In October 2023, Malaria Consortium participated in the 72nd Annual Meeting of the American Society of Tropical Medicine & Hygiene (ASMTH) in Chicago, USA. The conference brought together approximately 5,000 professionals from diverse global health fields, fostering cross-sectoral dialogues and knowledge exchange to advance universal health coverage. During the five day meeting, we presented research on critical global health issues aligned with our mission — to save lives and improve health through evidence-based programmes.
Research plays a pivotal role in advancing Sustainable Development Goal (SDG) target 3.3, which aims to end the epidemics of malaria and other communicable diseases by 2030. Our implementation research for seasonal malaria chemoprevention (SMC) — a highly effective intervention to prevent malaria in those most vulnerable to the disease’s effects — has played a critical role in supporting efforts to increase coverage and expand SMC into new geographies. This year alone, we are targeting 25 million children with lifesaving antimalarials across seven countries.
Using SMC outside of the Sahel
- Symposium 132: Effectiveness and efficacy of chemoprevention for children under five:
- Malaria in older children and adolescents and the intermittent preventive treatment of malaria in school-aged children
- Seasonal malaria chemoprevention effectiveness in Northern Mozambique: Results from a cluster-randomised controlled trial
- Rapid assessments for the deployment of seasonal malaria chemoprevention in new geographies of East and southern Africa
- Chemoprevention options from seasonal malaria chemoprevention non-eligible areas: Experiences from Nigeria
- Presentation 5688: A cluster randomised controlled non-inferiority trial to evaluate the protective effectiveness of sulfadoxine-pyrimethamine-amodiaquine (SPAQ) and dihydroartemisinin-piperaquine (DHAPQ) for SMC among children 3 to 59 months, in the context of high antifolate and aminoquinoline resistance, Karamoja region, Uganda
- Presentation 7240: SMC effectiveness in northern Mozambique: Results from a cluster Randomised Control Trial (cRCT)
Conducting rigorous research enables us to gain a deeper understanding of disease dynamics, treatment effectiveness, social and cultural barriers and facilitators to programme success, and emerging challenges such as drug resistance. Results from our research equips us with the knowledge to develop evidence-based strategies, allocate resources efficiently, and innovate new solutions, ultimately accelerating progress toward healthier communities and achieving SDG 3, “good health and well-being” for all.
Our work puts community engagement and sensitisation as a central pillar of our programmes, including SMC interventions. Research on the impact of caregivers, community health workers, distributors, community leaders, and village health teams in promoting the uptake of SMC has facilitated the design of programmes tailored to their specific contexts and has ensured the provision of adequate training for health workers and volunteers. This is supported by several studies conducted in Mozambique, Nigeria, South Sudan, and Uganda, which consistently show that community engagement and knowledge about interventions, particularly among groups involved in the implementation of SMC, result in greater acceptance, confidence and uptake.
- Poster 5491: Community leadership in SMC: Engaging communities in northern Mozambique
- Poster 6183: Caregiver knowledge and confidence in SMC effectiveness in Nigeria
- Poster 6200: The role of community distributors in ensuring the quality delivery of SMC delivery in Nigeria
- Poster 6201: Perceived factors impacting community health workers and lead mothers’ capacity to support SMC across delivery settings: Qualitative secondary analysis from recent studies in Mozambique, Nigeria, South Sudan and Uganda
Monitoring potential changes to drug resistance is an important focus of any new malaria intervention we introduce and have developed a novel protocol to assess the efficacy of sulfadoxine-pyrimethamine and amodiaquine (SPAQ) — the combination of medicines used for SMC — in an area with high drug resistance in Mozambique. The study showed agreement between parasitaemia quantification, qPCR, and microscopy, suggesting the utility and reliability of this methodology. Other studies assessing the how resistance impacts on the medicines used for SMC include one in Burkina Faso, which analysed resistance markers and concluded that SPAQ remains effective after eight years of SMC implementation. We have also undertaken a quasi-experimental study in South Sudan that showed that SMC reduced malaria in children during the high transmission season, despite potentially high levels of resistance to SPAQ. And in Uganda, another new geography for delivering SMC, a study provided molecular surveillance of SPAQ resistance markers, concluding that SMC has not notably altered sulfadoxine-pyrimethamine resistance after two consecutive annual rounds.
Antimalarial drug resistance
- Poster 5359: Molecular markers of sulfadoxine-pyrimethamine-amodiaquine (SPAQ) resistance in the health district of Boussé, Burkina Faso
- Poster 6046: Molecular surveillance of sulfadoxine-pyrimethamine-amodiaquine (SPAQ) resistance markers in northeastern Uganda
- Poster 6051: The impact of SMC on Plasmodium falciparum resistance to sulfadoxine-pyrimethamine-amodiaquine (SPAQ) in northern Mozambique
Significant progress has been made in the global fight against malaria, resulting in a marked decline in malaria-related deaths and cases compared to historic levels. However, this progress remains fragile and sustainable gains require robust health system strengthening efforts. Malaria Consortium is dedicated to enhancing health systems by developing new digital health tools, specifically to improve data quality and management at the community level. To achieve this goal, we created upSCALE, a government-led mobile health (mHealth) intervention in Mozambique that focuses on enhancing the quality and coverage of community-level health services.
upSCALE includes a smartphone app that guides community health workers, known locally as agentes polivalentes elementares (APEs), through patient registration, diagnosis, treatment, and referrals. Research presented at the conference shows that there is a need for frequent monitoring to inform future policy decisions and concludes that upSCALE can improve disease surveillance and community-based healthcare.
The significance of scientific discussion involving national partners, including national malaria control programmes, is essential to ensure that global health solutions are relevant to localised health issues. Stimulating such discussions, Malaria Consortium researchers, along with a representative from Mozambique’s National Malaria Control Programme, will engage in a comprehensive dialogue regarding the effectiveness and efficacy of chemoprevention for children under five. Other symposia will encompass discussions on defining the target product profile for antimalarials to address the specific needs of patients with severe malaria, as well as opportunities for collaborative learning through a community of practice and an informative session on diagnostic innovations aimed at improving pneumonia case management.
- Symposium 61: Benefits and challenges of WHO Chemoprevention Guidelines giving increased autonomy for decision-making to countries Opportunities for learning through a community of practice: How flexible and adaptable guidelines create opportunities for learning and rapid improvement in implementation
- Symposium 83: Reimagining the continuum of care for severe malaria patients Malaria in older children and adolescents and the intermittent preventive treatment of malaria in school-aged children
- Symposium 132: Effectiveness and efficacy of chemoprevention for children under five Chemoprevention options from seasonal malaria chemoprevention non-eligible areas: Experiences from Nigeria
- Symposium 168: Innovations in diagnostics supporting improved pneumonia case management in children under five years
Achieving universal health coverage necessitates the development of context-specific, people-centred strategies founded on evidence-based approaches. ASTMH provides a valuable platform for sharing research, identifying research gaps, gathering insights from other stakeholders and country experiences, and promoting evidence-based advocacy. Through active participation in discussions with peers in the field, we can pinpoint these research gaps and, through collaboration and partnerships, advance the realisation of UHC and sustainable healthcare delivery.
You can view dates, times and locations of all Malaria Consortium’s sessions at the ASTMH Annual Meeting in our schedule
All presentations made by Malaria Consortium at the ASTMH Annual Meeting will be made available for download on the dedicated Malaria Consortium at ASTMH 2023 webpage
If you would like to know more about Malaria Consortium’s SMC work, or to set up a meeting with one of our team at the ASTMH Annual Meeting, please email [email protected]