To guide elimination interventions in these regions the NVBDCP of both countries highlighted a need for the collection of reliable, accurate and programme-specific data at a household level; particularly as relevant geo-spatial census data was unavailable at the level of precision required for the designated target elimination areas. Modern GR approaches and technologies were used to develop rapid and accurate field-based procedures for the collection, spatial definition and mapping of malaria elimination target populations. As these survey areas are located in remote Pacific islands, an emphasis was placed upon minimising the external resources (including human) required to undertake such operations and empowering local vector control programmes by introducing effective, user-friendly tools to support and efficiently guide the increased operational demands associated with malaria elimination.
In the context of the target elimination areas, the coastal concentration and isolation of populations without roads and reliable infrastructure, transportation and access are likely to be limiting factors to the success of elimination. Sound planning will be essential to ensure interventions are efficiently and effectively carried out across all target areas. Data compiled and collected during GR activities will enable programme managers to visualize the spatial distribution of populations to assist in the delineation of operational zones, the development of intervention timelines, and identifying transportation routes and access strategies. Relevant data pertaining to these priority interventions such as populations requiring LLINs and the total number of spray-able structures within focal IRS zones will assist in the accurate allocation of resources to designated operational zones. Household checklists and maps will also provide field officers with a detailed mechanism for conducting and monitoring priority interventions in target areas to ensure maximum coverage is achieved. Reporting will also be enhanced as the progress and coverage of interventions can be mapped and visualized at the household level.
Population and household structure results from GR operations carried out in the respective elimination zones illustrate the significant amount of detailed data that can be collected over large geographical areas by small teams and within short timeframes, highlighting the efficiency of modern approaches to GR. Whilst there is an increased need for pre-operation training when using the handheld units for data collection , the time and opportunity costs associated with training have been seen as valuable investments in building human resource capacity within the national malaria programmes of both countries. It is expected that as the technical competencies and experiences of field officers in the operation of these digital handheld devices increases, the lag time associated with troubleshooting technical difficulties in the field will be reduced. Since the completion of these initial GR operations, additional PDA/GPS based surveys have now been independently conducted by VBDCP officers in these regions and expanding into other provinces, reflecting the high acceptability, willingness and capacity of these programmes to now implement GR operations using these modern techniques and technologies.
Observations from the respective GR operations indicate a high willingness and capacity of VBDCP field staff to adopt and successfully utilize modern mobile mapping technology following initial basic training and technical guidance. The adoption of a simple customized GIS-based application to automate data back-up and mapping updates on a daily basis has also provided a rapid and effective mechanism for VBDCP staff to monitor progress and edit data easily in the field. As household mapping and PDA data entry operations were lead by VBDCP staff well known within their respective target communities, it is also likely this had an influence on the high level of community acceptability and compliance observed in the field, emphasising the importance of building local programme capacity to independently drive contemporary intervention strategies and approaches. Ethical approval was not sought for GR operations as they were considered routine operational activities of the national malaria programmes in both countries, with all collected data managed as per confidentiality requirements of the respective Ministries of Health.
Whilst some data entry errors are expected as a result of the digital data entry at the point of collection approach, previous research suggests such errors are minimal when compared to traditional paper-based surveys [22, 24, 25]. The cost-benefit of adopting handheld technology for field-based data collection has also been well established in earlier previous large-scale field research [21, 22, 24, 25]. Relatively high-end handheld units were purchased prior to the implementation of these surveys with the anticipation of being used throughout all facets of elimination interventions. Whilst these specific units were somewhat expensive, they have been considered a viable investment as part of the respective national malaria programmes to support all routine field operations, mapping and data collection. With the growing availability of mapping and data collection software (including freeware and open source), as well as handheld and mobile phone technology capable of running GPS and data collection applications, alternative affordable technologies are also accessible to a wider market looking to implement GR principles.
Additional benefits such as the increased accuracy and resolution of GR data collected, and the immediate availability of summary information and maps relevant for priority elimination interventions also make integrated PDA/GPS handheld technologies favourable; overcoming constraining issues associated with traditional paper-based methodologies including low accuracy, and slow transaction times to verify data and prepare operational maps following fieldwork. The high portability of handheld PDA technology also provided considerable benefits in remote and difficult terrain where access and transportation posed significant logistical challenges.
In addition to the traditional applications of defining target populations and providing operational support, GR also provides an effective mechanism for further strengthening current-day priority monitoring and evaluation interventions such as detailed surveillance and case investigation. Malaria elimination requires robust and efficient surveillance mechanisms with full geographical coverage of target areas . Active surveillance of high-prevalence foci is also essential for successfully interrupting malaria transmission . The application of modern geo-spatial technology for GR can empower local programmes to carry-out detailed mapping and data collection operations in target areas efficiently and accurately. Data collected during the GR operations now provides a spatial framework to not only guide key interventions such as LLIN distribution and IRS, but also carry-out surveillance and investigation at a household level across entire populations living in elimination areas.
When coupled with additional tools such as malaria risk maps, entomology and mobility data, and local and historical knowledge of malaria transmission, strategic active surveillance can also be targeted and prioritized in key focal locations following GR operations. It is anticipated that the compilation of such data will provide the foundation for the establishment and expansion of spatial decision support systems (SDSS) in these elimination provinces. A SDSS developed from the ground up, offers the potential to provide a user-friendly tool to equip locally-based programmes in meeting the demands associated with the scaling-up of interventions and surveillance operations in malaria elimination as well as intensified malaria control regions.