Duration

01/09/2014 - 01/10/2019

Coordinator

Antoni Plasència

Funded by

Obra Social "la Caixa", Fundación Bill & Melinda Gates; Socios: CISM, Ministerio Salud Mozambique

Mozambique is among the ten countries with the highest burden of malaria worldwide, with a prevalence of infection in the population that ranges from 3% to more than 50% depending on the area. In 2016, an estimated 8 million cases and 14,000 malaria deaths occurred in the country. The main tools to control malaria include the use of mosquito nets impregnated with long-lasting insecticide, indoor spraying with insecticides and the diagnosis and adequate treatment of cases, and have been shown to achieve a significant decrease in transmission. However, these strategies are not sufficient to achieve malaria elimination.

Goals and Expected Outcomes

The objective of this project is to generate scientific evidence and provide technical, operational and economic support to assist the Mozambican National Malaria Control Program (NMCP) to design and evaluate new strategies to eliminate malaria in the south of the country (provinces of Maputo, Inhambane and Gaza). The project has been jointly financed by the Bill & Melinda Gates Foundation and the "la Caixa" Foundation for 5 years.

The project started at the end of 2014 with a pilot study in Magude, a district of about 52,000 inhabitants in the province of Maputo, with the aim of evaluating the feasibility, acceptability and impact of a package of interventions that consisted in:

• Universal coverage of indoor spraying with insecticides once a year
• Community engagement campaigns to increase the use of mosquito nets and the acceptability of the different interventions
• 2 rounds of mass administration of antimalarial drugs per year

In addition, a census was conducted and an entomological surveillance and epidemiological surveillance system (collection of the number of cases of malaria per month) were implemented to monitor and evaluate the impact of the interventions. Resistance studies (to the antimalarial used in the mass drug administration), prevalence surveys of malaria infection and cost-effectiveness analysis of the interventions were also carried out.

After two years of interventions, there has been a significant decrease in the incidence of malaria cases and a 71% decrease in the prevalence of infection in the district population, compared to 2014. These results suggest that the intervention package that was implemented accelerates progress towards malaria elimination, although it does not interrupt its transmission.

In order to continue evaluating interventions to maintain the gains achieved so far and eventually eliminate persisting malaria cases in Magude, a reactive case detection was implemented in the district in March of 2017. This system consists of detecting malaria cases, either at health centres or by community health workers, visiting the patient's house, and treating all members of the household (regardless of whether they test positive or negative with the rapid diagnostic test).

This intervention has managed to maintain low levels of malaria cases for another year while the team continues to analyse the results in order to understand the impact of each intervention and help tailor elimination strategies for Southern Mozambique.

The project, which also has a strong advocacy component, has been successful in socializing the elimination agenda to the point that it is now part of the country's national malaria strategy and of the political agenda, and a specific technical elimination working group has been created.

Project promoters

"la Caixa" Foundation

The Bill & Melinda Gates Foundation

Partners

Manhiça Health Research Centre (CISM)

Mozambique Ministry of Health (MISAU)