Path to Zero - Impact Story
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Path to Zero

Guiding malaria elimination efforts in Mozambique and beyond

Photo: Bea Galatas (1,2)

Malaria has a devastating impact on people’s health and livelihoods, particularly in sub-Saharan Africa. ISGlobal’s Malaria Elimination Initiative, in collaboration with Mozambican health authorities and the Manhica Health Research Centre (CISM), spearheaded a five-year project to test whether malaria elimination in the region was possible using an innovative mix of available interventions. The project, conducted in a district of southern Mozambique with low malaria transmission, showed that this approach was not sufficient to eliminate the disease, but it did achieve a large reduction in disease burden, a necessary step towards its elimination. At the local level, the Magude project averted an estimated 38,369 malaria cases over five years, increased healthy behaviours in the community, and reduced school absenteeism by 28% already after the first year of intervention. At the national level, it enabled instrumental changes in Mozambique’s malaria control policies and capacity. At the global level, the results helped to shift the narrative on malaria elimination in sub-Saharan Africa.

What is the problem?

Malaria remains one of the most pressing public health challenges in sub-Saharan Africa. In Mozambique alone, it was responsible for 12 million cases in 2020, with pregnant women and children being at higher risk of severe malaria.

In 1955, the world set out to eradicate malaria (e.g., eliminating malaria transmission from the planet). However, these efforts were put on hold due to emerging resistance to the DDT insecticide and the antimalarial drug chloroquine. In 2007, the Bill and Melinda Gates Foundation (BMGF) revived the call for malaria eradication alongside the Malaria Eradication Research Agenda.

At the time, there was much controversy – and a lack of robust evidence – on whether malaria elimination (a necessary step for its eradication) was even feasible in sub-Saharan Africa with the tools currently available, given the high burden of disease, fragile health systems and poor socio-economic conditions.

Key facts

76% reduction in malaria incidence
38K+ cases averted over 5 years
28% drop in school absenteeism

What did our researchers do?

Taking advantage of the political and scientific context, ISGlobal and its long-standing partner in Mozambique, the CISM, established a partnership in 2014 with the Mozambican National Malaria Control Programme (NMCP) and other local partners to form the Mozambican Alliance towards the Elimination of Malaria (MALTEM). The alliance obtained a grant from the BMGF and “la Caixa” Foundation to design, deploy, and evaluate an operational research project in southern Mozambique, specifically in the Magude district. This region was chosen because it had a lower malaria burden than the rest of the country and because there was wide support from local partners.

The five-year Magude project tested the efficacy of combining existing interventions targeting both the vector and the parasite. On one hand, mass drug administration (MDA) of antimalarials was provided to the entire community to clear the parasite reservoir, followed by focal drug administration (FDA) to all household members when a case was reported. This was accompanied by the distribution of long-lasting insecticidal nets and annual insecticide spraying of households to eliminate the mosquitoes. 

In parallel, a community engagement campaign in collaboration with district health authorities and the Fundação para o Desenvolvimento da Comunidade (FDC) was carried out, involving discussion groups with community leaders and the general population, as well as radio, public announcements, and events in schools, places of worship, or markets. 

The project also provided technical assistance for capacity strengthening of staff at the NMCP and training of local health workers to improve case management, surveillance, and response systems.

What changes has our research contributed to?

Improved health and well-being in Magude

Implementing the Magude project in Mozambique significantly reduced malaria incidence (number of new cases in one year), by 76.7%. This corresponds to an estimated 38,369 cases averted over the five years of project implementation. These efforts contribute to Mozambique’s progress towards the SDG 3.3 target of reducing global malaria case incidence by 90% by 2030. 

The community engagement activities encouraged healthy behaviours in the community, as measured by an increase in people using insecticide-treated bed nets (from 40.8% in 2015 to 70.6% in 2018) and of people seeking health care after a fever (from 40% at the beginning to 70% at the end of the project).

The health improvements had a direct positive impact on both education and work productivity. In schools, malaria reduction led to a 28% drop in absenteeism and a 2% increase in student performance, outcomes not observed in nearby control districts. Additionally, worker absenteeism during the peak malaria season was reduced by 15% after only one year of the project, underscoring the broader socioeconomic benefits of effective malaria control interventions.

Strengthened malaria control in Mozambique

The creation of the MALTEM Alliance in 2014, with the NMCP as a key partner, was instrumental in integrating malaria elimination goals into Mozambique’s national strategic plan for 2017–2022. As stated by NMCP members, the research conducted in Magude “strengthened the Mozambican NCMP’s approach to malaria policy-making through coordination mechanisms and the generation of in-country evidence to guide malaria strategies”. The partnership also promoted the formation of Mozambique’s Malaria Technical Advisory Committee, which continues to guide malaria elimination plans in low-endemic districts using local evidence.

Some of the interventions used in the Magude project, such as MDA and FDA, have been applied in other regions to assess the feasibility of integrating them into the regular national health system. 

Changed global perceptions of malaria elimination

The Magude study, alongside similar research from other regions, was cited by the WHO Evidence Review Group on Mass Drug Administration for Malaria, which concluded that while MDA can rapidly reduce malaria transmission, it does not fully interrupt it without additional interventions. This evidence contributed to a global conceptual shift about malaria elimination in sub-Saharan Africa, leading the WHO Strategic Advisory Group on Malaria Eradication (SAGme) to recognize eradication as a long-term goal, given current tools and funding limitations.

The Magude project’s impact extended further when it was referenced in the 2021 update to the WHO Global Technical Strategy for Malaria and its revised guidelines on MDA. These updates emphasised recommended MDA as a strategy to significantly reduce malaria cases in low-transmission settings.

Strengthened capacities

The Magude project significantly strengthened epidemiological and entomological capacities at the local and national levels. This includes training technical staff at the NMCP, as well as entomologists and young researchers at CISM. Additionally, community health workers received training in community engagement, demographic data collection, and reactive focal MDA. An example of this is Rosa, a fieldworker hired by CISM and featured in the 'A vida da Rosa' photostory.


This project not only delivered immediate health improvements but also ensured lasting benefits by building local capacities and influencing national and international policies that will continue to fight malaria long after the project's end.

Links and references