Preventing the Reintroduction of Malaria in Mauritius: A Programmatic and Financial Assessment

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

Total and per capita program costs, 1948–2008.

<p>*The bars reflect real data on expenditure per intervention while the lighter shading is extrapolated based on averages from 1982–1988. Literature indicates a similar allocation of funds, although surveillance-attributed expenditure was probably proportionally higher around 1960 due to a change of strategy with a new focus on surveillance. This figure indicates that the cost of malaria control dropped steadily since 1982, with per capita costs dropping faster than total costs due to growing population size (NB different vertical scales).</p

Four years into the Indian ocean field epidemiology training programme

Introduction: Following the 2005-6 chikungunya outbreak, a project to strengthen regional Public Health preparedness in the Indian Ocean was implemented. It includes the Comoros, Madagascar, Mauritius, Reunion (France) and Seychelles. A Field Epidemiology Training Programme (FETPOI) was started in 2011 to develop a pool of well-trained intervention epidemiologists. Methods: The FETP-OI consists of two years of supervised, learning-by-doing, on-the-job training at national sites involved in disease surveillance and response. It includes work placements at the Madagascar Pasteur Institute and the French regional epidemiology unit in Reunion and up to three training courses per year. Training objectives include epidemiological surveillance, outbreak investigations, research studies, scientific communication and transfer of competencies. Results: In four years, two cohorts of in total 15 fellows originating from four countries followed the FETP-OI. They led 42 surveillance projects (71% routine management, 14% evaluations, 12% setup, 3% other) and investigated 36 outbreak alerts, 58% of them in Madagascar; most investigations (72%) concerned foodborne pathogens, plague or malaria. Fellows performed 18 studies (44% descriptive analyses, 22% disease risk factors, and 34% on other subjects), and presented results during regional and international conferences through 26 oral and 15 poster presentations. Four articles were published in regional Public Health bulletins and several scientific manuscripts are in process. Conclusion: The FETP-OI has created a regional force of intervention consisting of field epidemiologists and trained supervisors using the same technical language and epidemiological methods. The third cohort is now ongoing. Technically and financially sustainable FETP-OI projects help addressing public health priorities of the Indian Ocean

Costs and capacity of workforce.

1<p>It was not possible to calculate full time equivalents (FTEs) for the first elimination period so the full staff was used. However, planning documents from the campaign indicate that most staff were engaged directly in the three year campaign.</p>2<p>While total expenditure for personnel was available for 1960–1961 in technical reports on the elimination program, exact figures for total workforce and FTEs were not available.</p

Surveillance definitions.

<p>Surveillance definitions.</p

Simulated annual risk of indigenous transmission in Mauritius with and without passenger screening at a range of potential R_C values.

<p>Simulated annual risk of indigenous transmission in Mauritius with and without passenger screening at a range of potential R_C values.</p