Feasibility assessment of the use of Optical Mark Recognition around Vivax Malaria surveillance

Malaria remains an important cause of both acute and chronic illness in Papua New Guinea (PNG), constituting 80% of the total burden of malaria cases in the Western Pacific. P. vivax is a major contributor to the public health burden of malaria in co-endemic settings with the highest burden observed amongst the vulnerable groups such as young children and pregnant women. Associated morbidity is largely due to recurrent P. vivax relapses from dormant liver forms (hypnozoites), a unique biological attribute of this Plasmodium species. Studies in PNG have demonstrated that 80% of P. vivax infections in PNG children are relapses from hypnozoites (6). The majority of endemic locations, including PNG, implement passive facility-based surveillance of P. vivax, focusing on RDT-diagnosis of symptomatic patients presenting to health facilities. The existing case-based surveillance system that is routinely implemented does not link repeat malaria presentations by the same patient. The PNG National Department of Health has committed to the ambitious goal of eliminating malaria by 2030(7). Achieving this will require a better understanding of the burden of recurrent P. vivax infections and innovative solutions to the radical cure of both the blood and liver stages of P. vivax. 10 Improving surveillance methods in countries will assist in determining the communities who are more affected by vivax and help governments monitor disease patterns more closely as out outlined by a recent WHO report on surveillance.

Having a strengthened surveillance system for vivax will enable the PNG NDOH to design more effective intervention methods and help assess the state of their malaria control programmes and how effective it really is in addressing the burden of malaria. Currently in PNG, data collection and surveillance methods do not allow for identification of repeat cases. The malaria register also does not clearly indicate whether the correct medication as well as dosage was prescribed to patients according to weight bands. Both these gaps in data collected make it difficult to closely monitor the management of vivax cases and identify the burden of relapses within communities. This study will evaluate strengths and weaknesses of the Remark Office OMR software, particularly with regard to identifying relapsing cases and tracking dosages of antimalarials prescribed to help improve current clinical treatment of vivax patients.

The project is uniquely positioned to build on the existing studies that have reviewed the eNHIS system of data collection by identifying issues with systems usage and subsequent response, as well as the newer method that utilises Remark OMR, to create a better, more cohesive method of data collection. If successful, the data collected in this project can help other related projects in informing policy change concerning vivax surveillance across the country.

This study will involve a mixed methods approach, utilising both interviews and observations to understand the perception of key stakeholders (health facility managers, health care workers, patients & data managers) and implementation barriers and enablers in the newly introduced surveillance methods. Research tools (interview guides and questionaries) will be tailored to the different participants recruited for the study.

P. vivax
Surveillance

Jun 2022 — Oct 2023

$15,000

Papua New Guinea

Australian Centre for Research Excellence in Malaria Elimination (ACREME)