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Open Access Advances in malaria elimination in Botswana: a dramatic shift to parasitological diagnosis, 2008–2014

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Background: Malaria elimination requires infection detection using quality assured diagnostics and appropriate treatment regimens. Although Botswana is moving towards malaria elimination, reports of unconfirmed cases may jeopardise this effort. This study aimed to determine the proportion of cases treated for malaria that were confirmed by rapid diagnostic testing (RDT) and/or microscopy.

Methods: This was a retrospective descriptive study using routine national data from the integrated disease surveillance and case-based surveillance systems from 2008 to 2014. The data were categorised into clinical and confirmed cases each year. An analysis of the data on cases registered in three districts that reported approximately 70% of all malaria cases was performed, stratified by year, type of reporting health facilities and diagnostic method.

Results: During 2008–2014, 50 487 cases of malaria were reported in Botswana, and the proportion of RDT and/or blood microscopy confirmed cases improved from 6% in 2008 to 89% in 2013. The total number of malaria cases decreased by 97% in the same period, then increased by 41% in 2013.

Conclusion: This study shows that malaria diagnostic tests dramatically improved malaria diagnosis and consequently reduced the malaria burden in Botswana. The study identified a need to build capacity on microscopy for species identification, parasite quantification and guiding treatment choices.
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Keywords: Botswana; RDT; SORT IT; malaria; malaria diagnosis; operational research

Document Type: Research Article

Affiliations: 1: World Health Organization (WHO) Botswana Country Office, Gaborone, Botswana 2: Médecins Sans Frontières, Brussels, Belgium 3: National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana 4: Inter-Country Support Team, WHO, Harare, Zimbabwe 5: Botswana University of Agriculture and Natural Resources, Gaborone, Botswana 6: International Union Against Tuberculosis and Lung Disease, Paris, France 7: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

Publication date: April 25, 2018

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  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

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