Malaria Indicator Survey presented in Malawi
13 April 2015
The Malawi National Malaria Control Programme launched the results of the 2014 Malawi Malaria Indicator Survey (MIS) during the 2015 malaria research dissemination day in Lilongwe, an event attended by a wide range of health professionals and journalists.
By Malawi-Liverpool Wellcome Trust Clinical Research Programme
MLW joined with a presentation on the developed novel methods for fine-scale monitoring of disease burden progress.
Key findings of the 2014 MIS include a national increase in household insecticide treated net (ITN) coverage (70%), use of ITNs by children below 5 years (67%) and pregnant women who received at least 2 doses of preventive treatment with SP (64%). Among children below 5 years who were treated with an antimalarial 92% received ‘LA’. With this coverage the national malaria parasite prevalence did not decrease (MIS 2010 43%, 2012 28%, 2014 33%), raising questions on the possible reasons.
These may include differences between surveys in climate and weather patterns, a need for higher population intervention coverage or remaining gaps in coverage among important subgroups. Increasing insecticide or drug resistance or changing vector behaviour in areas with a highly varying burden of malaria such as Malawi, different national random samples may have represented locations with underlying differences in disease burden by chance.
To help put these findings in perspective a number of research presentations accompanied the keynote MIS presentation.
Dr Dyson Mwandama from MAC highlighted the continued efficacy (>95%) of the current first and second line antimalarials, artemether-lumefantrine (‘LA’) and artesunate-amodiaquine, respectively.
In his presentation Dr Themba Mzilahowa from MAC highlighted how early morning and outdoor biting by key malaria transmitting mosquito species may allow them to circumvent bed nets and indoor residual spraying.
Also making a presentation was Dr Atupele Kapito from MAC who spoke on school-aged children as a vulnerable group that warrants more attention, supporting the changing focus of the NMCP to full population ITN coverage.
Dr Anja Terlouw presented the MLW work on fine-scale continuous monitoring of parasite prevalence showing a trend of decreasing disease burden in Chikwawa between 2010 and 2013. Both the data and use of novel mapping methods demonstrate how local data trends from selected sentinel sites can complement repeated national MISs, which are the internationally recommended methods for monitoring malaria control progress at country level.
“The local survey tools we developed for fine-scale mapping include a continuous MIS at household level and a continuous MIS in so-called Easy Access Groups (groups that are representative of the population in malaria risk and aggregate somewhere for other reasons that make them easily accessible for surveillance, such as young children attending vaccination clinics, or pregnant women attending antenatal care). Both are complementary tools that can be used in some key sentinel sites to help understand national trends”, she explained.
She said with Malawi’s targets to further increase intervention coverage, we need a better understanding of the key local factors that influence their uptake, effect and impact.
Dr Terlouw highlighted that MLW researchers and their partners focus on answering such key questions. Apart from the survey tools, other examples include ongoing and recently completed studies that help better understand household level health care seeking decisions for febrile children, studies that measure dose optimization and safety in vulnerable subgroups like young children and HIV+ adults on ARVs, drug safety with repeated ACT use in programmatic settings, ACT treatment adherence in young children and its determinants and pharmacological modelling to guide safe and effective, practical dose regimens.
With this work there is hope in guiding evidence-based decision making on how best to target areas or subgroups to optimize impact”.
Photo by: Helen Wong
