Top five moments of 2016

At Malaria Consortium we continued to work towards achieving our mission throughout 2016. With the support of our donors, partners and collaborators, we helped to improve lives in Africa and Asia through sustainable, evidence-based programmes that combat targeted diseases and promote child and maternal health. See below for a few of our highlights of 2016.

1) 6.4 million children receive seasonal malaria chemoprevention

Access smc

We continued to transform the malaria landscape in the Sahel through our ACCESS-SMC project that administers seasonal malaria chemoprevention. Funded by UNITAID, ACCESS-SMC treated approximately 6.4 million children during the 2016 campaign, including 88 percent of children under five years old.

 

2) Transforming Nigeria’s health sector 

Long lasting insecticide net demonstration

Long lasting insecticide net demonstration

The Department for International Development funded ‘Support to National Malaria Programme’ or SuNMaP concluded in 2016. This ground breaking eight-year project, led by Malaria Consortium, took an innovative approach to strengthening the country’s management of malaria at both state and federal level, harmonising intervention efforts and vastly improving demand for and access to malaria services. In addition, the project delivered millions of nets and has already saved an estimated 48,000 lives, which would have been lost to malaria.

3) Malaria Consortium placed as top GiveWell charity

GW_Logo_Standard_300ppi_CMYK (7) Malaria Consortium was selected as a GiveWell top recommended charity for our expertise in delivering seasonal malaria chemoprevention (SMC). GiveWell is a world-renowned meta-NGO that recommends charities by assessing them on four criteria: effectiveness, cost-effectiveness, transparency, and room for more funding.

 

4) New innovations in the fight against dengue and malaria 

Guppy fish eating mosquito larvae_During an experiment at the press chat

Guppy fish eating mosquito larvae during a presentation in Phnom Penh

We continued to develop and deliver innovative approaches to disease control in 2016. Most notably, our integrated vector management project, which uses larvae-eating guppy fish to reduce mosquito populations, was successful in reducing potentially dengue-carrying mosquito rates by 46 percent in Cambodia’s high risk areas. The project received wide spread recognition for being cost effective, sustainable and easy to implement, making it a suitable intervention for scale up.

In Myanmar, Malaria Consortium established an insecticide-treated clothing (ITC) project to determine the acceptability of ITC for malaria prevention among the key risk groups at the community level, such as rubber tappers. It was the first time this research had been conducted at the community level. Results showed that ITC was easy to use, durable, reduced mosquito bites and also has the potential for scale up.

5) 2016 World Malaria Report 

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Secretary of State for International Development, Priti Patel, at the World Malaria Report launch

Malaria Consortium supported the launch of The World Health Organization’s annual World Malaria Report in the UK at an event co-organised with Malaria No More UK, the All-Party Parliamentary Group for Malaria and Neglected Tropical Diseases, and other leading malaria NGOs. The report contained a range of achievements and detailed the progress made towards achieving the 2030 Sustainable Development Goals. These included a five-fold increase in the recommended three or more doses of preventive treatment for pregnant women and an 80 percent increase in the use of long-lasting insecticidal mosquito nets for all populations at risk of malaria.

At the report launch, the UK’s International Development Secretary, Priti Patel, reiterated the UK’s commitment to end malaria and announced an additional £75 million investment to support the development of antimalarial drugs and insecticides.

We look forward to continuing to work with all of our partners and donors throughout 2017 to improve lives and progress towards achieving the 2030 Sustainable Development Goals. 

 

 

Uncovering Asian tropical medicine – JITMM 2016

By Kyaw Thura Tun

jitmmThe Joint International Tropical Medicine Meeting 2016 (JITMM) took place this December with the theme ‘Uncover Asian tropical medicine’. The event was a great success, attracting over 800 regional and international participants, the highest attendance in over a decade.

During the conference Malaria Consortium staff presented the organisation’s expertise in innovative research, dengue and surveillance, outlined current regional projects and chaired group sessions.

Notable events included Malaria Consortium Asia Director Siddhi Aryal chairing the session ‘Meeting the challenge of outdoor transmission of malaria’. The session was extremely informative and featured presentations from World Health Organization (WHO) Emergency Response to Artemisinin Resistance Hub, Institute of Tropical Medicine of Antwerp Belgium and Infakara Health Institute of Tanzania. The WHO Emergency Response to Artemisinin Resistance Hub presentation by Michael MacDonald was a particular standout as he explained new paradigms for outdoor malaria transmission control, which showed options and opportunities moving from concept to programme implementation in the contexts of the Greater Mekong Sub-region. 

jitmm-2Other Malaria Consortium presentations included Vanney Keo and Dyna Doum’s dengue related presentations about the situation in Cambodia and Shafique Muhammad’s session entitled ‘Malaria elimination: Mobile populations and behaviour changes’. This session – with presentations from Malaria Consortium, Bureau of Vector Borne Disease of Thailand and Raks Thai Foundation – attracted an array of stakeholders and partners with an interest in more effective and regional behaviour changes among mobile populations.

On the final day of the conference, I presented ‘Improved surveillance towards malaria elimination in Myanmar’. The presentation detailed how the National Malaria Control Programme project, supported by Malaria Consortium, filled gaps in capacity and surveillance, and how data gathering and data accessibility has improved greatly. In particular, I explained why our approach and the consolidation of data at all levels, including townships, states and regional levels, is so appropriate to Myanmar.

jitmm-3JITMM is the most notable annual event for the tropical medicine community in Asia, bringing a wide range of researchers, scientists, lecturers, programme managers, implementers, students, donors and policy makers from around the world. This meeting was one of the opportunities for Malaria Consortium to present our work to the region and the world. I was glad to see such a great turn out and high quality presentations, not just from Malaria Consortium staff, but the whole community. I look forward to returning in 2017.

Meet the recipients of Mozambique’s largest ever mosquito net distribution

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By Dorca Nhaca

On 3rd November 2016 the Ministry of Health, Mozambique, launched the largest ever distribution of mosquito nets. In total over 13 million long lasting insecticide-treated nets (LLIN) will be distributed throughout the country – an important step to reducing the burden of malaria.

Malaria Consortium has supported the roll out of this mass distribution in the most populous province of the country, Nampula, located in the north of the country, delivering LLINs to protect over five million people.

As a consultant on the project, I travelled the Nampula province monitoring and supporting distribution efforts. The importance of this project was clear during my visits to various districts. Everywhere I went people converged en masse to the distribution points and were eager to get mosquito nets to protect their families.

I managed to speak with some of the recipients about the project and what it means for their families. This is what they told me:

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Mrs Gracinda Francisco, Monapo district

“Today I received two mosquito nets and I am very happy because my family will be protected from mosquito bites. The mosquito causes malaria which is a disease that makes us very weak. Before receiving these nets, the situation was very complicated in our home because we only had one old net to share with our son. The net was old and damaged and the mosquitos could easily enter through the holes. We had a terrible time because our home is close to the Monapo River which brings a lot of mosquitoes. People are constantly sick. Last month, my son fell ill and had to be admitted in hospital for treatment. I was worried because he is still very small. He is doing better now and these nets will help a lot to prevent malaria in my family.”

calima-primeiro-1Calima Primeiro, Rapale district
“I am very happy to have received these nets. It will greatly improve malaria care at home. The people in my neighborhood have suffered a lot from malaria and we have also suffered from this disease in our home. We had not used mosquito nets for a long time. A few weeks ago, I myself got malaria and I was very resentful because I was very weak and could not walk or work on the farm. We are currently in the agricultural season where we sow corn, peanuts and other crops, so my sickness caused a difficult situation. The children who live with me could not go to the farm because they had to take care of me. I had to stay home and could not do anything for about eight days. After this, my daughter and grand-daughter became sick with malaria and I had to take them to the hospital for treatment. This was a big learning experience for me: we got sick because we did not protect ourselves.

The government came at the right time to help us fight this disease. I know that malaria is dangerous and a killer disease. Now, if we use the mosquito net we can not only avoid getting sick, but also avoid spending money for the medicines and use this money for other things. So, I and my family will use the mosquito nets so we don’t get bitten by mosquitoes.”

valentim-antonio-cidade-nampula-2Valentim Daniel António, Nampula City
“I started using a mosquito net in 2010 when my wife became sick with malaria. At the time, she was pregnant. Besides not having the financial means to buy a mosquito net, we did not realise the importance of nets, because we thought that if we got sick we could just go to the hospital and get treated. But this time it was different. My wife was so sick that she had to be admitted to hospital while she was pregnant; she became very weak and had to take intravenous drugs. Luckily my wife got better and when she left the hospital, the nurse who cared for her asked us if we had a net at home and we said no. She gave a net to my wife and advised us to always use the net because malaria can be deadly. When we got home, we started using the net, but my kids did not because we had only one.

I bought two more nets for my children and nephews but after several years they developed holes and I could not replace them, but today, I received three new nets, and I want to thank the government.

I say with great pride that I use the mosquito net to protect my family’s health against malaria. If this net gets spoiled, then I will buy replacements. I am pleased to be a part of those benefiting from mosquito nets and I have been mobilising my family, friends and neighbors to use the mosquito net because it protects us from the mosquito bite that causes malaria – it is really worth it.”

pTrucks loaded with nets are sent to distribution centres around Nampulap
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Dorca Nhaca is a consultant to Malaria Consortium in its Nampula Office, Mozambique

This undertaking is part of a nation-wide initiative lead by the Ministry of Health with support from the Malaria Prevention and Control project, a country-wide initiative funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as primary partner, Malaria Consortium, Food for the Hungry (FH) and Foundation for Community Development (FDC).

Exciting times for new pneumonia diagnostic tools

kevin-photo2This year’s ASTMH saw a number of key sessions and presentations that highlighted the exciting work being done to evaluate the performance of new pneumonia diagnostic aids at the community level.

Day one included a presentation by Dr. Michael Hawkes from the University of Alberta titled: ‘Solar powered oxygen delivery: a randomized controlled non-inferiority trial’. The presentation provided evidence for to show solar powered oxygen delivery can be an effective intervention in resource poor settings. The study was conducted in Jinja, Uganda and based on the results the project team is now planning to expand the work to another 85 health facilities in Uganda.

This was followed by Save the Children’s evaluation of the Philips ChARM device (Children’s Automated Respiratory Monitor) – an innovative and easy to use pneumonia-screening tool for low resource settings. The evaluation showed that the ChARM device is an acceptable alternate diagnostic tool for identifying fast breathing among children under five. 

On day two, Malaria Consortium’s US Representative, Madeleine Marasciulo, moderated a symposium titled ‘Key elements for improving management of pneumonia in children in resource poor settings’. The symposium was attended by over 200 people.

The event featured a presentation from Malaria Consortium’s African Technical Advisor, Dr Ebenezer Baba, ‘Progress towards universal access to pneumonia treatment’, as well as results from the pneumonia diagnostics study, presented by Pneumonia Diagnostics Programme Coordinator, Kevin Baker. The results highlighted the difficulty health workers face when counting respiratory rates and the need for better tools to support them to better detect the symptoms of pneumonia.

Following this, Kristoffer Gandrup-Marino, Chief ofInnovation at UNICEF Supply Division presented plans for the ARIDA project and the important factors to consider when developing pneumonia diagnostic trials at the community level in resource poor settings.
If the pneumonia diagnostics project showed us anything, it is the urgent need for user-friendly devices and for technological innovators to continue developing diagnostic tools for the millions of health workers who use them to count respiratory rates every day. The ARIDA trial is taking this forward, Kevin Baker said.

Finally, Dr Grant Aaron, Global Health Director at Masimo, presented ‘Scaling up Medical Oxygen and Pulse Oximetry – the case of Ethiopia’. Dr. Aaron highlighted the work being done to scale up oxygen management in Ethiopia as well as a new respiratory rate device being developed by Masimo.

On Tuesday evening an important session was held on the Pneumonia Etiology Research for Child Health Study (PERCH). PERCH is a multi-country, comprehensive evaluation of the etiologic agents causing severe and very severe pneumonia among children 28 days to 59 months with data collected between August 2011 and January 2014, with over 9,500 cases enrolled.

It was great to see such high quality sessions on pneumonia at ASTMH this year with several of the sessions presenting important findings for the first time. Community health delivery in remote or low resource settings will surely benefit from the new diagnostic tools and study results.

By Kevin Baker

pPanel photo from the pneumonia symposiump
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Using community dialogues to prevent and control NTDs

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By Eder Ismael

blogNeglected tropical diseases (NTDs) constitute a serious obstacle to socio-economic development, quality of life and reducing poverty. In Mozambique, NTD rates are extremely high; the most common NTDs include schistosomiasis (or bilharzia), trachoma, intestinal parasites, lymphatic filariasis (LF) and onchocerciasis. Mass treatment campaigns have been implemented in recent years, but so far, efforts to involve the affected communities have been limited.

Malaria Consortium has been supporting the Provincial Health Directorate of Nampula to implement an approach that will increase community participation in the prevention and control of these diseases. Community participation is essential in the timely identification of patients and the promotion of preventive practices, such as hygiene and the handling of water. The community dialogue approach is a form of social mobilisation which improves knowledge, attitudes and practices at the community level and promotes ownership of health issues.

The approach has been tested in four districts of Nampula province and has been successful in raising the level of knowledge about the disease schistosomiasis.

The Provincial Health Directorate of Nampula and Malaria Consortium, with support from the Centre for NTDs at the Liverpool School of Tropical Medicine, are also testing how the approach can provide a mechanism to facilitate community initiatives for better home care of people suffering from the disease caused by LF.dr-jive

We interviewed the head of the NTD Programme of Nampula Province, Dr. Solomon Ercílio Jive, to gather his views

on the situation of these diseases in the province and the partnership with Malaria Consortium in the fight against NTDs.

Tell us about your job?
My role is to monitor, evaluate and implement community interventions for the prevention and control of NTDs as a whole, with an emphasis on diseases that are preventable through chemotherapy such as, LF, onchocerciasis, shistosomiasis, intestinal parasites and trachoma. Under the partnership between the Provincial Health Directorate and Malaria Consortium, I am the focal point of the community dialogues for the filariasis project, which is a continuation of the project of community dialogues on schistosomiasis (or bilharzia), which ended in March 2016.

What are the main challenges for the NTD programme?
We have specific targets to control the diseases, and to eliminate some, especially LF and trachoma by 2020. To achieve these objectives we must:
• Achieve greater population coverage in preventive chemotherapy campaigns
• Seek funding and support for the control of other tropical diseases that are not preventable by chemotherapy, as there are 17 diseases in total and so far only four of these benefit from direct funding
• Intensify awareness and social mobilisation efforts so that all rural communities have better understanding of tropical diseases, through radio spots, lectures, debates, community dialogues, and greater distribution of information and educational material
• Extend the community dialogues regarding LF and schistosomiasis to all districts of the province and if possible integrate other NTDs

What are the main challenges for the community dialogues approach?
We believe in the potential of the community dialogue approach to improve community participation in the prevention and control of diseases. However, we need more support and funds to cover more districts and to train community facilitators who will contribute to the intensification of social mobilisation and the dissemination of information on diseases, how to prevent and how to treat them.

blog-4What do you expect to accomplish with this project?
This year, the province conducted a mass treatment campaign for LF in the 23 endemic districts, which saw more than three million people treated. For the treatment of hydrocele cases (complication caused by LF), surgeries are performed in seven operating theatres throughout the province, with financial support from the Centre for Neglected Tropical Diseases at the Liverpool School of Tropical Medicine.

The community dialogue project can complement these efforts by triggering community mobilisation to improve the therapeutic coverage of preventive chemotherapy campaigns against LF, as well as identify patients with chronic conditions caused by LF. Community support for those with life-long conditions caused by LF can help alleviate suffering and possibly stigma . However, there is still no community based system in Mozambique to identify and provide appropriate assistance to patients in their villages. This requires identification of viable and affordable solutions at community level that the Ministry of Health could implement in a sustainable way.
The Memorandum of Understanding between the Provincial Directorate of Nampula Health and Malaria Consortium aims to provide one of those solutions, through the creation of community dialogues on LF, representing a commitment to support the Ministry of Health in efforts to fight communicable tropical diseases. The lessons drawn from this project will help to develop more effective interventions.

What is the most valuable part of this project?
Community dialogues serve to fill information gaps on health among community members, identifying problems and helping communities to take collective decisions for improvement of health practices. These help in the formation of new habits, particularly in relation to timely care-seeking, and thus contribute to achieving the goals outlined in the economic and social development plan of the province.

Malaria Consortium in Nigeria: reflections from a new Trustee

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My name is Mark Clark and I recently joined the Board of Trustees of Malaria Consortium. My interest in tropical diseases stretches back to a formative summer placement in the early 1980s as a biochemistry undergraduate at Colombo University, Sri Lanka. It was there I first observed the devastating effects of malaria and lymphatic filariasis. Thirty years on and I am delighted to have the opportunity to crystallise this long-held interest at Malaria Consortium, an organisation which makes such a difference to so many lives across Africa and Asia.

Among my first requests on joining the Board was to participate in a field visit so that I could become better informed about Malaria Consortium’s ‘on the ground’ activities. Helping to provide fiduciary oversight and governance is very rewarding in itself but of course there is no substitute for seeing the valuable work of the organisation ‘in action’.

Nigeria currently carries the highest burden of malaria of any country globally and is Malaria Consortium’s single largest funding recipient; it was an obvious choice for a visit. The country team, based in the capital Abuja and headed by the exuberant and inspiring Country Director, Dr Kolawole Maxwell, had already provided me with an extensive itinerary. This comprised a series of counter-party and partner meetings and a trip to Niger state to view one of the most innovative programmes for integrated childhood care, known as RAcE (Rapid Access Expansion).

Mark Clark visits Malaria Consortium staff in Abuja, Nigeria

What was immediately striking from the meetings with Government and State officials, donors and partners, was the esteem with which Malaria Consortium is held in Nigeria. It is seen not only as a key partner in the fight against malaria and other childhood diseases but as one of – if not the – key drivers of innovation and access to care in what is a complex and often difficult healthcare environment.

As an observation at this point, my 30-plus year business career prior was filled with meetings where levels of scepticism between the two sides around the table was the norm – here every meeting I attended was warm, collegiate and with a shared sense of purpose. Very refreshing and very motivating!

The success of the eight-year, DFID-funded SuNMaP (Support to National Malaria Programme), which Malaria Consortium was the lead implementing partner, is widely acknowledged and appreciated. Furthermore, Malaria Consortium chairs the National Technical Working Group on Malaria and has gained a reputation for evidence based innovation in projects such as RAcE, the related iCCM (integrated community case management) activities, and ACCESS-SMC (Achieving Catalytic Expansion of Seasonal Malaria Chemoprevention in the Sahel). We are optimistic about beginning a number of new programmes in the coming year, including some major programmes in nutrition, malaria and neglected tropical diseases.

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Prior to my visit to the project in Niger state, I attended a RAcE/iCCM sustainability workshop where the focus was on how these programmes could, in due course, transition from donor/NGO funding and oversight to federal/state funding and oversight. Of course, the ultimate target for Nigeria is for the government to operate an effective healthcare system for all, rendering the work of Malaria Consortium and other aid organisations unnecessary. However this can only happen in steps given the rather haphazard state of the current healthcare infrastructure, the lack of funding (Nigeria spends a low one percent of GDP on healthcare), and multiple other confounding geographic, political and social factors. It was nevertheless energising to see a group of like-minded individuals from all sides working together to devise a series of specific actions to try to ensure such a transition for RAcE/iCCM as of 2018.

Inevitably though it was the visit to the village of Butu in Paikoro, Niger state that will linger longest in my mind.

Butu is one of many villages in Niger state which benefit from Malaria Consortium’s RAcE programme, which delivers community-based diagnosis, treatment and referral of malaria, pneumonia and diarrhoea – the three biggest killers of under-fives in Nigeria. Central to the delivery of this programme are local community oriented resource persons (CORPs) who are supplied with training, educational materials and medical supplies. Their boxes contain diagnostic kits, artemisinin combination therapies (for malaria), antibiotics (for pneumonia), zinc and oral rehydration salts (for diarrhoea), and other medical necessities (e.g., sterile gloves and sharps boxes).

Our trip began with a two and a half hour drive from the state capital Minna on an increasingly pothole-ridden and near-impassable road. On arrival at Butu village (with the car’s axles thankfully intact!) we were met by the villagers and introduced to the CORP, a retired teacher. The CORP took us to his outbuilding, demonstrated the screening process for children who suffered fever, coughing, fast breathing or diarrhoea, and showed me how he logs each child in a register (which is shared regularly with supervisors in order to capture the records). In the first two weeks of October alone he had seen and treated or referred more than 20 sick children in the village, demonstrating the huge value he brings to the community – it’s truly worrying to think what would have happened had he not been available to those children, with the nearest hospital more than two hours away and with the transport difficulties I have already highlighted.

wavingAfter this I was introduced to the entire village and addressed by the village head who expressed his gratitude to Malaria Consortium for operating the programme. We in turn spoke about our vision where children can grow up without the threat of disease and stressed that the villagers should support the CORP as he is their ‘best friend’ in keeping the community healthy. We were then mobbed by a group of very excited children and many photographs were taken by those villagers with cameras or mobile phones! Notwithstanding the 20 or so sick children that the CORP had to see this month, my memory is of a village teeming with healthy, happy and excitable young children and for that we must, at least in part, thank the success of RAcE. It is why Malaria Consortium does what it does and it is truly heartening.

I have learned a huge amount this week and that I will carry through to perform my role more effectively as a Trustee going forward. Of course I have mainly highlighted the positives and it would be remiss not to re-state again the challenges, which largely revolve around the poor state of current healthcare infrastructure and the relative paucity of government funding. It is imperative for the foreseeable future that Malaria Consortium and its peers remain committed and motivated in this beautiful country if we are to see our mission through.

In closing I would like to express my gratitude for the extraordinary hospitality I received from Dr Maxwell and his team in Abuja and Minna. I was particularly pleased to be presented with a colourful Nigerian national outfit which will give me a new option for ‘dress-down Fridays’! The team in Nigeria really is of the highest quality, their reputation is second to none, and I am proud that they are carrying forward the vision of Malaria Consortium with such passion and involvement.

MC in the news: Dengue

dengue-map-displayed-in-the-middle-of-the-village-to-sensitise-communities-about-the-dengue-situation_positive-deviance-project2

Last week Malaria Consortium Myanmar was in the news with a story about dengue. We worked with Oliver Slow, a journalist to talk about our work and the dengue situation in the country.

The story “The dreaded dengue on the rise” was published in Frontier Myanmar print and online newspaper, an “unbiased voice in transitional Myanmar”

The number of reported cases is rising and more countries are being affected, but dengue fever remains one of the most neglected tropical diseases.

For Ko Yan Naing Soe, 18, it started with a high fever. Thinking it was nothing serious, he didn’t seek medical advice.

“But after four days of a constant high fever, my family took me to the township hospital where I was diagnosed with dengue fever,” Yan Naing Soe, who was 13 at the time, told Frontier.

The township hospital did not have the facilities to perform the necessary blood transfusions, so he was transferred to a children’s hospital in Dagon Township.

“It was quite serious for a while, but after about a week I returned to normal and was released after 10 days. It was lucky they diagnosed it early,” he said.

Although rare, in extreme cases dengue can lead to death.

Last year saw a surge in dengue fever cases worldwide. In Myanmar, 43,845 cases and 140 deaths were reported, of which 135 were children under 14, World Health Organization figures show.

“Dengue cases were reported from all States and Regions, among which Sagaing, Ayeyarwaddy and Mandalay had the highest cases reported,” a WHO spokesperson told Frontier.

In 2016, there has been no reported dengue outbreak. To the end of August 1,505 cases had been reported, including 30 deaths, the spokesperson said.

Dengue is transmitted by female Aedes aegypti mosquitoes (the same species that transmits Zika, yellow fever and chikungunya). Female mosquitoes do not actually feed on human blood for their own nutritional purposes; the protein is needed to produce eggs. So really they’re just being good mothers – something to think about the next time you swat at a mosquito buzzing around your ear.

One of the first recorded cases of dengue was noted by a founding father of the United States, Benjamin Rush, who wrote of “bone-break fever” in As It Appeared in Philadelphia, in the Summer and Autumn of the Year 1780 – a book title that doesn’t exactly roll off the tongue.

The Aedes mosquito was wiped out in Central and South America in the 1950s and 1960s, but it would later return. No such eradication was ever achieved in Asia.

“A severe form of haemorrhagic fever, most likely akin to DHF [dengue haemorrhagic fever, a severe form of the disease], emerged in some Asian countries following World War II,” according to a WHO handout on the disease.

Before 1970, only nine countries had experienced severe dengue epidemics, but that has since grown to more than 100 nations worldwide. Southeast Asia is one of the most severely affected regions, together with the Americas and Western Pacific, according to the WHO.

The UN agency’s figures show that cases in the three regions exceeded 1.2 million in 2008 and over 3.2 million in 2015. “Recently the number of reported cases has continued to increase,” WHO said.

“Countries across Southeast Asia are seeing increased prevalence [in dengue],” said Dr Prudence Hamade, senior technical adviser for Malaria Consortium. “Factors include the migration of people, global warming and increased urbanisation.”

She told Frontier that poor living conditions, including a lack of access to clean water and poor sewage disposal, were fertile feeding grounds for mosquitoes and created “ideal conditions” for the spread of dengue in cities.

A major challenge in diagnosing dengue is the similarity in symptoms with other diseases including malaria and Zika, the latter of which has seen its first cases in Southeast Asia in recent weeks. Symptoms for dengue include high fever, severe headaches, joint and muscle pains, and rashes.

In late 2015 and early this year, the first dengue vaccine, Dengyvaxia, was registered for use in people between nine and 45 years of age in endemic countries.

“Some countries are already deploying it, however it is only partially effective in preventing the disease and only useful in patients nine years and older,” said Dr Hamade. Some of the most vulnerable to death from the disease are young children.

“The most effective way to remove the threat of dengue is to control the mosquitoes that spread the disease. It is therefore important to monitor the presence of these mosquitoes and, if found, to take measures to remove them,” she said.

Measures include being active in looking for mosquitoes, removing breeding sites (mosquitoes can breed in a bottle-cap of water) and protecting from mosquito bites during the day.

A major difficulty in combating dengue is that the Aedes mosquito is active during the day, meaning that mosquito nets are not as effective and outdoor workers are more vulnerable, said Dr Jeffrey Hii, senior vector specialist for Malaria Consortium Asia. His organisation is looking into insecticide-treated clothing for people who work outdoors.

Malaria Consortium is also advocating for more funding for dengue programs worldwide. The organisation argues that while malaria programs receive significant attention and funding, those related to the control of dengue are “seriously underfunded”.

Dengue is classified as one of the 17 recognised neglected tropical diseases, which are typically related to poverty, endemic to the tropics and have poor research funding.

“However, even within NTD circles, it has often been further neglected,” said Dr Hii. It was not one of the 10 NTDs selected by the London Declaration in 2012 as a priority disease to be eradicated.

“There has been a major lack of investment in dengue prevention and control, which has also been mirrored by a lack of policy dialogue within the international community and among governments,” said Dr Hii.

“While remarkable progress has been made against the majority of these 10 NTDs … we have not seen the same high-profile announcements or a commitment to tracking data and progress for dengue. Simply put, it is neglected.”

Dr Sylvia Meek’s contribution to malaria elimination in Asia

It is with deep sorrow that Malaria Consortium must announce the passing of Dr Sylvia Meek, Malaria Consortium’s Global Technical Director, on 11th May 2016, after an 18-month battle with cancer.

Sylvia’s contribution to the fight against infectious disease, and malaria in particular, through her own, and Malaria Consortium’s work, cannot be overstated. From her ground-breaking work as an entomologist to her high-level policy work, she placed Asia in the epicentre of this fight.

Originating from Hull in Northeast England, Sylvia had a passion for the environment and disease control that led her to study Zoology at Oxford and later Animal Parasitology at the University College of North Wales, Bangor, followed by a PhD in mosquito genetics and control at the London School of Hygiene & Tropical Medicine and Liverpool School of Tropical Medicine. Her research at the London School laid some of the early foundations for current work on what are now termed ‘Wolbachia-infected mosquitoes’.

Sylvia as an entomologist
One of her dear friends, Dr Jeffrey Hii, Senior Vector Control Specialist at Malaria Consortium, remembers sharing a laboratory with Dr Sylvia Meek back in 1979-1980 when she was studying the inheritance of susceptibility to infection with Brugia pahangi and Wuchereria bancrofti in the Aedes scutellaris group of mosquitoes. These were the days before the advent of DNA sequencing techniques, so laboratory crosses were complex. Nevertheless, Sylvia was later able to show from these laboratory crosses that geographical isolation has probably been a very important factor in speciation within the Ae. scutellaris group (Meek, 1988).

During 1985 to 1989, Jeffrey and Sylvia’s paths crossed twice. “Firstly Sylvia joined our entomological team in the Bone-Dumoga forest reserve, in north Sulawesi  during the 1985 Project Wallace expedition organised by the Royal Entomological Society of London and Indonesian Institute of Sciences (LIPI),” he recalls. “She assisted in larval collections which led to the re-description of An. (Cellia) sulawesi Waktoedi, a hitherto incompletely described species.”

“We then met again in Chiang Mai where Sylvia informed me of her new job as World Health Organization (WHO) malaria adviser for the antimalarial programme in the Solomon Islands. We both participated at a WHO Special Programme for Research and Training in Tropical Diseases consultation on forest malaria in 1989 in Chiang Mai, Thailand. Sylvia’s presentation on forest malaria formed the basis of her landmark paper on ‘Vector control in some countries of Southeast Asia: comparing the vectors and the strategies’ (Meek 1995[1]).”

Throughout her career, Sylvia kept research close to her heart, contributing her expertise to shaping the various studies conducted in the Asia region.[2]

“During the past two years in Malaria Consortium, I have had the pleasure to work with Sylvia in research about ways to improve access to interventions that have been shown to work but have not reached many of the people who could benefit from them,” Jeffrey says.

Dr Sylvia Meek presenting at JITMM in Bangkok 2013

Dr Sylvia Meek presenting at JITMM in Bangkok, 2013 (© Malaria Consortium)

From research to helping refugees
Sylvia’s work with WHO took her around the world, during which time she gained the nickname ‘Mosquito Sylvia’. She also worked with the World Food Programme and the United Nations Development Programme, setting up and running disease control programmes for 200,000 refugees.

Dr Prudence Hamade, Malaria Consortium Senior Technical Advisor, another close friend and colleague describes this experience: “Sylvia worked in the refugee camps along the Thai-Cambodia border and although an entomologist she was soon diagnosing and treating malaria among the many patients there as well as doing her work and research into the entomology and providing protection for the refugees. During her stay there she had dengue at least a couple of times and has described to me how she lay on the floor of a hut with a high fever and had to get up and travel on the next day.”

Regional expertise and policy advice
Prudence continues, “She was instrumental in conducting the Cambodia malaria indicator surveys, the first of their kind in the Greater Mekong Subregion in 2004. In 2007 she supported both Thailand and Cambodia to develop their Global Fund bids and conducted Malaria Programme Reviews in Thailand and Myanmar to advise governments on how to improve their malaria programmes.

At WHO Technical Expert Group meetings, Sylvia provided well-thought logical arguments and brought the Asia view to the WHO Malaria Policy Advisory Committee (MPAC) which helped to drive some of the key policy changes related to malaria control and elimination in Asia. Through MPAC and drug resistance WHO regional meetings, Sylvia contributed to the recommendations of the treatment policies for Cambodia, a country particularly affected by multi- drug resistance. She was also an active member of the Emergency Response to Artemisinin Resistance (ERAR) in the Greater Mekong Subregion working groups.

“Sylvia’s impact on Malaria Consortium and our partners was, and continues to be, immense,” says Jeffrey. “She was an inspiration and everything we could ever admire in our profession and our personal lives. Sylvia’s values will be carried on by those she mentored, collaborated with and taught, and her inspiration has instilled a generation of malaria programme staff and entomologists in Solomon Islands, Greater Mekong Subregion, sub-Saharan Africa and elsewhere. She will be remembered for her subtle sense of humour, her enormously infectious curiosity and enthusiasm, her friendship and kind and generous nature.”

Dr Sylvia Meek surrounded by her colleagues at the Malaria Consortium Asia retreat 2015 in Thailand (© Malaria Consortium)

 

[1] Meek, S.R. (1995). ‘Vector control in some countries of Southeast Asia: comparing the vectors and the strategies’. Ann Trop Med Parasitol; 89: 135-147.

[2] Non exhaustive list of some of Dr Sylvia Meek’s recent publications:
Hustedt J, Canavati SE, Rang C, Ashton RA, Khim N, Berne L, Kim S, Sovannaroth S, Ly P, Ménard D, Cox J, Meek S, Roca-Feltrer A (2016). ‘Reactive case-detection of malaria in Pailin Province, Western Cambodia: lessons from a year-long evaluation in a pre-elimination setting’. Malaria Journal.

Edwards HE, Canavati SE, Rang C, Ly P, Sovannaroth S, Canier L, Khim N, Menard D, Ashton RA, Meek SR, and Roca-Feltrer A (2015). ‘Novel cross-border approaches to optimise identification of asymptomatic and artemisinin-resistant Plasmodium infection in mobile populations crossing Cambodian borders’. PLoS One.

Cox J, Dy Soley L, Bunkea T, Sovannaroth S, Soy Ty K, Ngak S, Bjorge S, Ringwald P, Mellor S, Sintasath D, Meek S (2014). ‘Evaluation of community-based systems for the surveillance of day three-positive Plasmodium falciparum cases in Western Cambodia’. Malaria Journal.

Meet the members of a community health committee in Inhambane Province of Mozambique

A facilitator of a community dialogue in Mozambique shows an illustration that demonstrates how to hang up an insecticide treated net. A facilitator of a community dialogue in Mozambique shows an illustration that demonstrates how to hang up an insecticide treated net.

Felismina lives in Inharrime, a region in southern Mozambique. She has been a member of her community’s health committee since 2013. “The committee meets twice a month: once with the whole community, and once with just the members of the committee. We talk a lot about hygiene – how to take care of latrines and keep your home clean so that people can stay healthy. We also discuss things like how to avoid getting malaria.”

The Ministry of Health has put community engagement at the forefront of its efforts to improve healthcare in remote areas for years. Given the high prevalence of malaria, pneumonia and other infectious diseases, they have encouraged the creation of these community health committees as a way to help spread awareness and offer a platform for discussion. Consisting of elected members, religious leaders and community health workers amongst others, these groups are promoted as an effective means of mobilising communities and getting them to talk about health problems and identify solutions.

“There are 15 regular members of our health committee,” says Adolfo Nhamize, who was elected president of the group. “I am responsible for leading our meetings. I make the reports and conduct dialogues with the community.”

Daimanhane Mausene, Secretary of the Health Committee (2)The committee’s secretary Daimanhane Mausene tells me what topics they cover at their meetings. “We discuss malaria, diarrhoea, pneumonia, HIV. We also educate women on pregnancy,” he says. “We sometimes go house to house and talk to people about the use of latrines, how to boil water so they don’t get sick, and how to take some medicines. Then we come back later and see if they are following our advice.”

Resources for these committees are often scarce, and the lack of attention they receive means that members do not always receive proper training. Malaria Consortium’s Rapid Access Expansion (RAcE) project began working with the committees in 2013 to address some of these obstacles and to apply participatory learning methods within communities. Our team worked with the committees to introduce the community dialogue approach in order to get communities talking. The dialogues focus on increasing demand for (and use of) health services available within the community as well as provide a platform for discussing health problems and identifying solutions. As part of the approach, community health workers and community leaders receive a two-day training to organise and lead the dialogues, using a repeatable 10-step process and focus on the three major childhood illnesses.

“We talk about all sorts of things during the dialogues,” says Felismina. “Sometimes we discuss mosquito nets, because some people don’t use them or don’t have them. Other times, people talk about diarrhoea because of the dirty water.”

“People used to complain a lot about getting malaria,” says Fernando Machapene, a religious leader and member of the committee. “So we told them to go to the hospital and take medicine.” Residents also talk about practical problems and put forward recommendations. “Some people said that we only had one community health workers serving five communities and that we needed more – maybe two or three.”

Community dialogue discussing malaria (54)When I arrived in Inharrime earlier that day, a community dialogue was taking place. The topic was malaria. Gathered under a tree, the health committee fielded questions, gave advice and walked around the group showing illustrations and other educational materials. These included pictures that showed how to effectively tuck in a mosquito net as well as other methods of protection. Unfortunately, the session was interrupted after about 30 minutes by a sudden and unexpected downpour. Some people ran home, while others huddled together under the tree in an attempt to stay dry. It was clear, however, that the dialogue could not continue.

Adolfo, a provincial coordinator of community health workers (called Agentes Polivalentes Elementares, or APEs in Portuguese) tells me that weather is not the only challenge that the health committee faces. “It is sometimes difficult to get people to come to the meetings,” he said. “People might not always show up. They will say that they have plans, or that they have to go to the field to work. One way we try to remind them is by having teachers tell their students, who then tell their parents when they get home.”

Despite these challenges, the community dialogue initiative has proved a good way to improve the community knowledge of some diseases and wrong behaviours. In his community, Daimanhane has also noticed some changes in behaviours. “They try to follow the advice we give them,” he says.

Check out the photo story below to learn more:

pA health committee in Inharrime Mozambique meets to discuss health problems facing the community Malaria Consortiumrsquos Rapid Access Expansion RAcE project began working with these health committees in order to get communities talking about health through an approach called community dialogues The project provides training and materials to help committees organise and carry out these dialoguesp
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Ilya Jones is the Communications Officer at Malaria Consortium

World Malaria Day in Bangladesh

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In late April 2016, I spent World Malaria Day in Bangladesh after being invited by the Director of Communicable Disease Control, Dr Shamsuzzaman of the Ministry of Health and Family Welfare. Malaria Consortium has been providing technical assistance and funding support to the Bangladeshi organisation iccdr,b to conduct a study in the Chittagong Hill Tracts areas regarding perceptions of health services. In addition, we have recently been in discussions as to where Malaria Consortium could best support the efforts of the government to control malaria, dengue and other neglected tropical diseases, especially focused in the border areas where malaria elimination needs to be accelerated to avoid artemisinin resistance crossing the border from neighbouring Myanmar.

It was a great privilege to be invited by Dr Shamsuzzaman, and we were happy to partially fund the event by providing $3,000 – funds that went towards travel for key government officials, renting of the venue, refreshments and the printing of key malaria materials.

DSC00386It was a hot day in Chittagong, the second largest city in Bangladesh, with lots of people out and about on the streets for the World Malaria Day celebrations. Bands were playing and I participated in the parade and subsequent rally where indoor residual spraying was demonstrated. The slogan of the event was ‘end malaria now’, which was chanted from the crowd and by officials.

After the parade, a large crowd gathered for an outdoor meeting. There were several speeches about how there has been a great reduction in malaria in Bangladesh over the past several decades, with cases now confined mostly to border areas – particularly in the Chittagong Hill Tracts. Given this progress, the focus of the Ministry of Health and Family Welfare has become centred on eliminating malaria in the country.

DSC00420During the panel session of the rally, Malaria Consortium and BRAC – a Bangladeshi international development organisation – were the only two non-governmental organisations to speak. The Minister of Health made an appearance by Skype, and the Directors of Health and Family Planning were also present.

On behalf of Malaria Consortium, I presented the results of a research project in Bandarban that investigated the knowledge, attitudes and practices of community members, facility-based health workers and community health workers in relation to malaria and neglected tropical disease control. We are hoping to be able to work with the family planning division in Bangladesh to train peripheral level health workers to use rapid diagnostic tests for malaria and give out treatments to patients attending community clinics for primary health and antenatal care. We are also looking into possibilities that will allow us to expand into malaria, dengue and community-based care of childhood diseases.

I would also like to thank the icddr,b organisation in Bangladesh for supporting our visit on this important day.

Prudence Hamade is Malaria Consortium’s Senior Technical Advisor