Global Technical Strategy Research Articles

Sandwich‐based surface‐enhanced Raman scattering probes for detection and quantification of malaria

AbstractMalaria continues to be endemic in the middle‐ to low‐resourced regions of the world. One of the World Health Organization (WHO) global technical strategy goals towards 2030 is to lower the malaria infection by 90%. Attaining this ambitious goal entails early and accurate diagnosis of the parasite that will inform treatment measures to be taken. Herein, we report on the application of the surface‐enhanced Raman spectroscopy (SERS) platform to fabricate malaria bio‐sensing probes: lactate dehydrogenase (LDH) malaria antibodies (mAb) were immobilized on a SERS substrate and used to capture Plasmodium falciparum (pf) malaria antigen. A detection hybrid, Ag plasmonic metals labelled with a Raman reporter (SERS tag) and conjugated to a second LDH mAb, was hybridized on the captured antigen. The detection hybrid binds the antigen on a specific epitope, and the sandwich is interpreted using vibrational Raman spectroscopy that indirectly confirms the pfLDH malaria antigen via the Raman reporter label. The SERS probes showed specificity, sensitivity and rapidity in the detection of pfLDH. They are proposed for secondary confirmation of field‐based lateral flows and offer improved sensitivity and quantification capabilities.

High Burden to High Impact (HBHI) Approaches - Country Perspective for Adoption and Adaptation in India

In India, a National Framework for Malaria Elimination (NFME) has been developed and launched on 11 February 2016 align with the Global Technical Strategy (GTS) for malaria elimination 2016-2030. Malaria elimination will be carried out in a phased manner. In accordance with the NFME, National Strategy Plan for malaria elimination 2017-2022 has been developed by National Vector Borne Disease (NVBDCP), MoH & FW, Govt. of India in collaboration with WHO Country Office India and launched in July 2017. The country has made significant improvement in the malaria situation in recent years. Reported malaria cases were reduced by 49 % and deaths by 50% in 2018 compared to 2017. However, India and ten countries in Africa contribute approximately 70% of the world’s malaria cases and deaths. These countries adopted the “High Burden to High Impact (HBHI) approach”. HBHI has four response elements: (i) Political will to reduce malaria deaths; (ii) Strategic information to drive impact, (iii) Better guidance, policies and strategies, and (iv) A coordinated national malaria response. India has adopted this approach in May 2019 to further accelerate and sustain the progress in the states with high malaria burden. Initially, HBHI approaches are being adopted by NVBDCP with the support of WHO in four high burden states namely Jharkhand, Chhattisgarh, West Bengal and Madhya Pradesh. During the first phase, an in-depth situation analysis on malaria in these states have been conducted using the tools provided by WHO. Key features of adaptation of HBHI approaches in India and detail analysis of one state Madhya Pradesh are presented in the article.

Epidemiology of clinical congenital and neonatal malaria in endemic settings: a systematic review and meta-analysis

BackgroundIn order to attain the objectives set out in the global technical strategy against malaria 2016–2030, it is important to have accurate epidemiological data on malaria in all age categories, including those which are often neglected because of an apparent low burden of disease. The current systematic review with meta-analysis synthesizes the epidemiology of clinical congenital and neonatal malaria in endemic areas.MethodsPubMed, EMBASE, Global Index Medicus, and Web of Science were searched up to 30th October 2019, to identify observational studies reporting on congenital (0–7 days) and neonatal (0–28 days) malaria. No restriction related to language was applied. Study selection, data extraction, and methodological quality assessment were performed independently by two investigators. A random-effects meta-analysis was used to pool prevalence data. Prevalence were adjusted taking into account the variance due to diagnostic method and regional distribution. Subgroup analyses were performed to identify sources of heterogeneity in case of substantial heterogeneity. This review was registered in PROSPERO with number CRD42020150124.ResultsThe bibliographical search identified 1,961 studies, of which 22 were finally retained with a total population of 28,083 neonates. The overall crude prevalence of clinical congenital malaria was 40.4‰ (95%CI 19.6–67.7; 17 studies). The adjusted prevalence considering the variance due to difference in region/country (hierarchical model) was 33.7‰ (95%CI 6.9–77.2). There was no difference between the prevalence of clinical congenital malaria in Africa 39.5‰ (95%CI 17.2–59.5; 15 studies) and outside Africa 56.3‰ (95%CI 0.0–406.1), p = 0.867. The overall crude prevalence of clinical neonatal malaria was 12.0‰ (95%CI 1.4–30.3; 12 studies), and the adjusted one (considering the variance due to diagnostic method and the region/country) was 12.9‰ (95%CI 0.1–39.7). There was no difference between the prevalence of clinical neonatal malaria in Africa 12.1‰ (95%CI 1.3–31.2; 11 studies) and outside Africa 12.5‰ (95%CI 0.0–52.9), p = 0.802.ConclusionThis study suggests a high prevalence of clinical congenital and neonatal malaria. It calls for an intensification of preventive measures against malaria during pregnancy and in the neonatal period, and to consider neonates as a distinct age category in the elaboration of malaria treatment and prevention guidelines.

Vector control for malaria elimination in Botswana: progress, gaps and opportunities

Botswana has in the recent past 10 years made tremendous progress in the control of malaria and this informed re-orientation from malaria control to malaria elimination by the year 2020. This progress is attributed to improved case management, and scale-up of key vector control interventions; indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs). However, insecticide resistance, outdoor biting and resting, and predisposing human behaviour, such as staying outdoors or sleeping outdoors without the use of protective measures, pose a challenge to the realization of the full impact of LLINs and IRS. This, together with the paucity of entomological data, inadequate resources and weak community participation for vector control programme implementation delayed attainment of Botswana’s goal of malaria elimination. Also, the Botswana National Malaria Programme (NMP) experiences the lack of intersectoral collaborations and operational research for evidence-based decision making. This case study focuses on the vector control aspect of malaria elimination by identifying challenges and explores opportunities that could be taken advantage of to benefit the NMP to optimize and augment the current vector control interventions to achieve malaria elimination by the year 2030 as per the Global Technical Strategy for Malaria 2016–2030 targets. The authors emphasize the need for timely and quality entomological surveillance, operational research and integrated vector management.

Main non-state actors and progress of actions in global malaria elimination programme: a review

With the joint efforts of countries and global non-state actors, great achievements have been made in the global malaria control programme; however, malaria remains a serious threat to human health. As the global leader for combating malaria, WHO formulated The Global Technical Strategy for Malaria 2016-2030, and the Global Malaria Programme, under the leadership of WHO, is responsible for implementing 5 key projects to achieve the goal proposed in The Global Technical Strategy for Malaria 2016-2030. In addition, the Global Fund, the U.S. President's Malaria Initiative and Bill & Melinda Gates Foundation also play an important role in global malaria elimination programme. This review describes the currently main non-state actors participating in the global malaria elimination programme, and calls for the enhanced inter-actor coordination and close collaboration with state governments to achieve the great goal of malaria elimination in the world.

Malaria and COVID-19: commonalities, intersections and implications for sustaining malaria control.

The devastating impact of infectious disease outbreaks and pandemics on health systems could be overwhelming especially when there is an overlap in clinical presentations with other disease conditions. A case in point is the disruptive effect of the Ebola Virus Disease outbreak on health service delivery and its consequences for malaria management in the affected West and Central African countries between 2014 and 2016. This could be the case with the current infectious disease pandemic (COVID-19) the world is experiencing as malaria illness shares many symptoms with COVID-19 illness. Caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19 is reported to have originated from Wuhan city, China in December 2019. COVID-19 was declared a Public Health Emergency of International Concern on 30 January 2020 and declared a pandemic on March 11, 2020 by the World Health Organization (WHO). Practically, all community infrastructure has been activated in affected countries in response to COVID-19. However, the deployment of huge resources in combating COVID-19 pandemic should not be a missed opportunity for the advancement of infectious diseases control including malaria. This calls for conscious and heightened effort to sustain the gains in malaria control. The WHO has emphasized that the response to the COVID-19 pandemic must utilize and strengthen existing infrastructure for addressing malaria and other infectious diseases globally. Leveraging these to maintain malaria control activities in endemic countries could boost and help to sustain the gains in malaria control in accordance with the 2016-2030 Global technical strategy for malaria (GTS) milestones. In addition, it will help to keep the “High burden to high impact” (HBHI) and other initiatives on track. This article highlights the commonalities of the two diseases, discusses implications and recommendations to support decision making strategies to keep malaria control on track in the COVID-19 pandemic era.

Household characteristics as determinants of ownership of mosquito nets in urban households in Nigeria

Abstract Malaria accounts for more than 435,000 deaths yearly. The mosquito net is a proven effective method for malaria prevention. Statistics from Nigeria shows that 55% of households in Nigeria possess at least one mosquito net for sleeping. Among these, only 48% of these households are in urban areas. Reports suggest that these figures might not be enough to contain and eventually eliminate malaria in Nigeria. Few studies have explored the relationship between household characteristics and ownership of mosquito nets especially in urban areas of Nigeria. Therefore, this study aims to explore the relationship between household characteristics and ownership of mosquito nets using the household recode dataset of the 2013 Nigeria Demographic and Health Survey (n = 16,540). The analysis was conducted using Stata 14 analysis software. The chi-square statistics and binary logistic regression were employed to examine the association and determine the extent of relationships between variables respectively. Results showed that female headed households (OR = 0.87 CI: 0.80–0.95); households with family size ≥10 members (OR = 1.42 CI: 1.10–1.75); households with 6–10 rooms (OR = 1.35 CI: 1.00–1.83); households with surroundings sprayed in the last 12 months (OR = 2.47 CI: 1.77–3.46) were found to be significantly associated with ownership of mosquito nets in urban households of Nigeria. The study concludes that socio-demographic factors influence ownership of mosquito nets in Nigeria. Therefore, Intensified efforts in the form of education on the importance of ownership and usage of mosquito nets, equitable distribution campaigns addressing the rural-urban divide is essential to improve ownership and usage of mosquito nets, therefore, contributing to efforts towards achieving the two critical 2020 milestones of the WHO Global Technical Strategy for Malaria 2016–2030: reducing case incidence and death rates by at least 40% from 2015 levels.

Mass drug administration can be a valuable addition to the malaria elimination toolbox

The Global Technical Strategy 2016–2030 of the World Health Organization (WHO) has the ambitious goal of malaria being eliminated from at least 35 countries by 2030. However, in areas with once-stable malaria transmission, the reservoir of human infection may be intermittently symptomatic or fully silent yet still lead to transmission, posing a serious challenge to elimination. Mass drug administration (MDA), defined as the provision of a therapeutic dose of an effective anti-malarial drug to the entire target population, irrespective of infection status or symptoms, is one strategy to combat the silent human reservoir of infection. MDA is currently recommended by the WHO as a potential strategy for the elimination of Plasmodium falciparum malaria in areas approaching interruption of transmission, given the prerequisites of good access to case management, effective vector control and surveillance, and limited potential for reintroduction. Recent community randomized controlled trials of MDA with dihydroartemisinin–piperaquine, implemented as part of a comprehensive package of interventions, have shown this strategy to be safe and effective in significantly lowering the malaria burden in pre-elimination settings. Here it is argued that effectively implemented MDA should be kept in the elimination toolbox as a potential strategy for P. falciparum elimination in a variety of settings, including islands, appropriate low transmission settings, and in epidemics and complex emergencies. Effectively implemented MDA using an ACT has been shown to be safe, unrelated to the emergence of drug resistance, and may play an important role in sufficiently lowering the malaria burden to allow malaria transmission foci to be more easily identified, and to allow elimination programmes to more feasibly implement case-based surveillance and follow-up activities. To be most impactful and guard against drug resistance, MDA should use an ACT, achieve high programmatic coverage and adherence, be implemented when transmission is lowest in areas of limited risk of immediate parasite reintroduction, and must always be implemented only once good access to case management, high coverage of effective vector control, and strong surveillance have been achieved. If these considerations are taken into account, MDA should prove to be a valuable tool for the malaria elimination toolbox.

Examination of malaria service utilization and service provision: an analysis of DHS and SPA data from Malawi, Senegal, and Tanzania

BackgroundEnsuring universal access to malaria diagnosis and treatment is a key component of Pillar 1 of the World Health Organization Global Technical Strategy for Malaria 2016–2030. To achieve this goal it is essential to know the types of facilities where the population seeks care as well as the malaria service readiness of these facilities in endemic countries.MethodsTo investigate the utilization and provision of malaria services, data on the sources of advice or treatment in children under 5 years with fever from the household-based Demographic and Health Surveys (DHS) and on the components of malaria service readiness from the facility-based Service Provision Assessment (SPA) surveys were examined in Malawi, Senegal and Tanzania. Facilities categorized as malaria-service ready were those with: (1) personnel trained in either malaria rapid diagnostic testing (RDT), microscopy or case management/treatment of malaria in children; (2) national guidelines for the diagnosis and treatment of malaria; (3) diagnostic capacity (available RDT tests or microscopy equipment as well as staff trained in its use); and, (4) unexpired artemisinin-based combination therapy (ACT) available on the day of the survey.ResultsIn all three countries primary-level facilities (health centre/health post/health clinic) were the type of facility most used for care of febrile children. However, only 69% of these facilities in Senegal, 32% in Malawi and 19% in Tanzania were classified as malaria-service ready. Of the four components of malaria-service readiness in the facilities most frequented by febrile children, diagnostic capacity was the weakest area in all three countries, followed by trained personnel. All three countries performed well in the availability of ACT.ConclusionsThis analysis highlights the need to improve the malaria-service readiness of facilities in all three countries. More effort should be focused on facilities that are commonly used for care of fever, especially in the areas of malaria diagnostic capacity and provider training. It is essential for policymakers to consider the malaria-service readiness of primary healthcare facilities when allocating resources. This is particularly important in limited-resource settings to ensure that the facilities most visited for care are properly equipped to provide diagnosis and treatment for malaria.

Malaria elimination: Using past and present experience to make malaria-free India by 2030.

Malaria causes significant morbidity and mortality worldwide. Since 2005, malaria cases have been declining globally with many countries having eliminated malaria and several other countries heading towards malaria elimination. The World Health Organization's Global Technical Strategy for malaria targets at least 90% reduction in case incidences and mortality rates, and elimination in 35 countries by 2030. India along with other Asia-Pacific countries has pledged to eliminate malaria by 2030. Sustainable vector control and case management interventions have played a pivotal role in malaria control leading to elimination. Malaria is complex in India due to the presence of multiple parasites and vectors species, asymptomatic cases, resistance against antimalarials and insecticides, social, demographic, cultural and behavioural beliefs. Therefore, maintaining zero indigenous malaria transmission and preventing malaria through importation of cases requires well-planned multi-pronged intervention strategies. This article provides insights into the past and present malaria control and elimination efforts that may be useful for the national programme for eliminating malaria from India by 2030.

Universal Access to Malaria Prevention, Diagnosis and Treatment as a Strategy toward Disease Control and Elimination: A Critical Look at Northeastern Nigeria

Background: As early as 2008 there was a call by the United Nations Secretary General to halt malaria death by ensuring universal coverage of malaria interventions to be attained by 2010. This was echoed by the World Health Assem-bly in 2015 by adopting the Global Technical Strategy or malaria 2016-2030 with universal access to malaria prevention, diagnosis and treatment as one of its three pillars. This study had a critical look at the supply and distribution of Artemisin-based Combination Therapy, Rapid Diagnostic Tests and Long Lasting Insecticide Treated Nets in 2017 with a view to critique the universal coverage of these commodities in Adamawa, Bauchi, Borno, Gombe, Taraba and Yobe States in the northeastern geopolitical region of Nigeria. Method: This is a quantitative cross-sectional study using secondary data. The research analyzed the data of malaria intervention commodities received by state malaria elimination programmes from six states across the northeast zone between January and December 2017. Results: The study result showed that RDTs were received and distributed in four of the six states and one state did not receive or distribute any. Commodities for treatment (ACTs) received and distributed showed that only one state had a significant supply and distribution of the commodity, two states had minimal supply and distribution while the other three states had insignificant quantities that did not match the RDT supply and the state that had the highest supply/distribution was the only state supported by the global fund in the northeast zone in 2017. Only one state had a significant quantity of LLINs distributed in 2017. Conclusion: The government of Nigeria and collaborating partners have made concerted efforts to improve access to ACTs, RDTs and LLINs with improvement in levels of intervention across the country. This study however clearly demonstrates the need to intensify efforts in making universal access possible in northeastern Nigeria so that the objectives of the National Malaria Strategic Plan 2014-2020 can be achieved. This comes at a time when donor funding is at cross-roads.

Planning and implementation of a countrywide campaign to deliver over 16 million long-lasting insecticidal nets in Mozambique

BackgroundIn 2016/2017, Mozambique conducted a countrywide long-lasting insecticidal nets (LLINs) universal coverage campaign (UCC). This paper aims to describe the planning and implementation process of the campaign in Mozambique.MethodsA cross-sectional and descriptive design was used for reporting the planning and implementation process of the UCC. The UCC used a collaborative approach, involving institutional and non-institutional actors, namely: National Malaria Control Programme (NMCP), provincial and district health authorities, community members and civil society partners. A new household registration strategy based on coupons, stickers, and one LLIN per two persons as allocation criterion was implemented. The campaign was implemented in phases, allowing for continuous improvement of implementation quality by applying lessons learnt from each phase.ResultsA total of 7,049,894 households were registered corresponding to a total of 31,972,626 registered persons. A total of 16,557,818 LLINs were distributed between November 2016 and December 2017, corresponding to 97% of LLINs needs based on household registration, and covering 95% of the registered households (6,708,585 households), resulting in an estimated 85% of the total Mozambican population with LLIN access.ConclusionsThe collaborative planning process and strong coordination of campaign actors allowed Mozambique’s NMCP and partners to successfully carry out the first countrywide LLINs UCC in the country. The increased access to LLINs in households will likely result in increased LLIN use and a reduction of the malaria burden in the country, therefore contributing to the achievement of the 2016–2030 Global Technical Strategy for Malaria goals.

Nightly Biting Cycles of Anopheles Species in Rural Northwestern Burkina Faso.

The biting behavior of anophelines is an important determinant of malaria transmission. Understanding the local vector host-seeking behavior, its outdoor/ indoor biting preference, and nocturnal biting periods is essential for effectively applying and improving vector control methods, such as Long Lasting Insecticidal Nets (LLINs) and personal protective measures. To better understand the biting and host-seeking patterns of Anopheles mosquitoes in Northwestern Burkina Faso, we performed biweekly Human Landing Catches (HLC) in six villages during the period of highest mosquito abundance and malaria transmission. We applied a negative binomial regression framework to statistically analyze the host-seeking activities of Anopheles species and test for differences across hours, months, and villages, as well as for differences between indoor and outdoor capture points. Anopheles gambiae s.l. was identified as the main malaria vector in this region, representing about 90% of the total anopheline population. Biting activity was significantly different across hours and showed a peaked plateau between 2000 and 0200 hours. Differences in the pattern of biting cycles were observed between the early and late rainy season. This study shows that anopheline biting activity in Northwest Burkina Faso is high throughout the night, at indoor and outdoor posts alike. Consequently, bed nets alone may not provide sufficient protection against early biting anophelines and should be complemented with additional strategies such as indoor residual spraying (IRS) and larval source management (LSM) to meet the WHO’s ambitious goals that are reflected in the global technical malaria strategy for 2030.

Lots Quality Assurance Survey (LQAS) as a Strategy to Achieving Quality LLIN Campaigns: The Nigerian Experience

Background: Nigeria, in its quest to scale up coverage and utilization of LLINs as a strategy for malaria control, had the first long lasting insecticidal net (LLIN) mass campaign across the country between 2009-2013. The NMEP with support from its RBM partners successfully distributed over 57.7 million LLINs during the period representing over 90% of the national target. In spite this, and to achieve universal coverage, the country maintained a continuous distribution through multiple channels and in particular the antenatal care outlets and the expanded programme on immunization. The Nigerian government, with support from the Global Fund and through the National Malaria Elimination Programme (NMEP), Catholic Relief Services (CRS), and the Society for Family Health (SFH) and with technical support from the World Health Organization, once again launched the LLIN replacement campaign in some states across the country. Methods: A cross-sectional survey was conducted in five states that conducted the LLIN replacement campaign using the lots quality assurance survey (LQAS) tool developed by the World Health Organization. The period of the survey across the states is between August and December 2017. The LQAS questionnaires were administered to households (HHs) by the WHO field officers trained on the use of the tool at least one week after the campaign. A total of 240 HHs were selected from 24 settlements (clusters) in 24 wards of six LGAs (lots) from each of the five (5) states that rolled out the campaign. Data collected were double entered, cleaned, crosschecked, and the results analysed using the SPSS version 24. Results: With a total of 9740 people surveyed from 1200 HHs across the five states, the average redemption rate was 95.5% (95% CI, 91.6% - 98.8%), average retention rate was 98.4% (95% CI, 97.0% - 99.8%), average hanging rate was 82.6% (95% CI, 80.0% - 85.5%), and an average card ownership of 83.5% (95% CI, 78.6% - 88.2%). While the main source of information 35.4% (95% CI, 21.8% - 49.0%) about the LLIN campaign was the health workers, the reasons for those missed out were mainly due to team performance 32.2% (95% CI, 26.8% - 37.4%) and net cards not issued 27.4% (95% CI, 23.2% - 32.0%). Similarly, the Pearson correlation (0.942, α 0.017, p < 0.05, 2-tailed test), the ANOVA test (F value of 23.751, α 0.017, p < 0.05), and Regression analysis (R-square 0.888 and Durbin-Watson 2.487), all shows significant relationships between LLIN redemption and usage with a resultant rejection of the Null Hypothesis. Conclusion: The outcome of this research underscores the need to adopt and scale up the use of the LQAS tool to assess the quality of LLIN campaigns within the shortest possible time. While the LQAS has been in use by the WHO Expanded Programme on Immunization cluster during polio campaigns, this is the first time that the tool was deployed by the WHO malaria unit as a strategy to identify post LLIN campaign gaps immediately after implementation. The scaling up of this strategy would undoubtedly improve LLIN campaigns that would be conducted in the remaining states across the country so as to ensure that Nigeria achieve LLIN universal access in line with the Global Technical Strategy (GTS) framework toward malaria elimination.

Pregnancy-associated Malaria, Challenges and Prospects in Sub-Saharan Africa

Pregnancy-associated malaria remains a major risk to the pregnant woman, her foetus and infants in sub- Saharan Africa. Infection by Plasmodium falciparum significantly affects maternal, foetal and neonatal wellbeing. Maternal anaemia, low birth weight, preterm labour, spontaneous abortion, and maternal and neonatal mortalities are some of its consequences. It complicates maternal immunological response and possibly also selfishly pre-empt foetal immunological response by transplacental communications. Therefore, the impacts may extend well beyond the duration of pregnancy and the immediate period post-delivery. Effective case management and prevention continue to yield positive results, but challenges still remains especially in sub-Saharan Africa. The challenges of antenatal service provision, compliance with intermittent preventive treatment at pregnancy by sulfadoxinepyrimethamine (IPTp-SP), widespread SP resistance, and resistance to insecticide treated nets (ITNs) and insecticides continue to complicate efforts at PAM control in sub-Saharan Africa. Hopefully, the Global Technical Strategy for Malaria 2016–2030 will comprehensively consider these challenges and improve the prospect of every pregnant woman in sub-Saharan Africa.

MalERA: An updated research agenda for malaria elimination and eradication.

Achieving a malaria-free world presents exciting scientific challenges as well as overwhelming health, equity, and economic benefits. WHO and countries are setting ambitious goals for reducing the burden and eliminating malaria through the “Global Technical Strategy” and 21 countries are aiming to eliminate malaria by 2020. The commitment to achieve these targets should be celebrated. However, the need for innovation to achieve these goals, sustain elimination, and free the world of malaria is greater than ever. Over 180 experts across multiple disciplines are engaged in the Malaria Eradication Research Agenda (malERA) Refresh process to address problems that need to be solved. The result is a research and development agenda to accelerate malaria elimination and, in the longer term, transform the malaria community’s ability to eradicate it globally.

A systematic review and synthesis of the strengths and limitations of measuring malaria mortality through verbal autopsy

BackgroundLack of valid and reliable data on malaria deaths continues to be a problem that plagues the global health community. To address this gap, the verbal autopsy (VA) method was developed to ascertain cause of death at the population level. Despite the adoption and wide use of VA, there are many recognized limitations of VA tools and methods, especially for measuring malaria mortality. This study synthesizes the strengths and limitations of existing VA tools and methods for measuring malaria mortality (MM) in low- and middle-income countries through a systematic literature review.MethodsThe authors searched PubMed, Cochrane Library, Popline, WHOLIS, Google Scholar, and INDEPTH Network Health and Demographic Surveillance System sites’ websites from 1 January 1990 to 15 January 2016 for articles and reports on MM measurement through VA. Inclusion criteria: article presented results from a VA study where malaria was a cause of death; article discussed limitations/challenges related to measurement of MM through VA. Two authors independently searched the databases and websites and conducted a synthesis of articles using a standard matrix.ResultsThe authors identified 828 publications; 88 were included in the final review. Most publications were VA studies; others were systematic reviews discussing VA tools or methods; editorials or commentaries; and studies using VA data to develop MM estimates. The main limitation were low sensitivity and specificity of VA tools for measuring MM. Other limitations included lack of standardized VA tools and methods, lack of a ‘true’ gold standard to assess accuracy of VA malaria mortality.ConclusionsExisting VA tools and methods for measuring MM have limitations. Given the need for data to measure progress toward the World Health Organization’s Global Technical Strategy for Malaria 2016–2030 goals, the malaria community should define strategies for improving MM estimates, including exploring whether VA tools and methods could be further improved. Longer term strategies should focus on improving countries’ vital registration systems for more robust and timely cause of death data.

Global investment targets for malaria control and elimination between 2016 and 2030

BackgroundAccess to malaria control interventions falls short of universal health coverage. The Global Technical Strategy for malaria targets at least 90% reduction in case incidence and mortality rates, and elimination...

The threat of antimalarial drug resistance

The battle between man and malaria has continued for thousands of years. Antimalarial drugs are essential weapons to fight the disease, but their efficacy is threatened by drug resistance which continues to emerge creating a major obstacle to malaria control and jeopardizing renewed hopes for elimination. As 2016 is the first year under WHO Global Technical Strategy for Malaria 2016–2030, it is a good time to ponder the progress of both sides and plan for the future.

Impact of the WHO Technical Support Towards Malaria Elimination in Zambia

Background: Zambia's National Malaria Strategic Plan (NMSP) 2011-2016 aims to eliminate malaria by the year 2020. The WHO Country Office is supporting Zambia in its goal to attain this national target earlier than the global goal contained in Global Technical Strategy (GTS) 2016- 2030. WHO's focus is to accelerate coverage of proven interventions and strategies, and promote their effective use. This study documents impact of the WHO technical support in Zambia to accelerate efforts towards elimination of malaria.Methods: This study involved a desk review of relevant documents and literature to obtain in-depth information on WHO technical support on malaria. Key documents included: malaria strategic plans, World Malaria Reports (WMR), WHO Annual Reports; Country Cooperation Strategy, for WHO in Zambia; and Health Bulletins and Health Management Information System (HMIS).Results: WHO contributed effectively to monitoring malaria trends. Malaria deaths reduced from 6000 in 2010 to 3,200 in 2014. In 2015, ownership of long lasting insecticide treated nets (LLINs) increased from 38% in 2006 to 77% in 2015; to be among the highest in Africa. Similarly, utilization of LLINs increased from 19% in 2006 to 55% in 2015 and use of Intermittent Preventive Therapy in pregnancy (IPTp) increased from 61.2% in 2006 to 77% in 2015. In 2014, WHO contributed to the revision of the national malaria diagnosis and treatment guidelines that included: Dihydroartemisinin piperaquine (DHA-PQ) as first line, an alternative to Artemether lumefantrine (AL); injectable Artesunate for treatment of severe malaria and the adoption of the new WHO guidelines on IPTp. In 2016, WHO contributed to epidemiological profile leading to the development of the novel Malaria Elimination Strategy 2017-2020.Discussion: WHO support has led to the determination of epidemiological profile and contributed to the improved focusing of interventions and surveillance activities for greater impact. These have been supported by clear guidelines on proven and evidenced-based prevention, diagnosis and treatment strategies.Conclusion: WHO's technical assistance to priority areas in Zambia remains pivotal for the accelerated health gains countrywide. The importance of this technical support is evidenced in the malaria elimination strategy within an environment of changing epidemiological malaria profile, insecticide and drug resistance.