Challenges to malaria surveillance following elimination of indigenous transmission: Findings from a hospital-based study in rural Sri Lanka

Abstract

Introduction: 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 staffand 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.