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A framework for assessing the feasibility of malaria elimination
Bruno Moonen, Justin M Cohen, Andy J Tatem, Jessica Cohen, Simon I Hay, Oliver Sabot, David L Smith
Malaria Journal , 2010, DOI: 10.1186/1475-2875-9-322
Abstract: During the Global Malaria Eradication Programme (GMEP) and the decade that followed, 37 countries with endemic malaria succeeded in eliminating transmission [1]. Since 1978, however, only nine more countries have reached this goal, while most malaria-endemic countries have aimed for control, not elimination [2]. Recently, some of the countries that halved their malaria cases between 2000 and 2008 [1] are revising their strategic plans and are considering elimination as an alternative to maintaining control measures indefinitely. In the wake of Bill and Melinda Gates' 2007 commitment to global malaria eradication [3,4], officials from many countries where elimination was considered infeasible during the GMEP because of high endemicity and poor infrastructure [5-7], including Nigeria [8], Ghana [9], Tanzania [10], and Kenya [11], have announced plans to eliminate malaria. It has been argued that premature commitment to elimination may be counterproductive as it could divert limited resources and negatively impact efforts to reduce the high burden of malaria [3,12,13]. There is thus an urgent need for clear, evidence-based guidance to assess whether elimination represents a realistic goal in a given region.Weighing elimination today is different from the beginning of the GMEP era, when the impact of eradication programs essentially was taken for granted. The spectacular early success of the GMEP in Europe [5,6,14,15] was not replicated elsewhere, however, and the early timelines and cost estimates proved overly optimistic [7]. The GMEP adapted by recommending that countries assess the feasibility of such an undertaking through "a preliminary study to accumulate and analyze the information required for realistic programme planning" before embarking on a costly and potentially ineffective campaign [16,17]. These studies were intended to "cover not only technical and operational aspects but also a wider sphere, with a view to elucidating the socio-economic implications of
Modelling malaria elimination on the internet
Richard J Maude, Sompob Saralamba, Adrian Lewis, Dean Sherwood, Nicholas J White, Nicholas PJ Day, Arjen M Dondorp, Lisa J White
Malaria Journal , 2011, DOI: 10.1186/1475-2875-10-191
Abstract: An internet site is presented with a simple mathematical modelling platform for population level models of malaria elimination. It is freely accessible to all and designed to be flexible so both the platform and models can be developed through interaction with users. The site is an accessible introduction to modelling for a non-mathematical audience, and lessons learned from the project will help inform future development of mathematical models and improve communication of modelling results. Currently it hosts a simple model of strategies for malaria elimination and this will be developed, and more models added, over time. The iterative process of feedback and development will result in an educational and planning tool for non-modellers to assist with malaria elimination efforts worldwide.By collaboration with end users, iterative development of mathematical models of malaria elimination through this internet platform will maximize its potential as an educational and public health policy planning tool. It will also assist with preliminary optimisation of local malaria elimination strategies before commitment of valuable resources.Mathematical modelling has great potential as a tool to help guide efforts towards malaria elimination [1]. Different combinations of interventions are required for different epidemiological settings. However, there are limited data available to policymakers to inform their decisions on which strategies to employ. Mathematical modelling combines mechanistic understanding with available data from multiple sources to make predictions. It could potentially be used for preliminary evaluation of different strategies for malaria elimination in different epidemiological contexts much more rapidly and at lower cost than is possible through trial and error in the field [1]. Modelling is particularly useful where a field study cannot be done as is the case with large-scale elimination programmes for which it is desirable to get the strategy right fir
Surveillance considerations for malaria elimination  [cached]
Barclay Victoria C,Smith Rachel A,Findeis Jill L
Malaria Journal , 2012, DOI: 10.1186/1475-2875-11-304
Abstract: Constant malaria monitoring and surveillance systems have been highlighted as critical for malaria elimination. The absence of robust monitoring and surveillance systems able to respond to outbreaks in a timely manner undeniably contributed to the failure of the last global attempt to eradicate malaria. Today, technological advances could allow for rapid detection of focal outbreaks and improved deployment of diagnostic and treatment supplies to areas needing support. However, optimizing diffusion activities (e.g., distributing vector controls and medicines, as well as deploying behaviour change campaigns) requires networks of diverse scholars to monitor, learn, and evaluate data and multiple organizations to coordinate their intervention activities. Surveillance systems that can gather, store and process information, from communities to national levels, in a centralized, widely accessible system will allow tailoring of surveillance and intervention efforts. Different systems and, thus reactions, will be effective in different endemic, geographical or socio-cultural contexts. Investing in carefully designed monitoring technologies, built for a multiple-acter, dynamic system, will help to improve malaria elimination efforts by improving the coordination, timing, coverage, and deployment of malaria technologies.
Malaria vaccines and their potential role in the elimination of malaria
Targett Geoffrey A,Greenwood Brian M
Malaria Journal , 2008, DOI: 10.1186/1475-2875-7-s1-s10
Abstract: Research on malaria vaccines is currently directed primarily towards the development of vaccines that prevent clinical malaria. Malaria elimination, now being considered seriously in some epidemiological situations, requires a different vaccine strategy, since success will depend on killing all parasites in the community in order to stop transmission completely. The feature of the life-cycles of human malarias that presents the greatest challenge to an elimination programme is the persistence of parasites as asymptomatic infections. These are an important source from which transmission to mosquitoes can occur. Consequently, an elimination strategy requires a community-based approach covering all individuals and not just those who are susceptible to clinical malaria. The progress that has been made in development of candidate malaria vaccines is reviewed. It is unlikely that many of these will have the efficacy required for complete elimination of parasites, though they may have an important role to play as part of future integrated control programmes. Vaccines for elimination must have a high level of efficacy in order to stop transmission to mosquitoes. This might be achieved with some pre-erythrocytic stage candidate vaccines or by targeting the sexual stages directly with transmission-blocking vaccines. An expanded malaria vaccine programme with such objectives is now a priority.
The feasibility of malaria elimination in South Africa  [cached]
Maharaj Rajendra,Morris Natashia,Seocharan Ishen,Kruger Philip
Malaria Journal , 2012, DOI: 10.1186/1475-2875-11-423
Abstract: Background Following the last major malaria epidemic in 2000, malaria incidence in South Africa has declined markedly. The decrease has been so emphatic that South Africa now meets the World Health Organization (WHO) threshold for malaria elimination. Given the Millennium Development Goal of reversing the spread of malaria by 2015, South Africa is being urged to adopt an elimination agenda. This study aimed to determine the appropriateness of implementing a malaria elimination programme in present day South Africa. Methods An assessment of the progress made by South Africa in terms of implementing an integrated malaria control programme across the three malaria-endemic provinces was undertaken. Vector control and case management data were analysed from the period of 2000 until 2011. Results Both malaria-related morbidity and mortality have decreased significantly across all three malaria-endemic provinces since 2000. The greatest decline was seen in KwaZulu-Natal where cases decreased from 42,276 in 2000 to 380 in 2010 and deaths dropped from 122 in 2000 to six in 2010. Although there has been a 49.2 % (8,553 vs 4,214) decrease in the malaria cases reported in Limpopo Province, currently it is the largest contributor to the malaria incidence in South Africa. Despite all three provinces reporting average insecticide spray coverage of over 80%, malaria incidence in both Mpumalanga and Limpopo remains above the elimination threshold. Locally transmitted case numbers have declined in all three malaria provinces but imported case numbers have been increasing. Knowledge gaps in vector distribution, insecticide resistance status and drug usage were also identified. Conclusions Malaria elimination in South Africa is a realistic possibility if certain criteria are met. Firstly, there must be continued support for the existing malaria control programmes to ensure the gains made are sustained. Secondly, cross border malaria control initiatives with neighbouring countries must be strongly encouraged and supported to reduce malaria in the region and the importation of malaria into South Africa. Thirdly, operational research, particularly on vector distribution and insecticide resistance status must be conducted as a matter of urgency, and finally, the surveillance systems must be refined to ensure the information required to inform an elimination agenda are routinely collected.
Prospects for Malaria Elimination in Mesoamerica and Hispaniola  [PDF]
Sócrates Herrera?,Sergio Andrés Ochoa-Orozco?,Iveth J. González?,Lucrecia Peinado?,Martha L. Qui?ones?,Myriam Arévalo-Herrera
PLOS Neglected Tropical Diseases , 2015, DOI: 10.1371/journal.pntd.0003700
Abstract: Malaria remains endemic in 21 countries of the American continent with an estimated 427,000 cases per year. Approximately 10% of these occur in the Mesoamerican and Caribbean regions. During the last decade, malaria transmission in Mesoamerica showed a decrease of ~85%; whereas, in the Caribbean region, Hispaniola (comprising the Dominican Republic [DR] and Haiti) presented an overall rise in malaria transmission, primarily due to a steady increase in Haiti, while DR experienced a significant transmission decrease in this period. The significant malaria reduction observed recently in the region prompted the launch of an initiative for Malaria Elimination in Mesoamerica and Hispaniola (EMMIE) with the active involvement of the National Malaria Control Programs (NMCPs) of nine countries, the Regional Coordination Mechanism (RCM) for Mesoamerica, and the Council of Health Ministries of Central America and Dominican Republic (COMISCA). The EMMIE initiative is supported by the Global Fund for Aids, Tuberculosis and Malaria (GFATM) with active participation of multiple partners including Ministries of Health, bilateral and multilateral agencies, as well as research centers. EMMIE’s main goal is to achieve elimination of malaria transmission in the region by 2020. Here we discuss the prospects, challenges, and research needs associated with this initiative that, if successful, could represent a paradigm for other malaria-affected regions.
Towards malaria elimination - a new thematic series
Marcel Tanner, Marcel Hommel
Malaria Journal , 2010, DOI: 10.1186/1475-2875-9-24
Abstract: The paradigm shift from malaria control to malaria eradication following declarations at the Gates Malaria Forum in October 2007 [1,2] and subsequent support voiced by World Health Organization (WHO) [2], the Board of the Roll Back Malaria (RBM) Partnership and many other institutions has renewed inspiration for innovation and public health action. New initiatives such as attempts to eliminate malaria in the Southern African region [3] and Pacific Island states [4] and the new global agenda and field manual for malaria elimination from WHO's Global Malaria Programme [5,6] foreshadowed this movement and are preparing the ground for another global attempt at eradication. Very swiftly a coherent global action plan for malaria eradication was established and approved by RBM in late 2008 [7]. A group of scientists, public health decision makers, control programme managers and funders, the Malaria Elimination Group, compiled - based on all currently available scientific evidence and case studies - a guide to policy makers for malaria elimination for areas that embark or have embarked on elimination strategies [8]. All these recent efforts illuminate a pathway from control through to elimination and, eventually to eradication, as the only ethical long-term strategy.Alongside and interrelated with these important developments over the past decade, a remarkable decline of malaria incidence in several countries in sub-Saharan Africa, and world-wide, has been observed in recent years. This fall seems to have started before the widespread introduction of insecticide-treated nets and is a reflection of the renewed efforts in malaria control [9-15]. In the world today, 108 countries are malaria-free and the remaining one hundred countries still experience malaria transmission; 39 of these countries have already embarked on elimination while the remaining 61 countries implement control strategies [8].It is against this background that the malaria community has to prepare for an "e
Malaria elimination gaining ground in the Asia Pacific  [cached]
Gosling Roly D,Whittaker Maxine,Gueye Cara,Fullman Nancy
Malaria Journal , 2012, DOI: 10.1186/1475-2875-11-346
Abstract: Countries in the Asia Pacific region are making substantial progress toward eliminating malaria, but their success stories are rarely heard by a global audience. “Malaria 2012: Saving Lives in the Asia-Pacific,” a conference hosted by the Australian Government in Sydney, Australia from October 31 to November 2, 2012, will provide a unique opportunity to showcase the region’s work in driving down malaria transmission. One of the features of Malaria 2012 will be the Asia Pacific Malaria Elimination Network (APMEN), which has focused on harnessing the collective experiences of 13 countries through regional political and technical collaboration since its inception in 2009. Run by country partners, APMEN unites a range of partners – from national malaria programmes and academic institutions to global and regional policymaking bodies – to support each country’s malaria elimination goals through knowledge sharing, capacity building, operational research and advocacy.
Continued Decline of Malaria in The Gambia with Implications for Elimination  [PDF]
Serign J. Ceesay,Climent Casals-Pascual,Davis C. Nwakanma,Michael Walther,Natalia Gomez-Escobar,Anthony J. C. Fulford,Ebako N. Takem,Sarah Nogaro,Kalifa A. Bojang,Tumani Corrah,Momodou Cherno Jaye,Makie Abdoulie Taal,Aja Adam Jagne Sonko,David J. Conway
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0012242
Abstract: A substantial decline in malaria was reported to have occurred over several years until 2007 in the western part of The Gambia, encouraging consideration of future elimination in this previously highly endemic region. Scale up of interventions has since increased with support from the Global Fund and other donors.
Malaria on isolated Melanesian islands prior to the initiation of malaria elimination activities
The Pacific Malaria Initiative Survey Group (PMISG) on behalf of the Ministries of Health of Vanuatu and Solomon Islands
Malaria Journal , 2010, DOI: 10.1186/1475-2875-9-218
Abstract: In Tafea Province, a school-based survey was conducted which included the 2-12 y age group, while in Temotu a village based all-ages survey was conducted. An effort was made to sample villages or schools from a wide an area as possible on all islands. Diagnosis was initially based on Giemsa stained blood slides followed by molecular analysis using polymerase chain reaction (PCR).In Tafea Province, 73% (5238/7150) of children (2-12 y) were surveyed and in Temotu Province, in the all-ages survey, 50.2% (8742/17410) of the provincial population participated in the survey. In both Vanuatu and Solomon Islands malariometric surveys of their southern-most islands in 2008 showed relatively low over-all malaria parasite prevalence (2 to 3%). Other features of malaria in these island groups were low parasitaemia, low gametocyte carriage rates, low spleen rates, low malaria associated morbidity, a high incidence of asymptomatic infections, and a predominance of Plasmodium vivax over Plasmodium falciparum.For various reasons malaria rates are declining in these provinces providing a favourable situation for local malaria elimination. This will be advanced using mass distribution of bed nets and selective indoor residual spraying, the introduction of rapid diagnostic tests and artemisinin combination therapy, and intensive case detection and surveillance. It is as yet uncertain whether malaria parasites can themselves be sustainably eliminated from entire Melanesian islands, where they have previously been endemic. Key issues on the road to malaria elimination will be continued community involvement, improved field diagnostic methods and elimination of residual P. vivax parasites from the liver of asymptomatic persons.The Melanesian nations of Vanuatu and Solomon Islands have been known for malaria from the reports of the earliest colonial observers; the parasites probably accompanied humans to the archipelagoes many millennia ago [1-4]. Efforts to both quantitate and control ma
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