Progress against malaria elimination is uneven across the world.
This is very much evident in the Democratic Republic of the Congo, where cases continue to be on the rise and, together with Nigeria, account for 40 percent of deaths from the disease.
Could it be that interventions aren’t that effective, given the rising cases of mosquitoes developing resistance against insecticides, or is it a matter of lack of access to the different preventive interventions available?
A study conducted by Médecins Sans Frontières Holland late last year in parts of the Congo — in Katanga, North Kivu and South Kivu provinces, areas where the medical group has active programs — shows a mix of these features, and more.
In the town of Shamwana in Katanga, MSF found that 62 percent of the 108 studied patients had probably taken their anti-malarial pills, but that up to 38 percent of those who did may not have taken the medicines properly or at all.
Dr. Bhargavi Rao, MSF’s malaria and infectious disease specialist, said “that is worrying, as we can only say 60 percent of asymptomatic infected patients were likely to have been adherent to a full course of treatment.”
Across the three provinces, meanwhile, MSF found only between 8 percent and 38 percent of households have adequate long-lasting insecticide-treated bed nets. Those that do don’t always sleep under them, or have nets that are of poor quality and with holes on them. The group also found a significant proportion of mosquitoes have developed resistance mutations against bed net insecticides, although the field impact of this is not yet known.
The study is limited, as it was only done in parts of the Congo. But it provides impetus for one critical area: more research to understand malaria trends, figure out the interventions that best work in a particular context, allow stakeholders to refine their approaches, inform efforts in changing people’s behavior, and find new tools that would work.
It could also help shine the light on malaria incidence in conflict-affected countries or those experiencing instability, where MSF is seeing a rise in cases.
As Rao said: “It is vital for us to understand much more about malaria in these unstable contexts so we can make sure our efforts are correctly directed to reduce the incidence and consequences of infection.”
Here are the numbers — and information — you need to know about the draft malaria strategy up for consideration by member states at this week's 68th World Health Assembly.
Interestingly, research cuts across the three pillars of the draft malaria strategy up for consideration by member states at this week’s 68th World Health Assembly.
The document calls on basic research so the international community would have a better understanding of malaria vectors, and for the development of more effective diagnostics and anti-malarial drugs, including vaccines, and improved or innovative vector control methods.
It also calls for implementation research “to refine approaches to applying existing interventions most effectively and efficiently in local contexts.” Focus should particularly be on population coverage, compliance and human resource.
But more importantly, there should be better sharing of these research and their results.
“All agreements for research or service delivery should include a provision for data-sharing, possibly through open-access portals,” according to the draft strategy.
Jenny Lei Ravelo is a Devex senior reporter based in Manila. Since 2011, she has covered a wide range of development and humanitarian aid issues, from leadership and policy changes at DfID to the logistical and security impediments faced by international and local aid responders in disaster-prone and conflict-affected countries in Africa and Asia. Her interests include global health and the analysis of aid challenges and trends in sub-Saharan Africa.
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