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

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
transmission), Dhenkanal (moderate transmission), Angul (high
transmission), and Kandhamal (hyper transmission). 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, an area of hyper
transmission, the impact was not evident. However, in Dhenkanal and Angul,
areas of moderate-to-high transmission, CCMP interventions precipitated a
dramatic increase in case detection and a subsequent decline in malaria
incidence, particularly in previously difficult-to-reach communities.

背景：综合病例管理项目（Comprehensive Case Management Project, CCMP）是一项协作性实施研究计划，旨在强化印度奥里萨邦的疟疾早期检测与规范治疗工作。
方法：本研究在奥里萨邦四个疟疾流行程度各异的县区采用双臂类实验设计，分别为博兰吉尔（Bolangir，低传播区）、登卡纳尔（Dhenkanal，中传播区）、安古尔（Angul，高传播区）以及坎德哈姆尔（Kandhamal，超高传播区）。每个县区均设置对照区块与CCMP干预区块：对照区块仅实施常规疟疾防控措施，干预区块则采用一系列强化监测、诊断与病例管理的干预手段。本研究通过双重差分法（difference-in-difference, DID）与间断时间序列分析（interrupted time-series, ITS），对三个阶段的月血液检测率（monthly blood examination rate, MBER）及月寄生虫指数（monthly parasite index, MPI）进行分析以评估干预效果：阶段1为CCMP实施前（2009—2012年），阶段2为CCMP干预期（2013—2015年），阶段3为CCMP实施后（2016—2017年）。
结果：在CCMP实施期间，校正对照区块的混杂影响后，双重差分法与间断时间序列分析结果显示，月血液检测率提升25%，月寄生虫指数增长96%；CCMP实施结束后，月寄生虫指数下降47%，而月血液检测率得以维持。阶段1与阶段2间的月寄生虫指数变化幅度以登卡纳尔与安古尔最为显著，分别增长976%与287%，而博兰吉尔与坎德哈姆尔则分别下降57%与22%。阶段2至阶段3期间，尽管月血液检测率基本保持稳定，但登卡纳尔与安古尔的月寄生虫指数均出现大幅下降，降幅分别为78%与59%；博兰吉尔下降幅度较小（13%），坎德哈姆尔则出现14%的增长。
结论：总体而言，综合病例管理项目通过完善现有疟疾服务网络，提升了疟疾早期检测与治疗水平，对三个县区的疟疾病例发病率产生了积极影响。在超高传播区坎德哈姆尔，项目未显现出明显效果。但在中至高传播区登卡纳尔与安古尔，CCMP干预措施大幅提升了病例检测率，随后疟疾发病率显著下降，这一效果在既往难以覆盖的社区尤为突出。