The persistently high malaria burden in the remote forested areas of Odisha, India has led to the introduction of `malaria camps' by the Odisha State Malaria Control Program where teams of health workers visit villages to educate the population, enhance vector control with long-lasting insecticide nets (LLINs) and indoor residual spraying (IRS), and perform village-wide screening with rapid diagnostic tests and treatment for malaria. The camps appear to be very effective but this is hard to assess in the context of ongoing changes such as LLIN introduction. The long-term goal of this project is to evaluate the effectiveness of malaria camps (MCs) by determining if they reduce malaria, and to characterize malaria transmission in MCs. The major objective to achieve this is through a hybrid cluster randomized effectiveness trial, to determine if MCs reduce the prevalence of clinical and asymptomatic malaria as detected by PCR. Villages will be randomized across three study arms: arm 1 to receive new MCs; arm 2 is a control with no MCs but with standard malaria control; and arm 3 consists of villages already in receipt of MCs to study longer term effects. MC effectiveness will be evaluated from epidemiology surveys and PCR detection of malaria prevalence with and without MCs. Malaria transmission will be characterized with further specific aims across all three study arms. Molecular and genomic methods will be used to assess exposure and immunity and the genetic epidemiology of Plasmodium parasites. Factors driving malaria transmission heterogeneity will be elucidated by studying human mobility and activity-space with topographical mapping and GPS trackers, and vector biting and dispersal by sampling host-seeking mosquitoes and use of vector landscape genetics. Data from these subprojects will be synthesized into mathematical models (deterministic and agent-based) to generate a deep understanding of malaria transmission, the effectiveness of alternative combinations of interventions, and how each intervention can be improved. The optimal implementation and efficacy of MCs will be further determined from assessment of the social factors affecting the coverage of MCs using qualitative interviews and focus group discussions, and a cost-analysis and cost effectiveness evaluation. A cross-cutting aim throughout is to build research capacity in India. Information from this integrated, multi-disciplinary study will be key to Odisha state policy makers to determine the optimal implementation of malaria camps with respect to timing, vector control methods, specific educational messages, strategies to enhance local participation, and cost effectiveness. And the results will be useful for other states in India to determine if malaria camps can be considered to reduce their malaria burden.
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