Evaluating malaria reactive surveillance and response strategies in northeast Cambodia: a mixed-methods study.

Background: Cambodia aims to eliminate malaria latest by 2030 applying the 1-3-7 malaria reactive surveillance and response (RASR) strategy which involves malaria case notification, investigation and classification on the same day as diagnosis, reactive case detection within three days, and investigation and classification of new active focus within seven days of case notification. This study investigates the implementation of the RASR strategy in terms of its timeliness, facilitators and barriers, and acceptability for implementation, thereby providing recommendations to improve the strategy in the context of the national health system.

Methods: A mixed-methods study of secondary data analysis of aggregated routine malaria datasets, and cross-sectional survey, in-depth interviews and focus group discussions with malaria programme stakeholders, frontline health workers and mobile and migrant populations was conducted in Ratanakiri and Stung Treng provinces. Quantitative and qualitative data were analysed descriptively and thematically.

Results: In 2020 and 2022, 72% and 59% of malaria cases were notified and investigated within one day after diagnosis. Timeliness of reactive case detection was 89% and 45% in 2020 and 2022 respectively. Despite having challenges including minimal community participation in reactive case detection, poor mobile phone network coverage and road conditions, a heavy workload at the commune health centre level, inadequate surveillance technical knowledge among village malaria workers and insufficient budget to execute RASR, the existing RASR strategy was deemed acceptable among all levels of health personnels.

Conclusion: The RASR strategy implemented in northeast Cambodia was generally functioning well despite some challenges. To improve the RASR strategy to achieve 100% timeliness and progress towards malaria elimination in Cambodia, allocating sufficient budget, capacity building to frontline health workers and better community engagement strategies are required.