New Meeting Report: Operational Research on Malaria Elimination

The World Health Organization (WHO) has published the report of the planning meeting for operational research on malaria elimination held on 17–18 October 2013 in Geneva, Switzerland. This meeting is part of WHO's work on accelerating countries' transition from malaria control to malaria elimination which is supported by the Bill & Melinda Gates Foundation.

The MESA Project Officer, Mar Velarde collaborated on the landscaping and planning meeting. Her contribution forms part of ISGlobal's broader support to WHO as a collaborating centre on advancing the science of malaria elimination and eradication in order to inform relevant WHO policies and guidelines.

The objectives of the planning meeting were to review the malaria operational research landscape; identify operational challenges, bottlenecks and priority research questions in the transition from malaria control towards elimination; and reach agreement among the meeting participants on the next steps, roles and responsibilities. Meeting participants had an intensive discussion on operational challenges and bottlenecks in the transition from malaria control to elimination.

The discussion centred on the following:

• Essential surveillance data to guide policy-makers in moving from control to elimination is inadequate and incomplete in countries with poor health systems. There are difficulties in integrating the malaria information from private-sector health providers into the health information system.
• Sustainability and phase-out of vector control interventions in low-transmission settings where financial support from donors is waning need to be addressed.
• Innovative approaches are necessary to address potential changes in vector behaviour, including selection for outdoor biting and increased biting during crepuscular periods, which will limit the effectiveness of long-lasting insecticidal nets and indoor residual spraying.
• There is an increasing need for accurate detection of asymptomatic infections and microscro-parasitaemic infections as transmission is being reduced.
• Low compliance with the 14-day primaquine course for radical cure of P. vivax infections and the safety of single dose primaquine for P. falciparum in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency need to be addressed.
• Insufficient operational research capacity of malaria control programmes needs to be addressed.
• Major epidemiological shifts are being observed as countries progress towards malaria elimination. Imported malaria is gaining more prominence and cases are increasingly reported in adult men, clustered geographically, and among migrants and other hard-to-reach groups.