Impact of the malaria comprehensive case management programme in Odisha, India

PLoS One. 2022 Mar 24;17(3):e0265352. doi: 10.1371/journal.pone.0265352. eCollection 2022.

Abstract

Background: The Comprehensive Case Management Project (CCMP), was a collaborative implementation research initiative to strengthen malaria early detection and complete treatment in Odisha State, India.

Methods: A two-arm quasi-experimental design was deployed across four districts in Odisha, representing a range of malaria endemicity: Bolangir (low), Dhenkanal (moderate), Angul (high), and Kandhamal (hyper). In each district, a control block received routine malaria control measures, whereas a CCMP block received a range of interventions to intensify surveillance, diagnosis, and case management. Impact was evaluated by difference-in-difference (DID) analysis and interrupted time-series (ITS) analysis of monthly blood examination rate (MBER) and monthly parasite index (MPI) over three phases: phase 1 pre-CCMP (2009-2012) phase 2 CCMP intervention (2013-2015), and phase 3 post-CCMP (2016-2017).

Results: During CCMP implementation, adjusting for control blocks, DID and ITS analysis indicated a 25% increase in MBER and a 96% increase in MPI, followed by a -47% decline in MPI post-CCMP, though MBER was maintained. Level changes in MPI between phases 1 and 2 were most marked in Dhenkanal and Angul with increases of 976% and 287%, respectively, but declines in Bolangir (-57%) and Kandhamal (-22%). Between phase 2 and phase 3, despite the MBER remaining relatively constant, substantial decreases in MPI were observed in Dhenkanal (-78%), and Angul (-59%), with a more modest decline in Bolangir (-13%), and an increase in Kandhamal (14%).

Conclusions: Overall, CCMP improved malaria early detection and treatment through the enhancement of the existing network of malaria services which positively impacted case incidence in three districts. In Kandhamal, which is hyperendemic, the impact was not evident. However, in Dhenkanal and Angul, areas of moderate-to-high malaria endemicity, CCMP interventions precipitated a dramatic increase in case detection and a subsequent decline in malaria incidence, particularly in previously difficult-to-reach communities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Case Management*
  • Data Collection
  • Humans
  • Incidence
  • India / epidemiology
  • Interrupted Time Series Analysis
  • Malaria* / diagnosis
  • Malaria* / epidemiology
  • Malaria* / prevention & control

Grants and funding

The study was funded by Medicines for Malaria Venture with financial and scientific assistance provided to the National Vector Borne Disease Control Programme, Delhi, and National Vector Borne Disease Control Programme, Odisha. Authors from these institutions contributed to the study design, conduct, oversight, analysis and reporting as detailed in the author contributions. Naomi Richardson of Magenta Communications Ltd. developed a first draft of this article from an outline by AD, PGD and SP and a report developed by the authors and provided editorial and graphic services, and was funded by Medicines for Malaria Venture. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.