World Malaria Day 2016: innovation leading the fight against malaria

Each year, World Malaria Day (April 25^th) provides an opportunity for the global health community to celebrate the successes in the fight against malaria and to look to the challenges ahead. The mosquito-borne disease has been a persistent blight for millennia, but over the last 15 years we have made incredible progress in reducing its burden thanks to high investment and sustained political will. In that time, malaria mortality has decreased by 60 percent, with 6.2 million lives saved since 2000. Reducing child deaths and mortality means healthier societies and economies, higher school attendance, improved worker productivity and an overall better quality of life of millions of people in Africa and Asia.

Despite this progress, our work is far from over. New challenges continue to arise, such as the spread of drug resistant malaria in Southeast Asia. These challenges require reinvention and creative thinking in addition to the tried and tested tools. At Malaria Consortium, we believe that innovation is key to progress. We constantly test out novel approaches to malaria control and bring research to all our projects. Some of our most promising innovations are highlighted below:

Insecticide treated clothing. This method involves the application of insecticides and repellents on locally-made clothing for protection against mosquito bites. The insecticide – typically permethrin – has little to no odour, colour or greasiness and has been found to be 82% effective in reducing mosquito bites*. There are a number of ways to treat clothing, like using affordable home spraying or dipping kits. Factory-treated clothing is an alternative that provides longer-lasting protection but is more costly.

Our recent UK aid-funded study in Myanmar focused on rubber tappers, who work at night when malaria carrying mosquitoes are most active. This is the first time that key risk groups were involved in a social acceptance study of treated clothing in a rural area with malaria transmission. Previously, treated clothing had been mainly used by military, wildlife, wetland and park workers and outdoor recreational markets. We asked the rubber tappers to try out the treated clothing and they scored it highly for effectiveness, appearance, ease of use, durability, texture, colour and ease of cleaning.

*Hii J et al, Efficacy and protection of permethrin-treated fabrics against the Mekong malaria vector, Anopheles (Cellia) dirus (Diptera: Culicidae)

Mobile phone applications. Much of our work revolves around training and supporting community health workers (CHWs) providing health services in hard-to-reach areas of Africa. Despite the success of these programmes, it is their very remoteness that leads to additional challenges such as drug stock-outs, lack of support and supervision, and challenges in diagnosing symptoms which can get in the way of CHWs’ abilities to provide effective services. Our inSCALE project, funded by the Bill & Melinda Gates Foundation, has helped to address these challenges by providing CHWs in parts of Mozambique with smartphones that come pre-installed with an application called CommCare. This app guides CHWs through the diagnosis process and enables rapid data submission on patients seen as well as drug stock levels to district and national health officials. It also provides performance-related feedback and a closed user group that allows free calls among CHWs and their supervisors.

Community dialogues. Providing healthcare services to remote communities is only half the battle. Residents must also be aware of these services, be willing to use them and to understand the value in adopting healthy practices. That’s why we have helped to set up ‘community dialogues’ in Mozambique, Uganda and Zambia with funding from the World Health Organization - to provide a platform for communities to discuss health issues, identify solutions and plan communal action. These dialogues are led by volunteers selected by the communities themselves and they have proven to be very successful in creating demand for community health services, getting those who participate to adopt healthy initiatives.

Cross-border surveillance. The movement of workers across borders is believed to be a big contributor to the spread of the drug-resistant strain of malaria that has emerged in Southeast Asia. As a result, we are working in the region to help limit its spread by setting up border checkpoints to screen migrant workers for malaria. If tests come back positive for traces of the malaria parasite, the patient is treated on the spot. These initiatives, supported by the Global Fund and UK aid, are not only important for identifying and mapping cases of drug resistant malaria, but also in providing treatment and information for groups who are often beyond the reach of health services. 

Seasonal malaria chemoprevention. Seasonal malaria chemoprevention (SMC) is a relatively new and highly effective method of preventing malaria in children under five. It involves administering up to four monthly doses of antimalarial drugs during the rainy season when transmission is the most intense. With funding from UNITAID, we are now carrying out the biggest distribution of SMC to date in seven West African countries. Together with our partners, we will have provided 45 million treatments to more than six million vulnerable children by 2017. If all eligible children received SMC, some 175,000 lives could be saved each year, and 18 million malaria cases prevented.

To learn more about our innovations, take a look at the photo gallery below:

Our study in Myanmar, funded by President’s Malaria Initiative and UK aid, tested the effectiveness of insecticide treated clothing in reducing mosquito bites compared with untreated clothing. Here, a woman places her covered arm into a mosquito-filled box to see how effectively the treated garment repels mosquitoes.

Our work developing mobile phone applications for community health workers (CHWs) in Uganda and Mozambique has helped them to diagnose patients (pictured above), submit patient data, notify district and national health officials of drug stockouts, and keep in closer contact with other CHWs and supervisors.

We have used mobile technology in other contexts, too. In Cambodia, we piloted a UK aid-funded project that used SMS technology in the private sector to improve referrals and integrate private patient data into the National Malaria Information System. In Uganda, we have sent reminder text messages to health workers to remind them of guidelines on how to provide preventive treatment for malaria to pregnant women.

Simply providing mosquito nets doesn’t guarantee a reduction in malaria cases. People must be willing and able to use them. In Mozambique, we have targeted at-risk groups (such as pregnant women at antenatal care clinics) with nets as well as information on their use, supported the commercial sector to develop a market for nets that make them affordable for all, and have worked to create demand as well as promote proper use of nets through communications activities.

In Nigeria, we promote health messages using a variety of platforms. Our Support to National Malaria Programme (SuNMaP), funded by the UK government, created demand for malaria services through radio jingles, dramas, television commercials, posters and leaflets. The photo above, showing a Lagos bus, is an example of some of the creative methods that we used to spread positive health messages.

Another innovative behaviour change approach that we have implemented in Asia involves the identification and promotion of healthy behaviour already existing within communities. Originally used to improve nutrition outcomes in the 1970s, the ‘positive deviance’ approach identifies role models who can share their everyday health-seeking behaviour with the rest of the community in an attempt to improve overall health. Malaria Consortium is the first organisation to apply this method to malaria control in an elimination context. In this photo, a ‘positive deviant’ volunteer holds a meeting to discuss healthy practices with residents of Kyun Su township in Myanmar.

We have set up community dialogues in Mozambique, Uganda and Zambia to provide a platform for communities to discuss health issues, identify solutions and plan communal action. These dialogues are led by volunteers selected by the communities themselves and have proven to be successful in creating demand for community health services and getting participants to adopt healthy behaviour. 

In Uganda, with funding from Comic Relief, we have supported motorcycle taxi drivers (called boda-bodas) to handle the transport of sick children to health facilities in Mbale district. Community health workers give these drivers vouchers indicating the amount that the health facility should pay the driver depending on the distance travelled.

In partnership with the National Malaria Control Programme (NMCP), and with funding support from the President’s Malaria Initiative, the US Centers for Disease Control and Prevention, and the Three Millennium Development Goal Fund (3MDG), Malaria Consortium led the first national survey for malaria in Myanmar last year. In the photo above, field workers go from house to house to assess gather data on the malaria burden.

In Cambodia, with funding from The Malaria Eradication Scientific Alliance (MESA), we have been working towards elimination by trying to catch every case of malaria. Part of this effort involves going to the households where malaria has been reported (often via text message from village malaria workers) and then screening other household members for malaria.

We are also working in the region to help limit the spread of malaria by setting up border checkpoints to screen migrant workers. If tests come back positive for traces of the malaria parasite, the patient is treated on the spot.

With funding from UNITAID, we are now carrying out distributions of seasonal malaria chemoprevention – an effective method of preventing malaria in children under five – in seven West African countries. Together with our partners, we will have provided 45 million treatments to more than six million vulnerable children by 2017.

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Other innovation resources

Beyond Garki Project: monitoring changes in malaria epidemiology

• Microsite
• Project brief
• Baseline report

inSCALE: community based health delivery

• Microsite
• Learning paper: Establishing Village Health Clubs to improve community health worker motivation and performance
• Animation: Filling the gap with community health workers

ACCESS-SMC: achieving catalytic expansion of seasonal malaria chemoprevention in the Sahel

• Microsite
• Animation
• Project brochure