Abstract
Mozambique has historically been one of the countries with the highest malaria burden in the world. Starting in the 1960s, malaria control efforts were intensified in the southern region of the country, especially in Maputo city and Maputo province, to aid regional initiatives aimed to eliminate malaria in South Africa and eSwatini. Despite significant reductions in malaria prevalence, elimination was never achieved. Following the World Health Organization’s renewed vision of a malaria-free-world, and considering the achievements from the past, the Mozambican National Malaria Control Programme (NMCP) embarked on the development and implementation of a strategic plan to accelerate from malaria control to malaria elimination in southern Mozambique. An initial partnership, supported by the Bill and Melinda Gates Foundation and the La Caixa Foundation, led to the creation of the Mozambican Alliance Towards the Elimination of Malaria (MALTEM) and the Malaria Technical and Advisory Committee (MTAC) to promote national ownership and partner coordination to work towards the goal of malaria elimination in local and cross-border initiatives. Surveillance systems to generate epidemiological and entomological intelligence to inform the malaria control strategies were strengthened, and an impact and feasibility assessment of various interventions aimed to interrupt malaria transmission were conducted in Magude district (Maputo Province) through the “Magude Project”. The primary aim of this project was to generate evidence to inform malaria elimination strategies for southern Mozambique. The goal of malaria elimination in areas of low transmission intensity is now included in the national malaria strategic plan for 2017–22 and the NMCP and its partners have started to work towards this goal while evidence continues to be generated to move the national elimination agenda forward.
Highlights
Introduction of rapid diagnostic tests (RDTs)Insecticide-treated nets (ITNs) for pregnant women and children under 5Mass ITN distributions Universal distribution of LLINsaintermittent preventive treatment for pregnant women (IPTp) at ANC with SP
The heterogeneity of transmission is mirrored at country level, where estimates of Plasmodium falciparum malaria prevalence ranged from 16% in Gaza province to 67.6% in the northern province of Zambezia [18], and the World Health Organization (WHO) estimated that approximately 9.5 million cases and 16,000 deaths were due to malaria in 2015 [3]
In 2014, a partnership between the La Caixa Foundation and the Bill and Melinda Gates Foundation prompted the creation of a malaria elimination programme in southern Mozambique that aimed to pave the way for malaria elimination in the country through the establishment of nationally-led platforms to design a plan for the south, based on the evidence generated through a malaria elimination demonstration project in the district of Magude
Summary
Introduction of RDTsITNs for pregnant women and children under 5Mass ITN distributions Universal distribution of LLINsaIPTp at ANC with SP. The prevalence of malaria in children of Maputo Province has declined from > 60% before the year 2000, to < 30% by 2005, to < 3% in 2015 [9, 16–18] (Fig. 2) This reduction is probably multifactorial, associated with the significant socioeconomic changes that took place in the country during the last decades (expansion of urbanization, changes in land use, increased education, increased per capita GDP, etc.), as well as a result of the malaria control efforts, including LSDI, despite the relatively low coverage of IRS (< 50%) and ITNs (< 30%) estimated for Maputo province through national surveys conducted in 2007 [16], 2011 [17] and 2015 [18]. The results from the pilot project indicated that malaria prevalence and vector density were significantly reduced to low and stable levels, and that ongoing transmission was mainly driven by the importation of cases from areas outside the pilot zone, and by outdoor biting [8], but the transmission was not interrupted
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