Malaria and health systems intervention research in The Gambia

by Julie Balen

Last week I visited my collaborators in The Gambia, a beautiful, small and friendly country known to many as “the smiling coast of West Africa”. We were recently awarded a Joint Global Health Trials research grant from the MRC, Wellcome Trust and DFID. The grant is supporting a malaria control research project, using a multidisciplinary approach that incorporates laboratory research, field epidemiology, social sciences, health systems and health economics.

Map of The Gambia

map of the gambia

In The Gambia, despite high coverage of standard malaria control interventions, such as indoor residual spraying (IRS) and use of long-lasting insecticidal nets (LLIN), transmission of malaria continues and is primarily maintained by carriers of asymptomatic infections (Sturrock et al, 2013a). In areas of low transmission – where prevalence of infection is ≤10% – previous studies have shown that asymptomatic carriers tend to be clustered around clinical malaria cases, within the same households (Sturrock et al, 2013b). This project is thus being implemented in the North Bank region where malaria prevalence is generally low – in 2012 average malaria prevalence as determined by molecular methods was 4.6%, ranging by village between 2.6% and 10.2%.

On route to the village

On route to the village

Our research is trialing a novel intervention that combines the passive detection of clinical malaria cases for identifying transmission hotspots and, subsequently, the systematic treatment of all individuals living around the case. This approach actively involves communities, in particular patients and their household members, and the health system.

Njaba Kunda Health Centre

Njaba Kunda health centre 1Njaba Kunda health centre 2

The purpose of the visit was to set up the trial, which will run in two stages: between June and December 2016 we will conduct formative research which will be used to assess the local response to the intervention and to identify potential constraints and enabling factors for successful implementation (Nichter et al. 2008). As such, the process of, and response to, the intervention will be evaluated, allowing us to optimize the intervention before fully implementing it in the second year of the study (June – December 2017).

A local shop

A local shop

The project draws on a range of collaborators from numerous institutions around the world, including the MRC Gambia, the London School of Hygiene and Tropical Medicine, UK, the Institute of Tropical Medicine, Antwerp, Belgium and the School of Health and Related Research (ScHARR) at The University of Sheffield, UK. It was a brief yet fruitful visit and all collaborators are looking forward to the exciting work that lies ahead. We hope to report on the results in due course.

If anyone is interested in collaborating with partners at MRC Gambia, please contact Julie on j.balen@sheffield.ac.uk

References

Nichter M, Acuin CS and Vargas A (2008) Introducing zinc in a diarrheal control program: guide to conducting formative research. Available at: http://whqlibdoc.who.int/publications/2008/9789241596473_eng.pdf Accessed 03/03/2016.

Sturrock HJ, Hsiang MS, Cohen JM, Smith DL, Greenhouse B, et al. (2013a) Targeting symptomatic malaria Infections: active surveillance in control and elimination. PLoS Med 10(6): e1001467. doi:10.1371/journal.pmed.1001467.

Sturrock HJW, Novotny JM, Kunene S, Dlamini S, Zulu Z, et al. (2013b) Reactive case detection for malaria elimination: real-life experience from an ongoing program in Swaziland. PLoS ONE 8(5): e63830. doi:10.1371/journal.pone.0063830.

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