Malaria is one of the most pressing global public health issues, and despite a real advancement in diagnostics, drugs, and interventions to treat, prevent, and control malaria, both surveillance and vector control remain daunting tasks, particularly in sub-Saharan Africa where the highest number of malaria cases persistently occur. Mozambique is a country burdened by malaria and is also a good example of the challenges and innovation in the malaria fight. This article will elucidate key malaria surveillance challenges and then outline Mozambique’s actions in addressing them.
Understanding Malaria Surveillance
Malaria surveillance involves the systematic collection and analysis of data on malaria incidence, and prevalence and the implementation of control measures, to detect and respond to outbreaks, track the impact of interventions, and inform prevention, diagnosis, and treatment policies. The funding of malaria control programs depends on surveillance being able to show how many deaths and cases have been prevented. Effective surveillance keeps transmission low, maximizes resource use by identifying areas and groups most affected, and ultimately informs policy.
Key Challenges in Malaria Surveillance
Data Collection and Accuracy
Another major obstacle in malaria surveillance is obtaining quality data. In high-burden areas such as Mozambique, where the healthcare infrastructure is often ill-equipped, it can be challenging to obtain and track good data. Poor records, inadequate staff, and difficult access to health facilities can all lead to missing or inaccurate data, preventing the appropriate implementation of control strategies.
Geographical Barriers
Mozambique is a large and geographically diverse country, making it difficult to survey for the disease. In remote rural areas of the country, the challenging environment may not be suitable for providing health services or mounting surveillance to track residents with the disease. The geography might delay reporting it. It also is not always clear where people are moving to and from and for how long, especially in regions that experience seasonal floods or other environmental changes that could affect the disease, complicating the tracking of cases.
Vector Control and Resistance
Still necessary but not sufficient, Anopheles mosquitoes – the primary vectors of malaria – are among the most difficult to control. Insecticide-resistant strains of mosquitoes have recently emerged, complicating the problem further. Finally, and most importantly on the list, surveillance must follow not only malaria cases but also the transmission dynamics of the vector. Are insecticide-treated nets (ITNs) and indoor residual spraying (IRS) affecting insecticide resistance, or are transmission rates increasing? The answer to this question has significant implications for the course of control.
Data Integration and Management
Effective malaria surveillance requires integrating data from primary care facilities, community health workers, and laboratory testing centers into a cohesive overview. However, this effort can be hindered by the need to standardize various disparate data collection systems. Particularly in high transmission settings, where patients typically have informal access to medicine and do not always follow recommended testing and treatment, including those whose infections go undetected, data inconsistency can largely thwart timely disease detection and efficient targeting of resources.
Funding and Resources
Protecting and improving malaria surveillance systems requires sustained funding and the capacity to maintain and scale up this endeavor; unfortunately, the lack of adequate funding and other resources is a reality in many low-resource settings such as Mozambique. For instance, achieving certain levels of surveillance capacity like training personnel, maintaining equipment, and implementing technologies can face obstacles due to these constraints. These shortfalls can affect the quality and frequency of data capture and analysis.
Community Engagement and Awareness
Community engagement is a key aspect of effective malaria surveillance and control. This is likely to be extremely challenging in areas with low community awareness of malaria prevention and treatment. Communities may also be suspicious of surveillance activities due to a lack of trust in health services or misconceived beliefs about malaria. Improving surveillance outcomes therefore requires building trust in surveillance activities and encouraging community engagement.
How Mozambique is Tackling These Challenges
Malaria remains endemic in Mozambique, and, in recent years, officials have been taking some innovative steps – and collaborating with the private sector – to tackle these challenges. This is social entrepreneurship as applied to the malaria business. How is Mozambique improving malaria surveillance?
Strengthening Health Infrastructure
Malaria surveillance, which indicates the number of infections in any group, has strengthened through investments in Mozambique’s health infrastructure. Key improvements include enhanced health facilities, upgraded data collection systems, and better training for healthcare workers. These elements now integrate into an electronic health records and reporting system, which improves and accelerates data collection. Modernizing the health infrastructure is essential for generating more reliable and timely surveillance data.
Utilizing Mobile Technology
We used mobile technology to circumvent the challenges posed by geography Mozambique has recently begun to use mHealth solutions to overcome these issues. Malaria data are being collected and transmitted remotely from the field into databases that support advanced data visualization and analysis. Remote health workers with mobile devices can send real-time malaria indicators, such as the number of cases, to central databases, which track trends and allow timely responses to localized outbreaks, or sub-national interventions. These systems also facilitate the tracking of vector control and surveillance activities over large areas.
Implementing Innovative Vector Control Measures
One of the major countries choosing to lead this new approach to vector control has been Mozambique; in recent times, the country’s malaria-control program has rolled out novel insecticides and tried biological control (mosquito larvivorous fish and genetically modified mosquitoes) in an integrated surveillance approach, leading the way against vector resistance and in the effort to reduce malaria transmission.
Enhancing Data Integration
This data-sharing was made possible because Mozambique has invested in centralized malaria surveillance since 2002. The system integrates information from various disease detection efforts and epidemiological surveys, allowing for monitoring of the collective impact of control actions. Since 2002, Mozambique has utilized GIS and data analytics tools to map high-risk areas for malaria, directing resources toward the most effective interventions.
Securing Funding and Partnerships
International organizations and donors have helped Mozambique grapple with funding challenges: increased financial and technical commitments from international organizations such as the World Health Organization (WHO) and the Global Fund, as well as a proliferation of non-governmental organizations (NGOs), have provided Mozambique with a needed financial and technical backbone to support surveillance infrastructure, training and research, and strengthen and sustain malaria control.
Engaging Communities
Mozambique is actively increasing community involvement by forming groups of men and women to support public health campaigns, educational programs, and community-based surveillance. Community health workers inform community members of malaria prevention, conduct surveys, and encourage the use of ITNs and IRS.
Future Directions and Recommendations
Mozambique has made tremendous progress in mastering the logistical challenges that stymied the early CDSSs. To sustain these advances, it must continue supporting surveillance at this level. Many lessons learned here can be applied elsewhere. Here are some steps to further improve malaria surveillance in Mozambique and beyond.
Invest in Training and Capacity Building
Ongoing training and capacity-building of healthcare workers and data collectors will need to take place for surveillance to remain of high quality. New malaria surveillance systems require an investment in regular training programs and refresher courses to ensure that staff are knowledgeable about the latest trends in malaria surveillance and the latest surveillance tools.
Expand Use of Technology
Remote sensing and artificial intelligence are some of the advanced technologies that can enhance malaria surveillance and control, such as collecting more reliable data, prediction of outbreaks, and rational allocation of resources.
Strengthen Community Involvement
These include forging closer working relationships with local communities and leaders to help improve malaria surveillance. It also means “getting closer to the patient,” as many countries are striving to do. This approach invites communities to share the responsibility of monitoring and reporting while also engaging in delivering malaria intervention activities.
Focus on Research and Innovation
Continued investigation into malaria vector biology, resistance mechanisms, and novel control tactics are all needed. We can support research and integrate its findings into surveillance and control strategies to keep pace with emerging challenges in malaria management.
Enhance Coordination Among Stakeholders
Malaria control can benefit from improved coordination among national, international, and local agencies to enhance surveillance and optimize the sharing and utilization of data, resources, and best practices.
However, whenever and however it does so, malaria surveillance will never be simple. Far from it. Moreover, whilst Mozambique’s struggles with malaria surveillance should not overshadow the progress that it has made in the fight against the disease, the spotlight that the mosquito and the feline virus shine on Mozambique reminds us that the country will always require accessible data, many maps, and an engaged, informed citizenry to combat the evolving problem that is malaria.
The battle against malaria is not over, but let’s continue working together to reduce its impact on lives – to one day reach a malaria-free world.
