Making strides against malaria

A young girl rests peacefully under an insecticide-treated bed net (ITN) at her home in the Magude District of Mozambique. Magude is a rural area in the south of the country where malaria transmission peaks during the rainy season from November to April. In 2017, under a mass distribution campaign, the government distributed more than 16 million ITNs to 97% of households nationwide. WHO recommends the use of long-lasting ITNs for all people at risk of contracting malaria.

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The government’s ITN distribution was complemented by another activity in line with WHO recommendations for keeping infected mosquitoes at bay in malaria endemic countries: indoor residual spraying (IRS). IRS involves spraying the inside walls of homes with long-lasting insecticides. It is considered a primary vector control mechanism and a critical tool for controlling the spread of malaria.

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Tchau Tchau Malaria (“Bye-bye Malaria”) is a non-profit organization founded by a group of African entrepreneurs and an implementing partner for the government’s IRS programme. The slogan is printed prominently on the uniform that employees wear when out in communities spraying homes. This reassures citizens that spray teams are authorized to access private homes, while also helping raise awareness of the ultimate goal of the country’s collective efforts.

WHO/ T. Trenchard

The first symptoms of malaria – fever, headache, chills – usually appear 10 to 15 days after a person is bitten by an infected female mosquito. The Government of Mozambique has committed to providing free diagnosis and treatment for all citizens by primary health care workers at health centres. At the public Manhiça District Hospital, an intake nurse examines a baby for malaria symptoms in the triage room.

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Early and accurate diagnosis is essential for detecting malaria in a patient. A late or inaccurate diagnosis can lead to delayed or wrong treatment, more entrenched illness, or even death. A reliable diagnosis begins with testing a small quantity of blood for the presence of malaria parasites. Here, a nurse extracts a blood sample from a young boy who came to the Manhiça District Hospital with a suspected case of malaria. WHO recommends diagnosis either by examining the blood sample under a microscope or by using a malaria rapid diagnostic test (RDT).

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The Government of Mozambique provides artemisinin-based combination therapy (ACT) to patients diagnosed with malaria through hospital-based dispensaries like this one at the Manhiça District Hospital. WHO recommends the use of ACTs to treat uncomplicated malaria caused by the Plasmodium falciparum parasite. While the total number of malaria cases reported has risen in the last three years, the number of deaths at hospitals and health facilities has fallen, with 2645 deaths reported in 2015, 1685 in 2016 and 1114 in 2017. Prompt diagnosis and treatment saves lives.

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Despite being one of the poorest countries in the world, Mozambique has a very advanced scientific research infrastructure to support the elimination of diseases like malaria. A leading example is the Manhiça Health Research Centre. The centre supports the National Malaria Control Programme through research around treatment, diagnosis and prevention of the disease. It carries out entomological activities to understand the behaviours of mosquitos and to test the ongoing efficacy of the tools and tactics the government is using to eliminate malaria. This research takes place both in the laboratory and in the field, including in Magude. Here, two Manhiça researchers are seen observing the behaviour of female Anopheles mosquitoes that are being bred at the research centre’s laboratory.

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According to a 2015 study, the prevalence of malaria parasite in Mozambique is 40.2%. As part of entomological malaria surveillance in southern Mozambique, a lab technician conducts sporozoite detection in the centre’s laboratory. Sporozoites are the parasites found in an infected mosquito’s salivary gland that are then passed to a person, infecting them, when the mosquito bites.

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Albino Vembane is a supervisor for the Manhiça Health Research Centre’s entomological research in the field. As part of the malaria surveillance, a tent trap outfitted with a miniature light trap is placed outside and inside homes for the daily collection of mosquitoes. This methodology aims to capture different types of mosquitoes exhibiting different behavior (indoor and outdoor, resting and feeding).

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Since 2015, malaria incidence has been reduced by 85% in the Magude district. In 2017, the Reactive Malaria Case Investigation (REACT) project began work in the district to prevent the number of infections from creeping back up. The project’s mechanism is straightforward: every time a new malaria case is detected at a government health facility, a team is dispatched to the patient’s household. Each member of the family is tested for malaria and given preventive treatment. Here, a mother who tested positive at a clinic administers anti-malarial treatment to her son who also tested positive during the follow-up home visit. During the home visit, a total of three family members tested positive; all three are currently receiving treatment.

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A health worker shows the positive result from a malaria RDT carried out during the patient’s follow-up home visit. Malaria RDTs provide results in 20 minutes and allow for treatment to begin immediately, especially important in remote areas with limited access to good quality microscopy services.

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Malaria transmission levels vary across Mozambique, with the prevalence of the malaria parasite in children ranging from under 15% in the southern regions to 60% in the central and northern regions. For the Government of Mozambique and partners to effectively prevent, treat and control malaria transmission, they must first obtain baseline data for each district, including how many people are at risk and where they live. In a process that began in 2015 and continues today, a census worker collects important data from citizens. That information is fed into the national statistical system to inform critical choices under the National Malaria Control Programme, such as which services to offer where, and for whom.

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