Malaria remains a significant public health burden in tropical and subtropical regions where Anopheles mosquitoes transmit the Plasmodium parasite. Effective control and eventual elimination of malaria largely depend on actively monitoring the disease and its vectors. Critically, community engagement can improve surveillance systems and can thus provide better support to existing malaria control programs. We recently attended the Third International Course on Community Engagement in Malaria Vector Surveillance, and we would like to share some of the highlights from that course.
Understanding Community Engagement in Malaria Vector Surveillance
By engaging with the communities affected by malaria, we conduct malaria vector surveillance “with” the people rather than “by” them. This collaborative approach allows us to share, analyze, and apply the data in ways that harness resources and foster a sense of ownership, empowerment, and efficacy in tackling the issue. When those living near the vectors actively engage and are trusted to use resources wisely, we can attain improved surveillance data, greater awareness, and more sustainable malaria control.
Key Lessons from the Third International Course
Experts, practitioners, community leaders, and entomologists from 20 countries came together to share and reflect on experiences and lessons from the field during the Third International Course on Community Engagement in Malaria Vector Surveillance (ie, vectors – mosquitoes that spread malaria). Here is what we learned.
1. Building Trust and Collaboration
One of the core messages arising from the course is that a successful response requires trust and collaboration between individuals and communities, local and national levels of government, and public health agencies. Trust underpins community engagement in public health activities and the reliability of surveillance data. Efforts to build trust include:
- Good ongoing communication: Keep members of the community well-informed about the purpose and benefits of malaria vector surveillance.
- Include in Decision-Making: Include community leaders and members in the planning and decision-making for surveillance activities, so that they are better aligned with the needs and priorities of the community.
- Cultural sensitivity: Ensure that surveillance activities are respectful of local customs and traditions. Local cultural contexts inform effective intervention and can enhance community acceptance and engagement.
2. Training and Capacity Building
Training and building capacity to strengthen communities’ role in vector surveillance Have capacity for:
- Local Training Programmes: Develop training schemes for local participants in the capture and analysis of vector data, the application of surveillance instruments, the provision of information, and the reporting of results.
- Areas of skill development: training human resources in vector identification, sampling techniques, and data recording.
- Available Ongoing Support: Continuously provide support and refresher training to ensure ongoing competence and motivation of the community members.
3. Utilizing Local Knowledge
Communities often have deep local knowledge about vector habitats, behavior, and seasonal trends. Local knowledge can be integrated into surveillance initiatives to improve the representativeness and utility of the data generated. Core strategies include:
- Participatory mapping: Bring communities together to chart vector breeding sites or high-risk locations to identify new (or previously unrecognized) hot spots.
- Local Observations: Depend on citizen sightings and reports on pest activity to track vector populations and behavior in real-time.
- Feedback Mechanisms: Develop feedback loops to ensure that community input is heard and that communities can provide good data because they learn how it will be used.
4. Integrating Surveillance with Control Measures
Effective vector surveillance is one of the six pillars of malaria control, so malariologists appreciated the integration of surveillance with other malaria control strategies, eg:
- Larval Source Management: Surveillance data to site and time vector breeding sites to enable the application of larvicides or habitat alterations to reduce the number of adult mosquitoes.
- Surveillance of insecticide resistance profiles to direct insecticide use to avoid resistance buildup.
- Community-Based Interventions: Scale up community-based interventions, such as promoting the use of bed nets (ITNs) and indoor residual spraying (IRS), as a result of surveillance findings.
5. Enhancing Data Management and Analysis
Accurate data management, analysis, and interpretation are essential for decision-making and assessing the results of vector control approaches from the subcounty to the national level. The course emphasized:
- Data Collection Tools: Utilizing the right tools and technologies, particularly those that are hand-held (e.g., mobile phones and applications), is essential for effectively managing data collection and capturing information.
- Data Sharing: Share surveillance data with relevant partners (such as local health authorities) to facilitate coordinated response, prevention, and control efforts informed by current data.
- Train the community and health workers in the interpretation and analysis of data, so that the surveillance data can inform decisions.
6. Promoting Sustainability and Ownership
For vector surveillance for malaria to be sustainable, embedded in communities, and shared in equitable ways, several strategies are essential.
- Building Local Champions: ID local champions who can champion vector surveillance and mobilize community support.
- Community-Based Organizations: Convene with local community-based organizations and NGOs to help implement and sustain surveillance activities.
- Integration with Local Systems: Integrate surveillance activities into existing local health systems and structures to ensure sustainability and reduce dependence on external support.
Case Studies and Success Stories
The Third International Course also described many community-based surveillance success stories for malaria vector control: Such community-based success stories show that proper community engagement can make a real difference in malaria control.
- Case Study 1: Uganda Community health workers were trained on vector surveillance and communicated their findings using mobile data collection tools. They managed to discover more vector breeding sites, all of which were targeted for control interventions. Overall, this approach reduced malaria cases by more than 70 percent in the region.
- In Case Study 2: India, local communities and affected populations were engaged in mapping vector habitats and seasonal patterns. This engagement enabled vector control teams to adopt a much more targeted approach to larval control, thereby improving the timing of vector control interventions.
- Case Study 3: Mozambique From 2012 to 2013, one randomized cluster of 30,000 individuals received community-based surveillance teams for vector populations and reporting on local mosquito populations as well as targeted messages and mailings on the importance of prevention, to work alongside local health authorities in the coordination of control efforts and targeting of interventions for maximum impact. We adjusted the intervention each year based on newly collected information about vector ecology and density; as a result, vector control became more responsive to local conditions.
Challenges and Future Directions
Even though community engagement in malaria vector surveillance offers benefits, there are still challenges that we have to deal with, including:
- Resources: Resources and funding can be a constraining factor in the implementation of community engagement initiatives.
- Data privacy: The data gathered through community surveillance should be subject to privacy in a legally guaranteed sense, to build trust in the system and protect rights.
- Internalising Successful Models: Utilise successful community engagement models to scale up efforts in other contexts, creating innovative ideas appropriate for different locations.
- Harnessing Technology: Use mobile health apps and data analytics to further community engagement and data management .
Community-based surveillance, for instance, involving local people in the hunt for mosquitoes or learning how to recognize a malaria vector based on breeding habits and land use, represents some of the most significant outcomes from the Third International Course. Ultimately, these efforts contribute to reducing the burden of disease. It is clear that, although ideally independent, there are significant synergies between surveillance and control interventions. Moreover, helping to strengthen surveillance activities, in turn, provides benefits for control activities. Specifically, three prioritized approaches to community engagement in malaria vector surveillance are based on the value of trust, training, the use of local knowledge, and the integration of surveillance and control activities.
We can use molecular tools to enhance the power of the community in vector surveillance to further improve the efficacy of the data, support malaria control efforts, and move forward toward elimination targets. Cooperation, innovation, and community action will remain key in sustaining anti-malaria gains and impact.
