Harnessing Surveillance Data to Eliminate Malaria in Thailand and Lao PDR

Thailand and Lao PDR are part of the Greater Mekong subregion, which has achieved significant progress in reducing the prevalence of malaria over the past two decades, with cases declining by 97% between 2000 and 2020.

However, malaria elimination is increasingly urgent in these countries due to the evolution and expansion of multidrug-resistant Plasmodium falciparum parasites, which put millions of people at risk and threaten progress made to date.

Strong malaria surveillance, which includes collecting high-quality data on cases, affected communities, and antimalarial drug resistance, is essential to reaching elimination. In 2015, the U.S. Agency for International Development (USAID) launched Inform Asia: USAID’s Health Research Program (2015-2023) with funding from the U.S. President’s Malaria Initiative, to support Thailand and Lao PDR in their goals of achieving malaria-free status by 2024 and 2030, respectively.

Implemented by RTI, Inform Asia has worked hand in hand with Thailand’s Division of Vector Borne Diseases (DVBD) and Lao PDR’s Centre for Malariology, Parasitology and Entomology (CMPE) to strengthen malaria surveillance systems, evaluate strategies and tools for the scale-up of malaria elimination, and improve the ability of national malaria programs to generate, analyze, and use strategic data for decision-making. Since mid-2020, Inform Asia’s support has focused on Thailand to accelerate results by its 2024 target.

Strengthening Malaria Surveillance Systems

We leverage expertise in information technology and epidemiology to help ensure that malaria surveillance systems in Thailand and Lao PDR are robust and user-friendly and capable of analyzing data, which is critical to developing evidence-based policy that can save lives.

Inform Asia supports Thailand’s DVBD to strengthen their malaria information system and adapt to the country’s changing epidemiology. Support has included integrating case-based malaria data into a single national database (Malaria Online), designing new web-based analytics and interactive dashboards to facilitate improved planning and decision-making, and training public health staff how to use and take ownership of the system. We continue to partner to improve the quality and completeness of case notification data and response.

As countries near elimination, malaria becomes isolated to small geographic areas called foci, and malaria programs need the ability to monitor and respond quickly to individual cases in these areas. We collaborated with the DVBD and the CMPE to launch the 1-3-7 surveillance strategy, in which health officials report malaria cases within one day, investigate cases within three days, and deploy appropriate responses within seven days. The strategy has become a cornerstone of malaria elimination in Asia.

Inform Asia also worked with the DVBD to develop a dashboard in Malaria Online that shows users the location of active malaria foci and enables tracking of the 1-3-7 strategy. After establishing this dashboard, timely reporting of malaria cases within one day rose from 17% in FY2016 to 60% in FY2018, an improvement of more than 200%.

Thailand is the first country to implement routine drug efficacy surveillance for malaria, important for monitoring the effectiveness of malaria treatments. We are a key partner in launching and strengthening Thailand’s integrated drug efficacy surveillance (iDES) system, which serves as a model for other countries. We worked with the DVBD and partners to pilot the iDES in three provinces in 2017 and are developing a new iDES dashboard in Malaria Online with interactive visualizations to ensure every patient is fully treated.

Evaluating Strategies and Tools for Malaria Elimination

Inform Asia and our partners are investigating ways to maximize the use of new technologies and innovative models to lead to better health outcomes – from strengthening case investigation and response, to improving processes for subnational verification, to ensuring treatments remain effective.

We conduct operational research to identify successes, challenges, and solutions for optimal strategies and tools that target elimination. Examples of research that improved health systems and processes include:

• Conducting a study which found that use of the 1-3-7 surveillance strategy has helped Thailand reduce active malaria foci by 68.5% since 2013 (see Figure 1 below), signaling the effectiveness of case investigation combined with focus investigation and response in supporting malaria elimination.
• Helping Thailand’s DVBD streamline processes for subnational verification of malaria-free provinces, an essential step towards reaching national malaria elimination. We also facilitate provincial-led discussions on case investigation data and surveillance requirements.
• Finding that efficacy of the recommended malaria treatment was waning in two provinces in Thailand that accounted for 10% of malaria cases but 67% of treatment failures. These results sparked Thailand to introduce a new treatment in these areas to ensure full recovery of malaria patients, highlighting the crucial role of malaria data collection and analysis in influencing policies that save lives.

Transforming Malaria Data into Strategic Information that Informs Policy

Strategic information—such as research articles, policy briefs, or data review presentations—helps national malaria programs to hone their interventions and develop goals based on evidence. We support the transformation of surveillance data into strategic information, enabling national malaria programs to publish findings in peer-reviewed journals, present at scientific conferences, and share results with practitioners and the public on social media.

By developing and communicating strategic information, we contribute to the technical knowledge base on the role of surveillance and health systems strengthening in malaria elimination. We also build local ownership and skills in using essential datasets to drive malaria elimination by coaching staff and developing tailored resources like data review protocols that outline how to access, extract, clean and interpret data.

Strategic information can also inform national decision-making and policy development and aid national malaria programs in advocating for malaria funding. For example, the DVBD and Inform Asia conducted a cost-benefit analysis that found that every Thai Baht invested in malaria elimination can return up to 15 Thai Baht to the health system, households, and economy. These results helped advocate for increased domestic resources to fully fund the National Malaria Elimination Strategy 2017–2026.