Surveillance as a Core Intervention to Strengthen Malaria Control Programs in Moderate to High Transmission Settings

Abstract

New tools are needed for malaria control, and recent improvements in malaria surveillance have opened the possibility of transforming surveillance into a core intervention. Implementing this strategy can be challenging in moderate to high transmission settings. However, there is a wealth of practical experience among national malaria control programs and partners working to improve and use malaria surveillance data to guide programming. Granular and timely data are critical to understanding geographic heterogeneity, appropriately defining and targeting interventions packages, and enabling timely decision-making at the operational level. Resources to be targeted based on surveillance data include vector control, case management commodities, outbreak responses, quality improvement interventions, and human resources, including community health workers, as they contribute to a more refined granularity of the surveillance system. Effectively transforming malaria surveillance into a core intervention will require strong global and national leadership, empowerment of subnational and local leaders, collaboration among development partners, and global coordination. Ensuring that national health systems include community health work can contribute to a successful transformation. It will require a strong supply chain to ensure that all suspected cases can be diagnosed and data reporting tools including appropriate electronic devices to provide timely data. Regular data quality audits, decentralized implementation, supportive supervision, data-informed decision-making processes, and harnessing technology for data analysis and visualization are needed to improve the capacity for data-driven decision-making at all levels. Finally, resources must be available to respond programmatically to these decisions.

Hyper-diverse antigenic variation and resilience to transmission-reducing intervention in falciparum malaria

“…The World Health Organization has recently underscored the importance of surveillance for malaria intervention ( 62, 63 ). Molecular epidemiology provides approaches to complement traditional surveillance, with methods best suited for moderate-to low-transmission intensities ( 64, 65, 66 ). Deep sampling of sequences of var genes in host population provides a basis to complement these efforts for high transmission, with a focus on the high diversity that characterizes the var multigene family in these regions.…”

Metagenomic next-generation sequencing to characterize potential etiologies of non-malarial fever in a cohort living in a high malaria burden area of Uganda

“…Given the non-specific disease presentation, determining etiologies of fever based solely on clinical examination is difficult, and therefore diagnostic testing is needed. For malaria, a major cause of morbidity and mortality in Africa [ 1 ], recent increases in point-of-care and laboratory diagnostic testing have led to demonstrable improvements in malaria case management [ 2 ]. However, there are sustained knowledge gaps on fever etiologies that do not result in a malaria diagnosis due to the lack of testing availability for other pathogens, and the relative burden of other emerging pathogens of global importance (e.g., arboviruses) remains largely uncharacterized.…”