Despite significant progress, tens of millions of people in sub-Saharan Africa are still at risk of malaria. New and innovative approaches are therefore required and are emerging. Research conducted in Uganda highlights similar findings to research conducted in Mozambique, but importantly also reveals new avenues of innovation in malaria prevention that could lead to further breakthroughs in malaria control. Here we summarise the key findings from research in Uganda and Mozambique and outline how malaria prevention research is being reshaped by these findings.
Research Overview
Uganda’s Community-Based Interventions
Results from Uganda’s interventions to implement and evaluate community-based malaria prevention strategies have focused on the following findings:
- Evidence of effectiveness of CHW programs: Studies have shown that the availability of CHWs can make a significant difference in achieving malaria control objectives. They can provide prompt diagnosis and treatment, using both RDTs and ACTs. These actions improve access to care among individuals in remote parts of communities, especially when other formal healthcare facilities are not readily available.
- Impacts of integrated vector management: The application of two or more vector control interventions (eg, indoor residual spraying and insecticide-treated nets) has been proven to provide a better malaria-prevention effect and to achieve a considerable reduction in the incidence of malaria in many parts of Uganda.
- Behavioral change interventions: There has been a growing interest in the effects of behavioral change interventions on malaria control. Educational interventions can be effective in increasing the uptake of ITNs and promoting early treatment-seeking behavior.
Mozambique’s Advances in Vector Control
These innovative findings in malaria vector control have led to progress in Mozambique:
- Routine use of Long-Lasting Insecticidal Nets (LLINs) In Mozambique, routine use was shown to significantly reduce malaria transmission. One study examined high-transmission LLIN coverage over time, finding that LLINs provide sustained protection from mosquitoes and contribute to a lower incidence of malaria.
- Larviciding and Environmental Management: Innovative larviciding strategies, including the use of biological agents and environmental management, have also proven effective in reducing breeding sites of mosquitoes. These strategies demonstrated that targeted larviciding in close tandem with environmental interventions can considerably reduce vector populations.
- ‘Genetic Solutions: Beyond mosquito control, genetic approaches to malaria control show promise.’ Another innovative option for dealing with the malaria parasite is controlling mosquitoes by genetically engineering them so they cannot harbor disease. As a proof-of-concept, scientists have such ‘gene drives’ designed to kill off specific populations of normal mosquitoes, or mosquito populations experimentally altered to be resistant to the malaria parasite. These types of innovative approaches also target the malaria parasite lifecycle to reduce vector populations.
Key Findings from Uganda
Community Health Worker Programs
- Access and Reach: Evaluations have demonstrated how CHWs improve access to malaria diagnosis and treatment in hard-to-reach locations. Investments in CHWs can reduce travel distances and time, and better connect underserved areas with formal health facilities.
- Training and support: Training that runs continuously and provides support to CHWs enhances their ability to perform well. Affordable training programs, with supervision and necessary supplies, can thus enable CHWs to better handle malaria.
- Integration with Health Systems Many people are treating malaria casually. Providing CHWs with sound protocols to work within and supporting CHWs with supplies and advice from health facilities will better integrate their efforts into overall health system coordination.
Integrated Vector Management
Sync it all up: Combining IRS and ITNs would have even better outcomes. In a meta-analysis of 11 studies, researchers found that using IRS and ITNs together provided a better reduction in disease than using a single control method alone.
Adaptation to resistance: Other research has focused on adapting vector control strategies to insecticide resistance, through the use of rotation of insecticides and other strategies to maintain efficacy.
Behavioral Change Interventions
- Educational campaigns: Educational campaigns focused on the use of ITNs, early diagnosis, and treatment have increased awareness of these methods and altered behavior. These campaigns typically reach communities through meetings, radio broadcasts, and local leaders.
- Community Engagement: Engaging community leaders and influential opinion leaders can enhance the uptake of malaria prevention interventions, especially when trusted community members deliver the messages. Community-led interventions are more likely to lead to sustained changes in behavior.
Key Findings from Mozambique
Long-Lasting Insecticidal Nets (LLINs)
- Extended protection: LLINs actively provide extended protection against malaria-vector mosquitoes that dwell in houses by reducing malaria transmission and incidence in the country. These LLINs rely on their durable properties to last for years ‘beyond their reserves’ to ensure sustainable malaria prevention.
- Coverage and distribution: It’s crucial to have high coverage of LLINs and distribute them widely for the best possible use. Several studies highlight the importance of replacement periodically, as well as education on use to keep high coverage.
Larviciding and Environmental Management
- Targeted Larviciding: Laboratory and field studies have shown that the use of targeted larviciding biological agents such as Bacillus thuringiensis israelensis (BTI) to affect pupae and larvae of mosquitoes in their breeding sites has a significant impact on the number of these stages in water bodies. The technology was demonstrated in a mobile laboratory, which can be relocated to showcase targeted larviciding in different cities and areas of Indonesia. This technology will complement other vector control efforts.
- Environmental Management: filling in water bodies with stagnant water to reduce the mosquito breeding area. and do not include any living organisms. Using the knowledge of the life cycle of the mosquito – which identifies larvae in stagnant water as the first stage of its development – environmental management has been highly effective in reducing vector populations.
Genetic Innovations
- Genetically Modified Mosquito With Ringer’s courtside job for life, she declined with AIDS on her mind We note that prophylactic measures, such as mosquito netting, have played a key role in reducing the annual number of cases of malaria from 360 million in 2000 to just over 200 million in 2015. However, malaria continues to be a major cause of mortality, particularly in children younger than five years and pregnant women. The flip side of optimism is despair. A more radical tactic involves genetically modifying mosquitoes and inserting resistance genes to malaria so that their offspring will not transmit the parasite. This sort of work is in progress in both laboratories and is theoretically valid.
- Ethical and practical elements: Although promising innovations are on the horizon, genetic science highlights important ethical and practical factors to consider, including public opinion, environmental impact, and political approval.
Implications for Malaria Prevention Strategies
The findings from Uganda and Mozambique have several implications for malaria prevention strategies:
- Combining Approaches: Combining multiple approaches in combatting malaria such as community-based interventions, vector control approaches and behavioral change approaches will improve the efficacy of the approach. This approach integrates various considerations for managing malaria transmission, offering a more comprehensive strategy for control.
- Focus on Community Engagement: We need to mobilize underserved communities and deploy community health workers, as they’re the key to diagnosing malaria and reaching the most vulnerable populations – and ensuring that malaria prevention and treatment remain accessible. Community engagement also promotes sustained ownership of malaria control.
- Adaptive vector control: adequately addressing insecticide resistance and working with insecticide-resistant mosquitoes means that we need to develop new strategies for vector control, as well as implement new technologies, like genetic innovations.
- Innovative technologies: Combining novel technologies (such as LLINs, larviciding, and genetic approaches) enables new approaches to control malaria. Ongoing research on new tools will sustain progress in reducing malaria transmission.
Long-term Efforts and Surveillance: regular surveillance to track malaria-control impacts and continued effort are essential to maintaining progress and managing evolving challenges. Policy and practice should be informed by the findings of this research to ensure that malaria-control strategies remain fit for purpose.
Based on the promising results below, we have clear targets for what could work well in implementing malaria control, both through community mobilization to common action, and with more adaptive, innovative Vector Control. They leverage community efforts, enhance modes of action, and broaden our focus on Vector Control. They vary in their points of attack, to shape their reach to be more tailored to diverse contexts of malaria.
