Tailored Interventions not “Prêt-a-Porter” for Malaria Elimination

[We are sending daily posts from Kampala, Uganda, during the week-long Keystone Symposia meeting, 'Malaria: From Innovation to Eradication', organized in collaboration with MESA. Additional funding was given by The Bill & Melinda Gates Foundation and the US NIH/NAIAD. This blog was posted simultaneously on ISGlobal's blog, the Malaria World website, and the MESA website]

Today’s morning session focused on tailoring packages of interventions to achieve the greatest impact in a specific setting.

Today’s morning session focused on tailoring packages of interventions to achieve the greatest impact in a specific setting

In Zambia they say “malaria ends with me” and the national programme is implementing a step-wise approach to make this happen.  Kafula Silumbe (Malaria Control and Elimination Partnership in Africa, PATH, Zambia) explained how, with a backbone of rapid reporting and a surveillance-response system, mass drug administration (MDA) has helped to rapidly reduce the number of cases in the Southern Province.  Currently, most of the case reporting comes from the community health workers (CHW) and novel approached to retain CHWs need to be tested. 

Caterina Guinovart (ISGlobal, Spain and Malaria Control and Elimination Partnership in Africa, PATH, USA) compared different drug administration strategies (mass/population-based and focal/household-based) along a range of transmission settings in Zambia and Senegal, with the aim of determining whether drug-based parasite clearance and case investigation can take us to elimination.  The results varied according to transmission setting and the coverage of vector control interventions.

Caterina Guinovart (ISGlobal, Spain and Malaria Control and Elimination Partnership in Africa, PATH, USA) compared different drug administration strategies

Melissa Penny (Swiss Tropical and Public Health Institute, Switzerland) gave a comprehensive overview of how models can be used in various aspects of malaria research, from clinical development of new tools to examining different implementation strategies. For example, modelling predicts that the RTS,S vaccine will have the greatest public health impact in medium to high transmission settings.  She emphasized that modelling provides a useful framework to guide thinking and must be an iterative process, using robust data from the field in collaboration with the programme partners.

The morning session closed with two short talks. Gareth Jones (Clinton Health Access Initiative, USA) presented an assessment of strengths and weaknesses of the malaria surveillance systems in Tanzania, Kenya and Uganda.  Gaps were identified in data collection and reporting, particularly from the private sector facilities.  Krystal Lorna Nkusi Birungi (Uganda Virus Research Institute, Uganda) presented the Target Malaria project.  Her works includes characterizing the biology and behaviour, ecology and breeding sites for Anopheles gambiae and other species, which together provides a baseline to test new gene drive technology in the future.  

The afternoon shifted its focus to health systems. Irene Misuka Masanja (Ifakara Health Institute, Tanzania) presented a study which evaluated the effectiveness of the health system and tested approaches to improve access to care.  Cartoons and posters with malaria messages were developed by the communities themselves, and in the intervention group where these materials were used, there was an increase in access to malaria treatment.  Only improving the quality of care does not directly translate into better access. Improving access requires an understanding of the socio-cultural, environmental and financial needs of the community.

Kathryn Roberts (University of California, San Francisco, USA) presented a practical approach to surveillance as an intervention as implemented through the Namibia Malaria Elimination Research Partnership, established in 2014. The surveillance system uses rapid case notification, robust data storage and management, and geographical reconnaissance. It is a powerful tool that allows the malaria programme to identify transmission foci and target interventions, but a number of challenges, including sustainability and internet access, remain.

Valentina Buj (UNICEF, USA) described UNICEF’s malaria strategy, integrated community case management work and shared examples of integrated multi-sectorial approaches.  Community engagement using radio shows and performance art, termed “edutainment” was a very successful and creative example from Madagascar.

The success story of Sri Lanka that was certified by WHO malaria-free on September 5, 2016 was one of the highlights of the session

The success story of Sri Lanka that was certified by WHO malaria-free on September 5, 2016 was one of the highlights of the session.  Sumadhya Deepika Fernando (University of Colombo, Sri Lanka) talked passionately about the achievements as well as the challenges of avoiding reintroduction of transmission in a context of high receptivity and high vulnerability.  She described the surveillance-response mechanisms in place to prevent the onward transmission of malaria infection imported by the armed forces returning from missions.  One of the challenges, she said, is that “malaria is becoming a forgotten disease” but “the job is not over once a country receives a certificate. We have a receptive vector and Sri Lanka must maintain its national surveillance system”.  

The day ended on a high note with the presentation of a non-invasive malaria detection laser from Vladimir Zharov (University of Arkansas for Medical Sciences, USA).  The concept is based on sampling the whole blood volume for parasite-infected cells which are travelling through blood vessels, using photo-acoustic flow cytometry. For the moment the technique has been tested in animal models, models for cancer and clinical prototypes will soon be developed.  Many Keystone attendees rushed to exchange ideas with Vladimir over the poster session and light bites that followed.

Related blog posts

Day 1. Pre-Meeting Workshop for Global Scholars Shines the Spotlight on Surveillance

Day 2. Tackling the Asymptomatic Reservoir to Achieve Malaria Elimination: the If, the Why and the How