Using technology to improve health systems is a large part of the Akros ethos. Since the inception of the malaria Active Infection Detection (AID) program in 2011 in the district of Lusaka, several successes have been scored in the fight against the disease. Much of this involved the development of a system to locate areas of potential local transmission of malaria in the heart of the capital. This allowed for better targeting of interventions, and the system continues to be improved.
Recently, another innovation was introduced to the district, the use of android-based tablets for data capture at clinics and during field responses. More than 30 Health workers – mainly environmental health technicians and nurses from five government clinics within Lusaka district – were selected to attend the electronic data training. The two-day training, organized by the Zambia Ministry of Health with technical assistance from Akros, also drew representation from the National Malaria Control Center and the District Community Health Management Team.
Indoor Residual Spraying (IRS) is one of the most effective tools in the fight against malaria. In Zambia, technicians enter dwellings once per year and spray the wall surfaces of buildings with insecticides that kill mosquitos who land on the walls and deter others from entering. Since mosquitoes feed in the evening and at night when humans are indoors, the spraying can greatly reduce the number of bites that occur.
But in rural areas like Zambia’s Luapula and Central Provinces, it is unclear how many dwellings exist, and where those dwellings are located. Without this information, deciding where to spray the insecticides is very difficult, the planners having no way to effectively target IRS to houses in areas of the highest malaria burden. While IRS remains one of the most effective tools for fighting malaria, the pesticides are expensive and must be targeted effectively.
So how to correct for this information gap? How to find out where exactly these dwellings are located so that they can be targeted effectively? Historically, if dwelling enumeration was done, it was done on foot, enumerators visiting villages in person, identifying houses visually and noting the GPS coordinates with a handheld device. It’s not hard to imagine that this method is extremely time-consuming and labor-intensive – especially for a large-scale enumeration. Zambia’s Ministry of Health (MOH), Ministry of Community Development Mother and Child Health (MCDMCH) and Akros technicians found a solution that is at the same time cost-effective and accurate, providing the pinpoint sort of data required for a more effective IRS implementation.
Akros has been awarded a grant from the Malaria Eradication Scientific Alliance (MESA) to continue the push towards malaria elimination in Lusaka, Zambia. The grant of almost USD $200,000 will be used to 1) Develop risk maps of residual transmission and the risk of onward transmission from imported malaria cases and 2) Assess sensitivity of risk maps to target malaria interventions to stop the importation and spread of malaria transmission in Lusaka, Zambia.
Malaria Indicator Surveys conducted in 2010 and 2012 found zero malaria parasite infections among children under the age of five during high transmission season. However, confirmed malaria cases were still reported at health facilities, likely due to small pockets of residual malaria transmission and malaria being transported into Lusaka through people returning to Lusaka from outlying regions. These pockets must be eliminated to achieve zero transmission and imported malaria cases must not be allowed to re-establish transmission once malaria elimination is achieved.
Zambia continues to work toward the ambitious goal of eliminating malaria in five zones by 2015. To make this goal a reality, myriad partners are working together on every level from the molecular to the administrative to the on-the-ground Community Health Workers (CHWs). These CHWs are responsible for visiting houses of those who present with active malaria cases at the clinic level and then testing the neighbors in the immediate area through a program Akros helped pilot called Reactive Case Detection. Often the distance to these active cases is significant despite the large number of CHWs, and visiting every case on foot can be an overwhelming and at times unachievable task.
So last week, the Government Republic of Zambia in partnership with PATH-MACEPA, Akros and World Bicycle Relief distributed over 1,100 bicycles to community health workers across seven districts in Zambia’s southern province. The distribution ceremonies took place from February 10 – 14 and were attended by village chiefs and leaders, ministry officials and partner organizations. The ceremonies included dramas, dancing, and an official handover of each and every bicycle to the very excited CHWs.
Akros has received the last major shipment of equipment for the newly installed molecular container lab at the Zambia National Malaria Control Centre (NMCC) through our collaborators at the Harvard School of Public Health. This lab will enable in-country technicians to perform a wide range of molecular investigations including genotypic analysis of malaria parasites and mosquito specimens, and it came at a fraction of the cost of traditionally constructed laboratories.
“For the first time, Zambia NMCC will have the resources and the throughput to perform genotypic analysis in-country,” said Dan Bridges, Director of Research for Akros. “This will expose Zambian scientists to new techniques, paradigms and enable the NMCC to remain at the forefront of understanding malaria.”
One long standing and successful deployment has been driven by a Malaria program run by the National Malaria Control Center in Zambia. The system is used for mobile reporting from health workers at health clinics and voluntary community health workers in the villages, with each of the two user groups reporting on key data that is relevant for their tasks and responsibilities. The project uses the DHIS Mobile Java clients for aggregate reporting, connected to a national DHIS2 instance that is also available for other projects and programs to share. The project supplies low cost mobile phones and prepaid SIM cards for health workers to report with, and the client uses mobile data (GPRS) to send information to the DHIS2 server.
This quarter, Akros finalized the extremely successful pilot of its mSpray tool: a field-based, GIS-integrated IRS data capture platform that allows IRS stakeholders to view real-time spray data through maps and charts. “This was a resounding success,” said Benjamin Winters, Zambia Country Director at Akros.
“For the first time in IRS history, stakeholders can see real-time data about the location and intensity of IRS operations,” said Winters. “With this tool, we can begin to answer some very critical but previously challenging questions. Are we spraying the right structures, for example, and is there a demonstrable impact on malaria transmission in these granular foci? Aggregate data at national or sub-national levels can’t answer these questions. Zambia is making tremendous progress here and NMCC now has maps detailing entomological surveillance data (more information about Akros innovation here) and case surveillance at very granular levels, all available in its national HMIS, and all of which can be cross-referenced to mSpray IRS data. These are very exciting times.”