Modelling the cost-effectiveness of mass screening and treatment for reducing Plasmodium falciparum malaria burden
A recent paper published in the Malaria Journal notes that mass screening and treatment strategies (MSAT) to detect and treat Plasmodium falciparum have not been historically effective at interrupting malaria transmission. Researchers assessed the cost-effectiveness of MSAT strategies, modeling their use in a variety of transmission settings. The study determined that in both higher- and low-endemic settings, MSAT is not more cost-effective than scaling up insecticide-treated nets (ITNs) or case management. The researchers conclude that MSAT is not likely to impact transmission in low endemic settings, and may only be useful in decreasing disease burden in medium- to high-transmission settings when used in conjunction with other malaria control measures.
Estimating the potential impact of seasonal malaria chemoprevention in African children
Published in Nature Communications, researchers have identified geographic areas that may prevent an estimated 11 million malaria cases and 50,000 deaths per year if preemptive malaria treatment of children – or seasonal malaria chemoprevention (SMC) – is provided during their rainy seasons. The purpose of SMC is to reduce the presence of malaria parasites in a given population during periods of higher malaria transmission, resulting in fewer infections in the community and reduced onward transmission. Lower-endemic countries with predictable rainfall patterns - and thus discernible malaria seasons - will be the best candidates for this strategy. For malaria-eliminating countries, innovative strategies such as SMC may help to interrupt the remaining pockets of transmission.
Applying spatial decision support systems to optimize malaria elimination programming
MEG member Marcel Tanner and colleagues recently published a paper in Trends in Parasitology on how geospatial data are used to support malaria elimination efforts. Spatial data have provided key information about malaria outbreaks since the first push toward malaria eradication in the 1950s and 1960s, and today the increased usability of global positioning systems (GPS) and mobile technologies have dramatically increased these data’s precision and power. The Solomon Islands and Vanuatu have used GPS-based malaria surveillance systems to target indoor residual spraying (IRS) and net distribution for the highest risk areas with immense accuracy. As GPS technology and its resolution are refined, more malaria programs will have the fine-grained information needed for optimally targeting malaria interventions and embarking on elimination.
Global Malaria Program publishes operational manuals for malaria programs
The Global Malaria Program of the World Health Organization recently published two new malaria surveillance manuals: one for control settings and the other for elimination settings, to guide malaria programs in their malaria surveillance systems. Obtaining more complete and accurate data on malaria incidence is critical when targeting the remaining strongholds of transmission. These manuals will help guide malaria program operations in their decision making so that countries can accelerate progress towards elimination.
In areas where malaria transmission has declined, additional strategies are needed to identify and treat asymptomatic cases to eliminate reservoirs of infection. A publication in PLosONE highlights the use of proactive case detection with artemisinin-based combination therapy to reduce transmission and provide indirect protection to household members. This strategy can be used in focal areas of transmission to achieve further reductions in malaria transmission.
A recent publication in PLoS Medicine by MEG member Bob Snow and colleagues examines the communication gaps that exist in many malaria-endemic countries in rural Africa and is a significant barrier to efficient control and elimination programs. Mobile phones and text messaging are becoming increasingly accessible throughout the world, and can be used as cheap and effective means of improving health services and health outcomes in developing areas. Improved communication between the health facilities and malaria programs, as well as between the health workers and patients, will enhance efforts to successfully control and eliminate malaria.
In collaboration with the Malaria Eradication Research Agenda (malERA) initiative, the Special Program for Research and Training in Tropical Diseases (TDR) and the WHO Global Malaria Program recently released a report, Community-based reduction of malaria transmission. The report calls for strengthened commitment and action by community health workers to reduce malaria. In an effort to build on the community-based approach to malaria case management, this strategy aims to train health workers to identify and treat asymptomatic malaria populations to eliminate the remaining reservoirs of infection.
Beginning in 2005, a five-year malaria control strategy, the Medical Mission Malaria Programme (MM-MP), was introduced in Suriname. The MM-MP included strategies for prevention, vector control, case management and strengthening of the health system. After only four years of implementation, national malaria cases decreased by more than 80%. Suriname now faces the task of maintaining the gains as it pursues complete elimination.
The Global Malaria Program at the World Health Organization recently launched the 2011 World Malaria Report summarizing data received from the 99 malaria-endemic countries and highlighting global success in reducing malaria. Significant gains have been achieved over the past decade in reducing malaria morbidity and mortality with many of the malaria-eliminating countries getting even closer to achieving their goal.
A recent article in Clinical Microbiology and Infection by MEG member Roly Gosling and colleagues, discusses the role of anti-malarial drugs and treatment strategies to effectively target asymptomatic carriers of infection and reduce the transmission of malaria. Strategies for targeting asymptomatic carriers are especially important in elimination settings, as they will be responsible for onward transmission. As countries reduce their malaria burden, strategies to find the last few parasites of infection will become critical in achieving elimination.
MEG members Simon Hay, Dave Smith and Andy Tatem, along with colleagues, recently published an article in Nature which highlights the significance of malaria importation in a low-endemic setting such as Zanzibar, and the critical need for a robust surveillance system to detect imported malaria cases. By quantifying malaria importation rates, identifying high-risk groups and assessing onwards transmission, malaria control efforts can be effectively targeted and onward transmission of malaria can be controlled and prevented. Being able to appropriately assess these factors will not only help a low transmission setting reach elimination, but will also assist in preventing the re-introduction of malaria once local transmission has been interrupted.
The Solomon Islands National Malaria Control Program, along with malaria researchers, conducted an assessment on the feasibility and acceptability of implementing a new approach to surveillance and response in Isabel Province. Focus group discussions and key informant interviews were conducted to assess the travel patterns of people within Isabel Province and to determine the attitudes towards a community-based surveillance program to manage suspected malaria. A robust surveillance and response system is essential in any elimination effort, and in logistically-difficult settings such as the Solomon Islands, innovative surveillance systems may prove very cost-effective.