TY - JOUR
T1 - Preventing the reintroduction of malaria in mauritius
T2 - A programmatic and financial assessment
AU - Tatarsky, Allison
AU - Aboobakar, Shahina
AU - Cohen, Justin M.
AU - Gopee, Neerunjun
AU - Bheecarry, Ambicadutt
AU - Moonasar, Devanand
AU - Phillips, Allison A.
AU - Kahn, James G.
AU - Moonen, Bruno
AU - Smith, David L.
AU - Sabot, Oliver
N1 - Funding Information:
AT, JC, BM, and OS work within or assist the malaria program at the Clinton Health Access Initiative, which is supporting malaria elimination in southern Africa. SA, NG, AB, and DM are actively involved in the management of elimination or prevention of reintroduction programmes in Mauritius (SA, NG, and AB) and South Africa (DM). AP works at The Global Health Group of the University of California, San Francisco; the Global Health Group exists in part to document and disseminate evidence from malaria elimination efforts, and is funded by the Bill & Melinda Gates Foundation and ExxonMobil. DM, AP, BM, DS, and OS are members of the Malaria Elimination Group. JK has a paid consultancy with the bednet manufacturer, Vestergaard Frandsen. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of their employing organizations nor the sources of funding.
Funding Information:
We are grateful to the Ministry of Health and Quality of Life in Mauritius (MOHQL) for its support and collaboration throughout this case study. We thank the many other individuals who contributed to this work, particularly T.R. Nundlall, P. Boolakey, S. Rawoteea, M. Massoodee, and the members of the Communicable Disease Control Unit and the Vector Biology and Control Division of the MOHQL for their commitment to preventing the reintroduction of malaria in Mauritius; and members of the Health Statistics Unit and Central Health Laboratory of the Mauritius MOHQL, Colin Boyle, Elizabeth Brashers, Cara Smith Gueye, Chris Cotter, and Dean Jamison for their invaluable contributions. The Clinton Health Access Initiative acknowledges support from the Global Health Group for its work on malaria elimination in southern Africa, and all authors are grateful for the support and guidance of the Malaria Elimination Group.
PY - 2011/9/2
Y1 - 2011/9/2
N2 - Sustaining elimination of malaria in areas with high receptivity and vulnerability will require effective strategies to prevent reestablishment of local transmission, yet there is a dearth of evidence about this phase. Mauritius offers a uniquely informative history, with elimination of local transmission in 1969, re-emergence in 1975, and second elimination in 1998. Towards this end, Mauritius's elimination and prevention of reintroduction (POR) programs were analyzed via a comprehensive review of literature and government documents, supplemented by program observation and interviews with policy makers and program personnel. The impact of the country's most costly intervention, a passenger screening program, was assessed quantitatively using simulation modeling. On average, Mauritius spent $4.43 per capita per year (pcpy) during its second elimination campaign from 1982 to 1988. The country currently spends $2.06 pcpy on its POR program that includes robust surveillance, routine vector control, and prompt and effective treatment and response. Thirty-five percent of POR costs are for a passenger screening program. Modeling suggests that the estimated 14% of imported malaria infections identified by this program reduces the annual risk of indigenous transmission by approximately 2%. Of cases missed by the initial passenger screening program, 49% were estimated to be identified by passive or reactive case detection, leaving an estimated 3.1 unidentified imported infections per 100,000 inhabitants per year. The Mauritius experience indicates that ongoing intervention, strong leadership, and substantial predictable funding are critical to consistently prevent the reestablishment of malaria. Sustained vigilance is critical considering Mauritius's enabling conditions. Although the cost of POR is below that of elimination, annual per capita spending remains at levels that are likely infeasible for countries with lower overall health spending. Countries currently embarking on elimination should quantify and plan for potentially similar POR operations and costs.
AB - Sustaining elimination of malaria in areas with high receptivity and vulnerability will require effective strategies to prevent reestablishment of local transmission, yet there is a dearth of evidence about this phase. Mauritius offers a uniquely informative history, with elimination of local transmission in 1969, re-emergence in 1975, and second elimination in 1998. Towards this end, Mauritius's elimination and prevention of reintroduction (POR) programs were analyzed via a comprehensive review of literature and government documents, supplemented by program observation and interviews with policy makers and program personnel. The impact of the country's most costly intervention, a passenger screening program, was assessed quantitatively using simulation modeling. On average, Mauritius spent $4.43 per capita per year (pcpy) during its second elimination campaign from 1982 to 1988. The country currently spends $2.06 pcpy on its POR program that includes robust surveillance, routine vector control, and prompt and effective treatment and response. Thirty-five percent of POR costs are for a passenger screening program. Modeling suggests that the estimated 14% of imported malaria infections identified by this program reduces the annual risk of indigenous transmission by approximately 2%. Of cases missed by the initial passenger screening program, 49% were estimated to be identified by passive or reactive case detection, leaving an estimated 3.1 unidentified imported infections per 100,000 inhabitants per year. The Mauritius experience indicates that ongoing intervention, strong leadership, and substantial predictable funding are critical to consistently prevent the reestablishment of malaria. Sustained vigilance is critical considering Mauritius's enabling conditions. Although the cost of POR is below that of elimination, annual per capita spending remains at levels that are likely infeasible for countries with lower overall health spending. Countries currently embarking on elimination should quantify and plan for potentially similar POR operations and costs.
UR - http://www.scopus.com/inward/record.url?scp=80052400372&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=80052400372&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0023832
DO - 10.1371/journal.pone.0023832
M3 - Article
C2 - 21912645
AN - SCOPUS:80052400372
SN - 1932-6203
VL - 6
JO - PloS one
JF - PloS one
IS - 9
M1 - e23832
ER -