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Objective: To understand the malaria epidemic situation and characteristics in Jiangsu Province in 2017, so as to provide the evidence for formulating the targeted strategy of malaria elimination., Methods: The data of malaria cases in Jiangsu Province in 2016 were collected from China's Routine Diseases Surveillance Information System (CRDSIS)., Results: Totally, 239 imported malaria cases were reported in Jiangsu Province in 2017, and the cases decreased by 22.40% compared to 308 cases in 2015. Except 2 malaria case caused by blood transfusion, the rest patients were all imported. Among them, there were 163 falciparum malaria cases, 21 vivax malaria cases, 11 quartan malaria cases, 43 ovale malaria cases, and 1 mixed infection case ( Plasmodium falciparum and P. ovale ). The numbers of imported cases of Nantong (39 cases, 16.32%), Suzhou (26 cases, 10.88%), Taizhou (25 cases, 10.46%), Huai'an (24 cases, 10.04%), and Lianyungang (22 cases, 9.21%) ranked in the top 5 cities across Jiangsu Province, the malaria cases in the five cities accounted for 56.90% (136/239). The infection source areas of the imported malaria cases included Africa (225 cases), Asia (8 cases), Oceania (2 cases), and South America (2 cases)., Conclusions: Jiangsu Province has no local malaria cases for 6 consecutive years. Despite the imported cases in 2017 decreased some-what compared to that in 2016, it is still necessary to strengthen the surveillance of imported malaria cases and improve malaria diagnosis and treatment in the whole province.

Objective: To analyze the results of samples testing of Jiangsu Provincial Malaria Diagnostic Reference Laboratory in 2017, so as to provide the evidence for improving the malaria diagnostic performance in this province., Methods: The samples of reported malaria cases in Jiangsu were collected by the provincial reference laboratory (PRL) in 2017. The microscopy and nucleic acid test were performed to confirm the infection of Plasmodium species of each case, while Plasmodium antigen tests (rapid diagnostic test, RDT) were performed as well. The detection results were analyzed among different areas and different species., Results: Totally 242 malaria cases were reported and the samples were collected by PRL in 2017. A total of 239 cases were confirmed Plasmodium infections, including 163 cases of Plasmodium falciparum infection, 21 cases of P. vivax infection, 11 cases of P. malariae infection, 43 cases of P. ovale infection, and 1 case of P. falciparum and P. ovale mixed-infection. The diagnostic coincidence rates of reported malaria case in 13 prefectures with districts were all > 80%, and the total coincidence rate was 88.8%. The species diagnostic coincidence rates of P. falciparum , P. vivax , P. malariae , and P. ovale were 98.8%, 57.1%, 63.6%, and 81.4% respectively, and the detection rates by RDT to those four species infections were 95.7%, 85.0%, 63.6% and 79.1% respectively., Conclusions: In 2017, the malaria diagnostic quality of medical technicians is generally high in Jiangsu Province. However, the diagnostic capacity is slightly different among different regions, and the ability to identify non- P. falciparum parasites remains to be improved. RDT is not ideal for the detection of non- P. falciparum infection. In the current stage of malaria elimination, the malaria diagnostic capacity of technicians in all the sectors should be strengthened and maintained.

Objective: To investigate the malaria rapid diagnostic testing (RDT) - related knowledge, attitude, practice (KAP) of primary healthcare professionals in Jiangsu Province and analyze the corresponding influencing factors., Methods: Four cities in Jiangsu Province were selected as the study sites by the typical sampling method to conduct a survey for the RDT related KAP and work satisfaction of primary healthcare professionals, and the multiple logistic regression model was used to explore the relevant influencing factors., Results: Totally 1 150 questionnaires were issued and 949 valid questionnaires were collected with the recovery rate of 82.52%. The valid questionnaires included 453 questionnaires from laboratory technicians, 466 from clinicians, and 30 from malaria prevention and control workers. Totally 83.98% of the surveyed professionals had a low mastering level of essential RDT-related knowledge. A total of 52.17% of the surveyed laboratory technicians recognized that the application of RDT technology could effectively improve the current primary-level microscopy work, and the degree of recognition of RDT technological advantage in the laboratory technicians was higher than that in the clinicians. Totally 79.25% of the surveyed laboratory technicians regarded themselves to be capable of conducting the standardized RDT operation, and 84.55% of the surveyed clinicians regarded themselves to be capable of conducting the qualified malaria clinical diagnostic practice. The key influencing factors of RDT-related KAP of primary healthcare professionals included the laboratory technicians' gender, educational level, employer's institutional level, professional title, and working years, and the employer's institutional level of clinicians., Conclusions: The primary healthcare professionals in Jiangsu Province exhibita good acceptability towards RDT technology. However, their essential knowledge on RDT remains to be improved. Therefore, it is necessary to establish a specific training and educational system for primary healthcare professionals to better guarantee the advantageous impact of RDT technology on the consolidation of the malaria elimination work achievements.

Objective: To evaluate the implementation effect of the optimization strategy for the use and management of malaria rapid diagnostic testing (RDT) technology in Jiangsu Province, so as to provide the empirical evidence and suggestions for promoting the standardized use of RDT technology., Methods: Questionnaire surveys of primary-level health professionals' RDT-related knowledge, attitude, and practice (KAP) and work satisfaction were conducted in 4 pilot cities in Jiangsu Province before and after the intervention., Results: After the implementation of the intervention, 13.9% of surveyed laboratory technicians, 21.9% of surveyed clinicians and 4.1% of surveyed staff of the centers for disease control and prevention (CDCs) had significant improvements in RDT-related knowledge. About 10.9% of the surveyed laboratory technicians and 25.6% of the surveyed CDC staff improved their attitudes toward RDT technology. About 38.4% of the surveyed laboratory technicians and 10.0% of the surveyed clinicians improved the standardized use of RDT technology. All types of primary-level health professionals had high evaluation in the satisfaction and effectiveness of the optimization strategy. However, the evaluation of the surveyed clinicians was slightly lower than that of the laboratory technicians and CDC staff., Conclusions: The optimization strategy in this project can effectively improve the knowledge, attitude and behavior of all types of primary-level health professionals and help to promote the standardized use of RDT technology.

There were vivax malaria, falciparum malaria, and malariae malaria epidemic in Jiangsu Province, and vivax malaria was the dominant disease. Anopheles sinensis and An. anthropophagus were malaria-transmitted vectors. Since the founding of People's Republic of China, there have been two major malaria outbreaks in Jiangsu Province, when the highest annual malaria incidence reached up to 24.95%. According to prevention and control principles of "adjusting measures to local conditions, giving different guidance to different categories and highlighting key points", during the epidemic outbreak stage, the largescale malaria prevention and control measures were implemented for all the residents who were target population in Jiangsu malaria-endemic areas. During the basic eradication stage, the targeted prevention and control measures had been carried out according to the different epidemic features to gradually consolidate the achievement of prevention and control in Jiangsu Province. In the malaria elimination stage, Jiangsu Province focused on controlling of the source of infection and malaria surveillance. According to the "1-3-7 targeted elimination" work model, the management of infectious sources and investigation and disposal of foci were carried out for each epidemic focus to block the malaria transmission. By the end of 2017, there had been no indigenous malaria cases for the six consecutive years in Jiangsu Province. All the 13 cities have passed the assessment of malaria elimination of Jiangsu Province. Although Jiangsu Province has achieved the goal of malaria elimination, it is urgent and necessary to maintain and improve malaria surveillance capabilities to prevent malaria reintroduction.

Objective: To establish a systemized malaria biobank with well-rounded epidemiologic data and a computer-aid management system, thus to provide qualified sources for malaria elimination and human malaria research., Methods: The malaria biobank was based on the platform of Jiangsu Institute of Parasitic Diseases. The blood smear samples, dried blood samples, whole blood samples and parasite strains isolated from patients (from both local and imported cases) were collected since 2011 according to a standardized operational procedure. The biobank management software was applied to input of the epidemiological data and samples, and the quality of samples was monitored regularly., Results: A standard malaria biobank was established. The Information Management System was applied to input, storage and output of samples. Totally 99.42% (2 223/2 236) of the blood smear samples, 92.58% (2 070/2 236) of the dried blood samples, 94.50% (2 113/2 236) of whole blood, and 2.06% (46/2 236) of the isolated stains in 2 236 reported cases were included in the malaria biobank in Jiangsu Province from 2011 to 2017. Based on the malaria biobank, 99.42% (2 223/2 236) of the blood smears and 82.74% (1 850/2 236) of DNA (from dried blood and whole blood samples) from malaria patients in Jiangsu Province were re-checked. Moreover, the samples in the malaria biobank were used in the studies of the mechanism of parasite drug resistance, malaria molecular epidemiology, and diagnosis technology development and evaluation., Conclusions: The establishment of malaria biobank provides a guarantee for malaria elimination in Jiangsu Province and also provides a qualified resource for malaria research.

Objective: To analyze the situation of malaria elimination, identify the current main challenges and difficulties of maintaining the achievements of malaria elimination, and find out feasible solutions in Jiangsu Province., Methods: Through randomized grouping, the subject discussion and questionnaires were conducted by malaria control staffs from centers for diseases control and prevention of 13 cities of Jiangsu Province and Jiangsu Institute of Parasitic Diseases. The basic characteristics of participants and the effect of the discussion were analyzed through questionnaires., Results: Twenty-seven professional participants were randomly divided into 3 groups. Totally 27 questionnaires were released and 24 valid questionnaires were retrieved. Among the 24 participants, 79.1% (19/24) of them were with mid-level and senior professional titles, and 66.7% (16/24) of them had worked for more than 10 years. Before the group discussion, only 16.7% (4/24) of the participants were aware of the current main challenges and difficulties in Jiangsu Province. After the discussion, 87.5% (21/24) of them thought the discussion increased their understanding of the challenges and difficulties. Through the subject discussion, the expert group summarized the current challenges and difficulties as well as the solutions in malaria prevention in Jiangsu Province in 4 aspects, namely the management guarantee of prevention work, diagnosis and treatment of the cases, field epidemiological investigation and others. Finally, a framework about these discussion results was established., Conclusions: During the post-stage of malaria elimination, Jiangsu Province still faced many challenges and difficulties, such as management guarantee, case diagnosis and treatment, epidemiology survey and focus disposals, and malaria surveillance sustainability. The feasible solutions of these challenges may provide examples for other provinces and regions which are undergoing malaria elimination or in post-stage of malaria elimination.

Objective: To analyze the working conditions and evaluate the effectiveness of blood smear examinations in fever patients after the start of national malaria elimination program (NMEP), and explore the suitable strategy for malaria diagnosis and surveillance in NMEP, so as to provide the evidence for the development and adaptation of malaria elimination strategies and measures in Jiangsu Province., Methods: The data of malaria epidemic situation reported by network, fever patients' blood test tables, and epidemiological surveys of malaria cases were collected and statistically analyzed by SPSS 16.0 in Jiangsu Province from 2010 to 2016., Results: A total of 2 367 cases of malaria cases were reported from 2010 to 2016. Among the 3 691 188 person-times of fever patients tested, there were 2 252 positives (0.06%). The number of blood tests of fever patients decreased from 742 900 in 2010 to 277 000 in 2016. At the same time, the positive rate increased from 0.04% in 2010 to 0.16% in 2016. The positive rate of blood tests of fever patients in 2016 was significantly higher than that in 2010 ( χ 2 = 161.61, P < 0.01). From 2010 to 2016 in Jiangsu province, the centers for disease control and prevention of cities and counties, that completed the blood review within 3 days, deleted 273 negative cases. In 2010, the centers for disease control and prevention of cities and counties deleted 61 negative cases, but in 2016, the centers deleted only 14 negative cases, and the negative rate of blood review in 2010 was significantly higher than that in 2016 ( χ 2 = 22.99, P < 0.01)., Conclusions: A large number of blood smear examinations have been tested in fever patients in Jiangsu Province. It not only conforms to the strong monitoring system requirements issued by World Health Organization (WHO) in malaria elimination, but also provides the evidence for no local malaria case in Jiangsu since 2012.

Objective: To understand the malaria epidemic situation and characteristics in Jiangsu Province in 2016, so as to provide the evidence for formulating and adjusting the strategy and measures for malaria elimination., Methods: The data of malaria cases in Jiangsu Province in 2016 were collected from China's Routine Diseases Surveillance Information System (CRD-SIS) and analyzed statistically., Results: Totally, 308 malaria cases were reported in Jiangsu Province in 2016, and the cases decreased by 23.95% compared to 405 malaria cases in 2015. Except for 1 malaria case that was caused by blood transfusion, the rest patients were all imported. Among the 308 cases, 237 were infected with Plasmodium falciparum , 11 were infected with P. vivax , 8 were infected with P. malariae , 51 were infected with P. ovale , and 1 was mixed infection. Among all the cities in Jiangsu Province, the numbers of imported cases of Nantong (53 cases), Huai'an (41 cases), Taizhou (40 cases), Lianyungang (36 cases) and Yangzhou (29 cases) ranked in the top 5, and the total malaria cases in the five cities accounted for 64.61%., Conclusions: There were no local malaria cases in Jiangsu Province for 5 consecutive years up to 2016. Although the imported cases decreased slightly compared to those in 2015, we still should strengthen the surveillance of imported malaria cases as well as improve malaria diagnosis and treatment abilities for related personnel at all levels of medical institutions. Also we should focus on the Plasmodium check, focus survey and disposal to realize the aim of malaria elimination in Jiangsu Province in time.

Objective: To understand the population, density, seasonal fluctuation and nocturnal pattern of malaria vectors in Jiangsu Province, thus to provide evidences for malaria elimination in this province., Methods: Seven counties (cities, districts) were selected as the monitoring sites for malaria vectors in Jiangsu Province from 2013 to 2015. The mosquitoes were captured by human bait trapping in bed nets and mosquito-lured lamp overnight, and the seasonal fluctuation and nocturnal pattern of malaria vectors were observed., Results: A total of 11 041 Anopheles sinensis mosquitoes were captured by the mosquito-lured lamps in 7 counties of Jiangsu Province from 2013 to 2015, and no An. anthropophagous was found. Among all the 7 monitoring sites, the number of An. sinensis captured in Sihong County was the most (6 742 mosquitoes), while that in Xuyu County was the least (34 mosquitoes). During this period, the density peaks of An. sinensis were the first half of July, the first half of August and the second half of July. A total of 2 421 An. sinensis were collected in 7 monitoring sites from 2013 to 2015 by human bait trapping in bed nets overnight. Among all the 7 monitoring sites, the captured number of An. sinensis in Sihong County was the most (1 085 mosquitoes), while that in Ganyu County was the least (13 mosquitoes). The nocturnal peak of An. sinensis was from 19：00 to 20：00 and 525 An. sinensis mosquitoes were captured during this period of time, which accounted for 21.68% of the total. Hereafter, the captured number of An. sinensis reduced over time., Conclusions: The density of An. sinensis mosquitoes is still high in individual areas in Jiangsu Province, so the epidemic and vector monitoring still should be strengthened to prevent the local transmission of imported malaria.

Objective: To analyze the channels of going abroad of imported malaria patients in Jiangsu Province, so as to provide the evidence for the control of imported malaria and health intervention for high-risk population., Methods: The data of imported malaria cases in Jiangsu Province in 2015 were collected and the channels of going abroad were analyzed. The Quantum GIS 1.7.4 software was applied to map., Results: Totally 405 imported cases were reported in Jiangsu Province in 2015, and the cases increased by 14.1% compared with those in 2014. All the patients were migrant workers. The migrant workers were mostly sent abroad by construction companies [43.21% (175/405)]. The dispatching companies were mainly concentrated in Taizhou, Lianyungang, Zhenjiang and Yangzhou cities, accounting for 6.17% (25/405), 3.21% (13/405), 2.72% (11/405) and 2.22% (9/405), respectively. Totally 176 (43.46%) patients returned to China having accompanied workers, and 1.21% (9/745) of accompanied workers were found having symptoms of malaria later., Conclusions: It is difficult to monitor malaria in overseas migrant works in Jiangsu Province. The channels of going abroad of migrant workers are various and complicated, formulating the main difficulty and challenge of imported malaria control.

Abstract Background It was recommended that malaria rapid diagnostic tests (RDTs) should be available in all epidemiological situations. But evidence was limited on the implementation of RDTs and its effectiveness in malaria elimination settings. This study examined the implementation of RDTs and how it affected the diagnosis of imported malaria patients in Jiangsu Province, China. Methods To scale up RDTs, this study developed an intervention package with four major elements covering the supply of RDT test, the training on RDTs, the monitoring and management of RDT use, and the advocacy of RDTs. By using a pretest-posttest control group design, we implemented the interventions in 4 cities in Jiangsu Province with the rest nine cities as controlled areas, from January 2017 to January 2018. Difference-in-Difference approach was used to evaluate the impact of the scale-up of RDTs on the identification of malaria cases. Three binary outcome measures were included to indicate delayed malaria diagnosis, malaria cases with confirmed malaria diagnosis at township-level institutions, and severe malaria cases, respectively. Linear probability regression was performed with time and group fixed effects and the interaction term between time and group. Results Intervention areas received sufficient RDT test supply, regular professional training programs, monthly tracking and management of RDT supply and use, and health education to targeted population. The implementation of interventions was associated with 10.8% (P = 0.021) fewer patients with delayed diagnosis. But intervention areas did not see a higher likelihood of having confirmed diagnosis from township-level institutions (coefficient = -0.038, P = 0.185) or reduced severe malaria cases (coef. = 0.040, P = 0.592). Conclusions The comprehensive package of RDT implementation in this study is promising in scaling up RDT use and improving access to care among malaria patients, especially in malaria elimination settings.

Abstract Background Rapid diagnostic tests (RDT) can effectively manage malaria cases and reduce excess costs brought by misdiagnosis. However, few studies have evaluated the economic value of this technology. The purpose of this study is to systematically review the economic value of RDT in malaria diagnosis. Main text A detailed search strategy was developed to identify published economic evaluations that provide evidence regarding the cost-effectiveness of malaria RDT. Electronic databases including MEDLINE, EMBASE, Biosis Previews, Web of Science and Cochrane Library were searched from Jan 2007 to July 2018. Two researchers screened studies independently based on pre-specified inclusion and exclusion criteria. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was applied to evaluate the quality of the studies. Then cost and effectiveness data were extracted and summarized in a narrative way. Fifteen economic evaluations of RDT compared to other diagnostic methods were identified. The overall quality of studies varied greatly but most of them were scored to be of high or moderate quality. Ten of the fifteen studies reported that RDT was likely to be a cost-effective approach compared to its comparisons, but the results could be influenced by the alternatives, study perspectives, malaria prevalence, and the types of RDT. Conclusions Based on available evidence, RDT had the potential to be more cost-effective than either microscopy or presumptive diagnosis. Further research is also required to draw a more robust conclusion.