Harnessing Surveillance Data to Eliminate Malaria in Thailand and Lao PDR

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

Achieving malaria elimination has become increasingly urgent due to the evolution and expansion of multidrug-resistant Plasmodium falciparum parasites; increasing numbers of cases due to Plasmodium knowlesi, a parasite that had been mainly associated with non-human primates; and the localized resurgence of malaria cases due to conflict and population movement. Combined, these challenges threaten to undermine the progress that countries in the subregion had made against malaria. 

Inform Asia: USAID’s Health Research Program (September 2015–December 2023) worked hand in hand with Thailand’s DVBD and Lao PDR’s 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. 

Malaria Elimination Progress in Thailand

From mid-2020, Inform Asia’s support primarily focused on Thailand to help the country meet its target of malaria elimination. 

The program’s activities supported Thailand’s DVBD to make significant progress in reducing the number of malaria cases: From 2015 to 2021, malaria cases dropped from 23,668 to just 2,949. Although that number increased to 16,524 in 2023, the malaria surveillance database and other tools and approaches strengthened under Inform Asia will help Thailand get back on track by identifying causes for the resurgence of cases and designing mitigation strategies to effectively respond to it. 

At the program’s end in December 2023, 46 of Thailand’s 77 provinces were designated “malaria free,” compared to just 33 provinces in 2019. 

Improved malaria surveillance 

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

Malaria Online is a robust and user-friendly health information system that collates real-time data on malaria epidemiology, drug efficacy, expenditures, and programmatic interventions. Inform Asia collaborated with the DVBD to integrate and organize malaria case data into this single national database and designed new web-based analytics to facilitate planning of and decision-making for malaria elimination efforts.

To promote local ownership and sustainability of the database, public health staff were trained on how to use and maintain the system and interpret data to guide their next steps. Inform Asia also transitioned responsibility for Malaria Online’s server, security, and maintenance to the DVBD, while providing training and a detailed reference guide to help the DVBD manage the database without external support.

A survey conducted in the program’s final year found that more than 90% of malaria officers had used Malaria Online in the previous two weeks—up from only 35% of respondents in the early years of Inform Asia. Additionally, 86% of final year survey respondents felt that the database has sufficient information to plan, monitor, and evaluate Thailand’s malaria programmatic efforts.

          Learn more: Integrated Drug Efficacy Surveillance (iDES) in Thailand (video)

Better reporting and visualization of malaria data

Inform Asia also collaborated with the DVBD to establish a 1-3-7 dashboard within Malaria Online. The 1-3-7 surveillance strategy, which calls for health officials to report every malaria case within one day, investigate each case within three days, and deploy an appropriate response within seven days, has become a cornerstone of malaria elimination in Thailand. 

With the launch of the dashboard, on-time reporting of malaria cases within one day rose from 17% in 2016 to 85.5% by the end of 2023. The 1-3-7 surveillance strategy has helped Thailand reduce active malaria areas by 68.5% since 2013, signaling the effectiveness of case investigation combined with malaria foci investigation and response.

          Learn more: Assessing Thailand’s 1-3-7 surveillance strategy in accelerating malaria elimination

Research to inform malaria elimination strategies 

Inform Asia worked closely with the DVBD to co-design research on malaria elimination strategies and best practices that also aligned with the country’s strategic priorities. For example, Inform Asia produced a cost-benefit analysis on the value of investing in malaria elimination that convinced the Royal Thai Government to fully fund the National Malaria Elimination Strategy 2017–2026.

Other research activities included designing a protocol to optimize proactive case detection and plan effective, high-quality screenings to disrupt malaria transmission, as well as data analysis to identify risk factors for school age children, who are the most affected age group for malaria, and suggest solutions to protect school-aged children.

The Inform Asia project produced:

• 8 peer-reviewed papers,
• 18 oral and 15 poster presentations at regional and international meetings and conferences,
• 106 strategic information products, and
• 29 elimination tools and strategies.

In keeping with the Ministry of Public Health’s commitment to position women as equal partners in the fight to eliminate malaria, women were the lead or senior authors on 88% of the project’s publications and they delivered 39% of the conference presentations. 

Gaining Ground Toward Malaria Elimination 

To support continued progress toward eliminating malaria in Thailand, Inform Asia and the DVBD helped provinces understand the criteria for being designated malaria-free and identify surveillance challenges that could jeopardize their verification. 

The program also partnered with other organizations—including the SERVIR-Mekong project supported by USAID, NASA, and implemented by the Asian Disaster Preparedness Center—to assess the importance of environmental factors on malaria transmission in Thailand and collaborated with USAID and the Thailand International Cooperation Agency to support cross-border learning on entomology for malaria elimination. This work informed new data-based planning strategies to prevent the re-establishment of malaria.