Malaria continues to be one of the most intractable global health problems, accounting for the majority of cases and deaths from this mosquito-borne disease worldwide. Malaria is endemic in sub-Saharan Africa and other tropical regions where understanding the complexities of the underlying factors (such as climate, land use, vector behavior and ecology, and human behaviors) and working on strategizing effective ways to reduce malaria deaths and cases are critically important. There has been remarkable progress, despite these complications, in reducing the burden of disease from malaria through a diverse set of community-based projects in different parts of the world. These projects leverage locally derived knowledge and promote the active participation of community members in implementing site-specific interventions as much as possible. In this article, we discuss some of these successful community-based malaria projects and the lessons learned from these cases.
1. The Malawi Indoor Residual Spray Program
- Context: Malaria has been a major public health problem in Malawi, especially in rural districts. The government and its partners had a long-running program of Indoor Residual Spray (IRS) as part of the effort to control high transmission.
- Intervention: Malaria-killing insecticides are sprayed on the walls and ceilings of homes by a program run by the IRS. The intervention also includes community-level education campaigns and the distribution of insecticide-treated nets (ITNs).
Successes:
The rate of malaria incidences was much reduced (the number of malaria cases fell by more than 50 percent) in the areas where IRS had been carried out.
the scale at which it was implemented to extend coverage to more than 2 million households, meaning that mosquito populations in covered areas declined markedly.
Community involvement: local volunteers trained to spray and to educate about the importance of IRS and ITNs.
Lessons Learned:
- Community Engagement: recruiting local communities to participate in the spraying process enhanced trust and cooperation and improved coverage and efficacy.
- Sustainability: Ensuring the necessary funding and logistical support to keep IRS programs operating and effective.
2. The Tanzania Malaria Control Program
- Context: Malaria is a common problem in Tanzania (Box 1). From 2004-05, Tanzania ramped up a community-based malaria control program.
- Intervention: The Tanzania Malaria Control Program made use of ITNs, indoor residual spraying, and seasonal Intermittent Preventive Treatment in Pregnancy (IPTp); community education and engagement were a priority, too.
Successes:
- Fall in Malaria Cases: Between 2000 and 2015, the incidence of malaria in Tanzania lowered by 50 percent.
- Access Enhanced: Now, more than 90 percent of households utilize ITNs; IPTp coverage among pregnant women exceeds 80 percent.
- Community Health Workers: Trained community health workers play a significant part in distributing ITNs, attending tests, and treating malaria.
Lessons Learned:
- Integrated Approach: Combining multiple interventions—ITNs, IRS, IPTp, and community education—proved to be highly effective.
- Local Health Workers: Using community health workers means that interventions reach the areas where people live, and also increase local commitment.
3. The Ethiopia Community-Based Malaria Control Project
- Context: Malaria is a perennial problem in Ethiopia, particularly in the rural areas where health services are more limited.
- Intervention: The Community-Based Malaria Control Project recruited local health workers in the community, teaching them how to provide diagnoses and treatment for malaria, and distributed ITNs to competitors and control groups. The project also sought to educate villages about preventative measures against malaria.
Successes:
- Better treatment access: more than 80 percent of suspected malaria cases are diagnosed and treated by trained community health workers.
- ITN Distribution: The project has distributed over 3 million ITNs, significantly reducing malaria transmission.
- Community Awareness: Local education campaigns have raised awareness about malaria prevention and treatment.
Lessons Learned:
- Empowering Local Health Workers: By training local health workers to provide malaria services, they become more accessible and better able to offer treatment before the disease advances.
- Continuing education: education needs to be continued so that communities know how to use their malaria controls.
4. The India National Vector Borne Disease Control Program (NVBDCP)
Malaria in India is a problem on a massive scale, driven by the sheer number of people involved and the accompanying diversity. One approach that the NVBDCP works with – and which is particularly important under a One Health agenda – is prevention at a community level.
Intervention: The NVBDCP had components of indoor residual spraying, ITN distribution, and community mobilization; it also included a free diagnosis of malaria cases and free treatment for residents near the study location.
Successes:
- Dramatic Reduction in Cases: India has witnessed dramatic reductions in malaria cases by up to 90 percent.
- New approaches: These new approaches have included community-level surveillance and rapid diagnostic tests to improve malaria control.
- Engaged communities: The program is successfully reaching local leaders and community groups to better support them.
Lessons Learned:
- Adaptability: Tailoring interventions to fit local contexts and challenges improves effectiveness.
- Community Leadership: Engaging local leaders and community groups helps drive program success and sustainability.
5. The Burkina Faso Malaria Prevention Program
Burkina Faso in West Africa suffers from high transmission of malaria, especially during the rainy season.
Intervention: Burkina Faso’s Malaria Prevention Program distributes ITNs, employs indoor residual spraying, and offers seasonal malaria chemoprevention (SMC) for children under the age of five.
Successes:
- Greatly Significant: The disease has been down more than 40 percent in targeted regions since the program was undertaken.
- High Coverage: high coverage rates for ITNs and SMCs (90 percent of the target population) were achieved.
- Community Support: The community stepped in to assist by playing a role in distribution and education.
Lessons Learned:
- Seasonal chemoprevention: Severe malaria transmission takes place in a seasonal pattern, making seasonal interventions particularly helpful.
- Collaborative Action: Working with government, NGOs, and community groups to provide high coverage leads to the greatest impact.
Local, nimble, and responsive community-based malaria projects – for example, indoor residual spraying programs in Malawi and community health worker projects in Ethiopia – have shown us that we can and should keep on top of this disease. We need to keep refocusing the fight on localities; work with communities; let them help us understand what is needed and why.
The success stories from around the globe highlight several key lessons:
- Engagement and Education: Getting active participation from the community about prevention and treatment is important for program success.
- Multiple Interventions: Integrating different approaches, including the use of ITNs, IRS, and community health worker programs.
- Local Leadership: Ensure local leadership and engagement of community-based health workers so that interventions represent local contexts and benefit the right people.
But as the global fight against malaria moves forward, these community-based projects hold their lessons and promise to serve as models for additional areas around the world. Using local knowledge, engaging communities, and creating comprehensive strategies have given villagers a powerful way to combat this disease and improve their health.
