protocol are being considered, including the use of anti-malarials with a longer lasting, post-treatment prophylaxis.
  
  
  CONCLUSIONS
  The RCD system in Zambia is one example of a malaria elimination surveillance system which has increased access to health care within rural communities while leveraging community members to build malaria surveillance capacity.
authors.affiliation: Akros, Cresta Golfview Grounds, Great East Road, Lusaka, Zambia. dlarsen@akros.com.|Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, NY, USA. dlarsen@akros.com.
authors.forename: David A
authors.initials: DA
authors.lastname: Larsen
authors.affiliation: Akros, Cresta Golfview Grounds, Great East Road, Lusaka, Zambia. zundac@gmail.com.
authors.forename: Zunda
authors.initials: Z
authors.lastname: Chisha
authors.affiliation: Akros, Cresta Golfview Grounds, Great East Road, Lusaka, Zambia. bwinters@akros.com.|University of Montana School of Public and Community Health Sciences, Missoula, MT, USA. bwinters@akros.com.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Winters
authors.affiliation: National Malaria Control Centre, Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia. nmercie@yahoo.com.
authors.forename: Mercie
authors.initials: M
authors.lastname: Mwanza
authors.affiliation: National Malaria Control Centre, Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia. mkamuliwo@yahoo.co.uk.
authors.forename: Mulakwa
authors.initials: M
authors.lastname: Kamuliwo
authors.affiliation: Lusaka Community District Medical Office, Ministry of Community Development Mother and Child Health, Government of the Republic of Zambia, Lusaka, Zambia. cmbwili@hotmail.com.
authors.forename: Clara
authors.initials: C
authors.lastname: Mbwili
authors.affiliation: National Malaria Control Centre, Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia. mhawela@yahoo.co.uk.
authors.forename: Moonga
authors.initials: M
authors.lastname: Hawela
authors.affiliation: National Malaria Control Centre, Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia. bossbusk@gmail.com.
authors.forename: Busiku
authors.initials: B
authors.lastname: Hamainza
authors.affiliation: National Malaria Control Centre, Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia. jacob.chirwa@yahoo.co.uk.
authors.forename: Jacob
authors.initials: J
authors.lastname: Chirwa
authors.affiliation: Malaria Branch and US President's Malaria Initiative (Currently Global Immunization Division), Centers for Disease Control and Prevention, Atlanta, GA, USA. acraig@cdc.gov.
authors.forename: Allen S
authors.initials: AS
authors.lastname: Craig
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia. mrutagwera@path.org.
authors.forename: Marie-Reine
authors.initials: MR
authors.lastname: Rutagwera
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia. clungu@path.org.
authors.forename: Chris
authors.initials: C
authors.lastname: Lungu
authors.affiliation: Akros, Cresta Golfview Grounds, Great East Road, Lusaka, Zambia. tngwenya@akros.com.
authors.forename: Tokozile
authors.initials: T
authors.lastname: Ngwenya-Kangombe
authors.affiliation: Akros, Cresta Golfview Grounds, Great East Road, Lusaka, Zambia. scheelo@akros.com.
authors.forename: Sanford
authors.initials: S
authors.lastname: Cheelo
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia. jmiller@path.org.
authors.forename: John M
authors.initials: JM
authors.lastname: Miller
authors.affiliation: Akros, Cresta Golfview Grounds, Great East Road, Lusaka, Zambia. dbridges@akros.com.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bridges
authors.affiliation: Akros, Cresta Golfview Grounds, Great East Road, Lusaka, Zambia. awinters@akros.com.|University of Montana School of Public and Community Health Sciences, Missoula, MT, USA. awinters@akros.com.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Winters
mesh_terms: D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000008:administration & dosage; D002846:Chromatography, Affinity; D003150:Community Health Workers; D018562:Disease Transmission, Infectious; D004338:Drug Combinations; D062665:Epidemiological Monitoring; D004983:Ethanolamines / Q000008:administration & dosage; D005449:Fluorenes / Q000008:administration & dosage; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D015024:Zambia / Q000453:epidemiology
chemical_list: D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes