Prioritizing Interventions – Targeting IRS to Maximize Effectiveness

By Annie Martin on October 30, 2018 in Malaria, News

Malaria kills a staggering number of people every year — nearly half a million. That number is unacceptable given malaria is both preventable and treatable and somewhat surprising given donors and governments spend hundreds of millions of dollars each year attempting to control malaria.

So why is that number still so high? Well, first of all, malaria is primarily in countries with largely rural and hard to reach populations. Getting to those populations is logistically complicated and costly. Secondly, the mosquitos that transmit malaria quickly adapt to resist insecticides and to evade interventions. Thirdly, the scale of the problem is massive. While there are half a million deaths and over 200 million cases annually, the population at risk is even larger – half of the global population. Half of seven billion people are at risk for malaria.

With this context, hundreds of millions of dollars in control efforts begins to sound like a drop in the bucket. In order to make the most of the resources at hand, we must maximize the impact of each dollar spent. For example, interventions like indoor residual spraying (IRS) – where spray operators move household to household spraying the walls of homes with insecticide in order to kill the malaria transmitting mosquitoes – are very effective at killing mosquitoes and reducing malaria. However, IRS is expensive. We need to ensure we are distributing IRS resources in the most strategic and likely most impactful way.

In 2017, Akros worked with the Zambia National Malaria Elimination Centre (NMEC), the Africa Indoor Residual Spray (AIRS) Project implemented by Abt Associates, and the U.S. President’s Malaria Initiative (PMI) to conduct a comparison control trial of IRS prioritization strategies. The question was simple: If we do not have enough resources to spray every house, where should we spray to see the greatest decreases in malaria incidence? Should we spray one condensed geographic area? Should we spray the areas near the health centers with the highest burden of malaria? Or, should we spray the areas predicted to have the most mosquitoes? Each of these questions defined an arm of the study; one arm targeted IRS by concentrating it in one geographic area, one arm targeted IRS by prioritizing its delivery by health facility-measured malaria burden, and one arm targeted IRS by prioritizing its delivery by predicted mosquito density due to ecological factors. The NMEC implemented each arm in two districts of Eastern Province during the 2017 IRS operations.

USAID Awards Global Contract to PSI and Partners to Advance Malaria Service Delivery in 28 Countries

By Akros Media on February 26, 2018 in Malaria, News

We are excited to announce that PSI has been successfully awarded a new contract by USAID to support the President’s Malaria Initiative (PMI) to Advance the Progress of Malaria Service Delivery (APMSD) in 28 malaria-affected countries and selected Akros as an implementing partner. The project, worth over $160 million USD over five years, will be delivered by a consortium of core partners, led by PSI and including JHPIEGO, Medical Care Development International (MCDI) and University of California-San Francisco.

The project will focus on supporting national malaria control programs in USAID-supported Malaria Endemic countries including 25 in Africa and three in Asia. The interventions aim to improve quality of and access to malaria case management and malaria in pregnancy interventions. They will also improve quality of and access to other malaria drug-based approaches and provide support to pilot/scale-up newer malaria drug-based approaches. Global technical leadership, support for operational research, and advances in program learning are priorities as well. In addition to the core team, private sector partner Akros and University of Oslo and Medicines for Malaria Venture will support.

Akros will lean into its experience working with national ministries by leading efforts on strengthening capacity building of Ministries of Health (MoHs) for HMIS and executing a central strategic plan around data use within the MoHs and communities.

Globally, the world has made remarkable progress in controlling malaria; halving the burden of disease between 2000 and 2015, but progress is stalling. The WHO’s most recent World Malaria Report highlights the current state of case management of children under five years and delivery of intermittent presumptive treatment for pregnant women as major concerns.

The President’s Malaria Initiative, led by USAID and implemented with the U.S. Centers for Disease Control and Prevention, is the U.S. Government’s primary vehicle for assisting malaria affected countries to scale up proven malaria control and elimination interventions.

The PMI Strategy for 2015-2020 accounts for much progress over the past decade and offers a strategy for new and emerging challenges. Malaria prevention and control remains a major U.S. foreign assistance objective and PMI’s strategy fully aligns with the U.S. Government’s vision of ending preventable child and maternal deaths and protecting communities from infectious diseases. By working with PMI-supported countries and partners, the U.S. Government aims to further reduce malaria deaths and substantially decrease malaria morbidity, towards the long-term goal of elimination.

This new contract comes as PSI launches its new global strategy for consumer-powered healthcare. APMSD will innovate ways to bring healthcare closer to the consumer in developing countries. PSI is proud to be associated with USAID and its partners to achieve this goal.

Akros-led consortium to develop Elimination 8 regional malaria database

By Akros Media on August 19, 2016 in Malaria, News

We are excited to announce that an Akros-led consortium has been selected to develop a regional malaria surveillance platform for a coordinated, eight-country effort to achieve the historic goal of eliminating malaria in eight southern African countries. The Southern African Malaria Elimination 8 (E8) is a partnership between Botswana, Namibia, South Africa, Swaziland, Angola, Mozambique, Zambia, and Zimbabwe. The first four of these countries (frontline countries) have an elimination goal of 2020, and the later four (second line countries) hold a goal of elimination by 2030. Consortium members working with Akros include HISP-SA and Compre Health.

E8 countries reported a tremendous reduction of malaria cases of more than 50% since 2004. However, the closer we get to elimination, the better surveillance we must have. Malaria does not respect borders, meaning the four eliminating countries cannot eliminate as long as high transmission remains within the region, and human migratory patterns facilitate parasite movement from more highly endemic countries. Therefore, new regional strategies are needed to support the surveillance and control efforts by the second line countries in order to reduce the reservoir of malaria parasites which have a potential for cross border spread of infections that could re-establish infection in the frontline four countries. As frontline countries progress towards malaria elimination, second-line countries are intensifying their malaria control efforts in order to achieve pre-elimination status.

The knowledge of malaria trends between countries will be one of the main factors influencing the success of malaria elimination. To facilitate the ease of information sharing, the E8 working with the consortium have developed a regional database, which will sit within the District Health Information System (DHIS 2), a system already familiar to many of the 8 countries. The regional database will not be a parallel system — no new malaria data elements or indicators will be collected. Rather several malaria data indicators already captured in countries will be shared amongst countries via the regional database. This is in-line with E8 country-level commitments to malaria data sharing in efforts to eliminate the disease. The more data we have consistently and accurately, the better we can plan and target relevant interventions that will drive the malaria burden in southern Africa down to zero.