Malaria Case Investigation Standard

Operation Procedures in Selected

Elimination districts in Ethiopia

Training on foci Investigation and response Standard Operating

Procedures (SOPs) in Ethiopia, March 1-7, 2021
By Gudissa A.
1. Map of Malaria risk and stratification based on elevation, climate
and API in Ethiopia, 2018
District-level Annual Parasite Incidence in Ethiopia , 2018
Map of malaria elimination targeted districts in Ethiopia
Annual parasite incidence (API/1000p) in 2016
2. What is an Index Case?

An “Index Case” is :
• any malaria infection (unique or mixed species identified by a health worker (typically
the HEW or clinician/laboratorian at the PHCU) and hospitals for which a local address
can be ascertained (resident or a visitor who stayed for at least 21 days)
• Case identification may occur through either passive detection when a
symptomatic/asymptomatic individual presents to the health post, health center,
or hospital or directly to the HEW or
• outreach service when the HEW is in the community on health activities and finds
an individual who is then confirmed positive for malaria parasites
3. Reactive Case Investigation Results: Examples (1)
Cumulative number and percentage of secondary cases in relation to
distance (meters) from the index case
99% 100%
80 100%
92% 93%
75
Cum-sum 7490%
Cumulative Number of secondary cases

70 73
Cum(%)

Cumulative Percentage
68 69 80%
65 74%
60 69% 70%
55 62%
57% 55 60%
50 53% 54% 51
45 46 50%
45%
40 42
39 40 40%
35
3033 30%
0 1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100
Distance from Index Case (meters) October 22,
2019
Reactive Case Investigation Results: Examples (2)

October 22, 2019

Reactive Case Investigation Results: Examples (3)
Households in Yegind Lomi Village Number of HH and Secondary cases around the
index case (yellow) at 50 and 100 m buffer zones

October 22, 2019

Reactive Case Investigation
1. Introduction (5) Results: Examples (4)
District-level Annual Parasite Incidence in Subnational malarial elimination targeted
Ethiopia , 2018 districts in Ethiopia
3. Case Investigation Procedures (1)
3.1 Summary of Case Investigation with Reactive FTAT work
• PHCU will be the ‘command center’ for the implementation of case
investigation within their respective catchment areas and HEWs are
responsible to conduct case investigation.
• Whenever there is a new malaria case diagnosed, the HEW or HC/hospital
laboratorian will use a pencil to write/stick the following information on the
back-side of the positive RDT/BF for each passively detected malaria case:
• Name/standard code of the patient INCLUDING the serial number in the
register,
• Date of diagnosis (EC),
• Full Name of the HH head, Kebele and Gott, where the case resides
3. CI Procedures (2)
• Positive RDT/BF are placed in a sealable plastic bag/slide box for quality
assurance/quality control purposes.
• Document all malaria cases passively detected in the FTAT PASSIVE CASE
DOCUMENTATION SCREENING FORM
• Determine if a case investigation can be done for each documented case as per
the decision criteria & CONSULT IF NECESSARY the respective PHCU Director or
delegated person on the results of the decision.
• If the case is NOT fit for investigation, the HEW will document the reason why
and the decision should be reported immediately
• The random validation of passively detected positives NOT investigated is
mandatory;
• HEWs will perform index case’s household visits and all homes in the
neighborhood within about 70m radius to conduct the FTAT;
3. CI Procedures(3)
3.2 Case investigation using reactive FTAT

• All necessary treatment and follow up including adherence to treatment

regimen will be conducted as per the National Malaria Guidelines.
• Record information for all individuals consulted in HEALTH POST/CENTER
STANDARD REGISTER BOOKS;
• Label with unique ID & preserve positive RDTs/BF from the
passively/outreach detected patients for FTAT (case investigation work and
quality assurance/quality control purposes);
• Document all malaria cases passively detected in the FTAT PASSIVE CASE
SCREENING FORM, source of positives could be from within the HP
catchment area or outside,
October 22, 2019
3. CI Procedures (4)
• Determine if a case investigation can be done for each documented case as per
the FTAT Passive Case Screening Form (Annex-xx) decision criteria for index case
and if necessary consults respective PHCU Director or delegated focal person on
the proposed course of action
• If the case is NOT fit for investigation, the HEW will document the reason why
and the decision should be reported immediately to PHCU Director or delegated
focal person
• If case investigation is decided, it should be initiated immediately without any delay.
• Initiate & conduct the case investigation within 3 days of the diagnosis date,
• HEW is responsible for conducting the standard procedures.
• However, if case investigation is to happen out of the proper catchment area,
notify respective PHCU Director or delegated focal person, so that case
investigation will be assigned to respective HP/HEWs where the case resides;
3. CI Procedures (5)

• The HEW documents a household paper FTAT CASE

INVESTIGATION TRACKING FORM for the investigation.

• The HEW will begin FTAT HOUSEHOLD QUESTIONNAIRE for the index
case household while in the HP and will record:
• a unique ID, woreda, kebele, and focus (Gott) for the index case.
• the name, age, sex, of the index case in the first row of the listing
and prepare for travel to the Index case’s HH;

• Visit index case’s household and confirm that it is the target HH;
3. CI Procedures (6)
• All HHs in the vicinity (within about 70 meters radius) or if not possible five
neighborhood households around an index case will be investigated within
three days of an index case detection;
• Each HEW will be expected to visit all households within about 70-meters
radius around the index case HH.
• For the index case and delineated neighboring HHs (within about 70m radius)
visited:
• Collect household-level information, if a competent respondent is
available (Refer box-1 for terms & possible scenarios for respondents);
• List, and invite HH members starting from the HH head to the youngest
child including visitors (= Guest who spent at least a single night before
investigation) for the FTAT HH questionnaire to Identify eligible
participants,
3. CI Procedures (7)
• Determine who is eligible for FTAT within the household members and visitors
(note that all members are eligible EXCEPT INFANTS (age <6 months) and
SEVERLY ill)patients, who should be referred to higher HF).
• For each eligible participant presented at the time of the visit:
• Inform about the purpose of the case investigation,
• Interview each participant in a private setting,
• Measure temperature according to the MEASUREMENT OF AXILLARY
TEMPERATURE SOP and record results,
• Perform RDT according to the TESTING FOR MALARIA PARASITES USING
RAPID DIAGNOSTIC TESTS SOP, label RDT with unique code, record
results, inform participant on the results and transcribe unique code to
the FTAT HH QUESTIONNAIRE
 Thank You!!
Any questions??