BACKGROUND The National Plan for Malaria Elimination (NPME) in Myanmar (2016-2030) aims to eliminate indigenous Plasmodium falciparum malaria in six states/regions of low endemicity by 2020 and countrywide by 2030. To achieve this goal, in 2016 the National Malaria Control Program (NMCP) implemented the "1-3-7" surveillance and response strategy. This study aims to identify the barriers to successful implementation of the NPME which emerged during the early phase of the "1-3-7" approach deployment. METHODS A mixed-methods study was conducted with basic health staff (BHS) and Vector Born Disease Control Program (VBDC) staff between 2017 and 2018 in six townships of six states/regions targeted for sub-national elimination by 2020. A self-administered questionnaire, designed to assess the knowledge required to implement the "1-3-7" approach, was completed by 544 respondents. Bivariate analysis was performed for quantitative findings and thematic analysis was conducted for qualitative findings using Atals.ti software. RESULTS Although 83% of participants reported performing the key activities in the "1-3-7" surveillance and response approach, less than half could report performing those activities within 3 days and 7 days (40 and 43%, respectively). Low proportion of BHS correctly identified six categories of malaria cases and three types of foci (22 and 26%, respectively). In contrast, nearly 80% of respondents correctly named three types of case detection methods. Most cited challenges included 'low community knowledge on health' (43%), 'inadequate supplies' (22%), and 'transportation difficulty' (21%). Qualitative data identified poor knowledge of key surveillance activities, delays in reporting, and differences in reporting systems as the primary challenges. The dominant perceived barrier to success was inability to control the influx of migrant workers into target jurisdictions especially in hard-to-reach areas. Interviews with township medical officers and the NMCP team leaders further highlighted the necessity of refresher training for every step in the "1-3-7" surveillance and response approach. CONCLUSIONS The performance of the "1-3-7" surveillance and response approach in Myanmar delivers promising results. However, numerous challenges are likely to slow down malaria elimination progress in accordance with the NPME. Multi-stakeholder engagement and health system readiness is critical for malaria elimination at the sub-national level.

中文翻译：

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在消除疟疾环境中实施1-3-7监视和应对方法的初期挑战：缅甸的一项实地研究。

背景技术缅甸国家消除疟疾计划（NPME）（2016-2030年）旨在到2020年消除低流行性的六个州/地区以及到2030年在全国范围内消除恶性疟原虫。为实现这一目标，2016年实施了国家疟疾控制计划（NMCP）实施了“ 1-3-7”监视和响应策略。这项研究旨在确定成功实施NPME的障碍，这些障碍是在“ 1-3-7”方法部署的早期阶段出现的。方法在2017年至2018年之间，对六个州/地区的六个乡镇中的基本卫生人员（BHS）和媒介传染病控制计划（VBDC）的人员进行了混合方法研究，目标是到2020年消除次国家级疾病。问卷，旨在评估实施“ 定性数据确定了对关键监视活动的了解不足，报告延误以及报告系统的差异是主要挑战。认为成功的主要障碍是无法控制移民工人涌入目标辖区，特别是在难以到达的地区。与乡镇医务人员和NMCP小组负责人的访谈进一步强调了“ 1-3-7”监视和响应方法中每一步的进修培训的必要性。结论缅甸“ 1-3-7”监视和响应方法的执行结果令人鼓舞。但是，根据《国家植物保护战略》，许多挑战有可能减慢消除疟疾的进程。