UCSF Joins Research Partnership to Eliminate Malaria in Namibia

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The Global Health Group at University of California San Francisco (UCSF) is celebrating the success of Namibia, where malaria case have dropped 98 percent over the past decade.

In 2003, Namibia saw 450,000 cases of malaria; in 2013, that number fell to 2,500. The country is now on track to becoming malaria-free by 2020.

The deadly disease, caused by parasites that are transmitted from person to person by mosquitoes, is now found mostly in the northern regions of Namibia.

The National Vector-borne Disease Control Program (NVDCP) at the Namibia Ministry of Health and Social Services effectively controls the spread of malaria with interventions such as spraying dwellings with insecticides, distributing mosquito nets treated with insecticides, using malaria tests that can give accurate results within 15 minutes, and distributing medicines that kill the parasite.
The UCSF Global Health Group’s Malaria Elimination Initiative is teaming up with the Multidisciplinary Research Centre at the University of Namibia, the Novartis Foundation for Sustainable Development, the London School of Hygiene and Tropical Medicine, the Clinton Health Access Initiative, and others to research new strategies and interventions that the NVDCP can use to get rid of the remaining pockets of transmission and eliminate malaria by 2020. Members of this research partnership will be working together to strengthen the national malaria surveillance system, learn more about how to eliminate the remaining reservoirs of infection in the Zambezi region, and understand the risk factors that are associated with malaria transmission.

The steering committee of the malaria research partnership meets with the chancellor and vice chancellor of the University of Namibia. Photo courtesy of Novartis Foundation

Worldwide, an estimated 3.3 million lives have been saved since 2000 through stepped up malaria control and elimination efforts, according to the World Health Organization. Mortality rates have been cut almost in half.

UCSF’s Global Health Group received a $15 million grant from the Bill & Melinda Gates Foundation in December to help nearly three dozen countries eliminate malaria within their borders.

In 2012, an estimated 207 million people got sick from malaria, and 627,000 of them died, mostly children under five in sub-Saharan Africa. In 2013, 97 countries had on-going malaria transmission.

Applying Research to Malaria Elimination in Namibia
NVDCP, UCSF and their partners have been working in Ohangwena and Omusati regions since 2012 to conduct similar research to understand malaria transmission.

Early results from initial studies show that people who become infected with malaria are more likely to be young males who have traveled recently to areas with more malaria, and those who live with or near people infected with malaria. Often these malaria-infected neighbors and household members do not show signs and symptoms because the number of parasites infecting them is very low. These “asymptomatic” individuals pose a new challenge for the NVDCP in achieving malaria elimination because they’re tough to identify.

To address these challenges, the NVDCP has implemented a new strategy called reactive case detection, which requires health staff to follow up on every case of malaria to determine where the infection came from, and whether it has spread to other people.

Starting in May 2014, the research partners will begin supporting the NVDCP in Zambezi to ensure that every malaria case is reported. Members of the research team will work alongside NVDCP staff to conduct reactive case detection and map each reported case with mobile technologies, to better understand where malaria occurs. This information will be used to help the NVDCP and its research partners to better understand malaria transmission patterns in Zambezi region, and ultimately select the most effective and efficient strategies to eliminate it.

This groundbreaking research is not only providing answers to vital questions for malaria elimination in Namibia, but is also generating knowledge that will be useful for other countries who seek to eliminate malaria.

The UCSF Global Health Group, part of the UCSF Global Health Sciences, is an “action tank” dedicated to translating new approaches into large-scale action to improve the lives of millions of people. The Group’s Malaria Elimination Initiative provides research and advocacy support to countries moving towards an evidence-based path to malaria elimination.

Source: UCSF

Malaria Nearly Eliminated in Sri Lanka Despite Decades of Conflict

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UCSF, Sri Lankan Researchers Credit Adaptability of Malaria Control Program

Despite nearly three decades of conflict, Sri Lanka has succeeded in reducing malaria cases by 99.9% since 1999 and is on track to eliminate the disease entirely by 2014.

According to a paper published today in the online, open-access journal PLOS ONE, researchers from Sri Lanka’s Anti-Malaria Campaign and the UCSF Global Health Group examined national malaria data and interviewed staff of the country’s malaria program to determine the factors behind Sri Lanka’s success in controlling malaria, despite a 26-year civil war that ended in 2009.

Typically, countries with conflict experience a weakening of their malaria control programs and an increased risk of outbreaks and epidemics, the researchers said.

Chief among its keys to success was the program’s ability to be flexible and adapt to changing conditions, the study found. For instance, to protect hard-to-reach, displaced populations, public health workers deployed mobile clinics equipped with malaria diagnostics and antimalarial drugs, whenever it was safe to do so. Likewise, when it was impossible to routinely spray insecticides in homes in conflict zones, the malaria program distributed long-lasting insecticide-treated nets, engaging non-governmental partner organizations familiar with the areas to help with distribution.

The program was able to sustain key prevention and surveillance activities in conflict areas through support from partner organizations and support from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Otherwise, researchers found that the keys to Sri Lanka’s success were the same as those deployed in non-conflict areas: rigorously and consistently providing interventions to prevent malaria among high-risk populations; proper and prompt diagnosis and treatment of all confirmed malaria cases; and maintenance of an effective surveillance system to quickly detect and respond to spikes in cases. Still, challenges remain.

“Sustaining the gains of elimination efforts and preventing resurgence is even more challenging today, especially in tropical settings such as Sri Lanka,” said Rabindra Abeyasinghe, MD, the paper’s first author, who led the research at the Sri Lankan Anti-Malaria Campaign. “In this era, sustaining the interest of partners and local decision makers, and ensuring continued funding, are becoming increasingly difficult.  To avoid the tragic mistakes of the past, we must resolve to continue to devote the necessary resources and energy to the fight against malaria in Sri Lanka.”

Sri Lanka has an extensive history of battling malaria, and nearly eliminated it once before. In 1963, during the era of global eradication efforts, the country achieved a low of only 17 cases, down from 92,000 cases in 1953. With funding declines and reduced spraying and surveillance, the country saw a massive resurgence to 1.5 million cases in 1967-1968.

Since 1970, Sri Lanka has worked to bring malaria back under control, with compelling success, the authors said. In 2011, the country recorded just 124 locally acquired cases – about six cases per million people. This reduction is particularly noteworthy, the researchers noted, given that much of the progress was made during the civil war.

“It is very exciting to document Sri Lanka’s current progress toward malaria elimination, to add another chapter to our country’s ongoing fight against the disease,” said Gawrie Galappaththy, MD, a study coauthor at the Anti-Malaria Campaign at Sri Lanka’s Ministry of Health. However, she said, achieving zero malaria will require continued investments and hard work.

“There is no silver bullet for malaria elimination,” Galappaththy said. “Instead, it’s a daily commitment to finding the cases, treating the patients and preventing transmission.”

Today, even with the country’s great progress, Sri Lanka continues to face hurdles in its goal of driving malaria transmission to zero. Total malaria cases have dramatically dropped, but the proportion of Plasmodium vivax malaria infections – the more difficult to diagnose and treat form of malaria most common in Sri Lanka – is on the rise.

Another challenge is the shift in the population group at highest risk for malaria.  In most of the world, children and pregnant women are most at risk; however following the success of Sri Lanka’s control program in protecting and treating these populations, the researchers found that the group most at risk today in Sri Lanka is adult men, particularly those exposed to malaria-carrying mosquitoes through their work, such as gem mining, military service and farming. Sri Lanka is developing new strategies to target these groups.

“Sri Lanka is showing the world how to eliminate malaria,” said Sir Richard Feachem, KBE, FREng, DSc(Med), PhD, director of the Global Health Group and senior author of the paper. “The country has made extraordinary progress, reducing malaria by 99.9 percent in the past decade. And all this achieved during a particularly nasty civil war. With continued commitment from the country’s Government and supporters, we are confident that Sri Lanka will finish the fight and become a malaria-free country.”

The paper can be found here: “Malaria control and elimination in Sri Lanka: documenting progress and success factors in a conflict setting,”  The research was funded by the Bill & Melinda Gates Foundation. The authors did not report any disclosures.

The Global Health Group is part of UCSF Global Health Sciences and is dedicated to translating new approaches into large-scale action to improve the lives of millions of people. The group’s Malaria Elimination Initiative provides research and advocacy support to countries moving towards an evidence-based path to malaria elimination.

Source: UCSF