Posts or Comments 28 September 2021

Monthly Archive for "June 2012"



Malaria in Pregnancy &Performance &Private Sector Bill Brieger | 30 Jun 2012

Malaria in Pregnancy – analyzing processes, involving new partners

Malaria in Pregnancy: A Solvable Problem—Bringing the Maternal Health and Malaria Communities Together – a meeting in Istanbul organized by the Maternal Health Task Force, Harvard University.

Take Away Messages from Day 2 Presentations. Report by James Kisia, Kenya Red Cross.

Jayne Webster of the London School of Hygiene and Tropical Medicine as the Malaria in Pregnancy Consortium shared a tool that helps identify and address barriers to the delivery of malaria in pregnancy services.  She referred to the tool as “An innovative ‘soft’ technology, a decision-making tool to improve the effectiveness of the delivery of IPTp and ITNs.” The tool is still under development, but key components were presented.

dscn1612b.jpgJayne noted that there are still research questions to answer on how to effectively implement interventions, but while we are waiting for these questions to be answered there are improvements in data collection, collation and use to be made and used for decision making.

Jayne said that we must use the wealth of knowledge we already have to start to take action and make improvements! She took us through the work in progress of a decision tool for use by health managers to assess country and/or sub-national barriers and priority actions required for effective scale-up of the IPTp and ITNs. The tool will eventually be available on the Malaria in Pregnancy Consortium website.

Nancy Nachbar of Abt Associates presented her experiences on Malaria in Pregnancy: The role of the private sector. She said we must talk about the complete health system. If we fail to consider the private sector, we are not considering the whole system!

Half of care for fever or Diarrhea is happening in the private sector- and much of this is happening in the informal sector. Those who are poorer are utilizing the informal sector for treatment seeking. Unfortunately we lack similar utilization data for antenatal care.

Nancy discussed challenges to private sector participation from the public sector perspective as well as from the private sector perspective. She also discussed opportunities for improving private sector participation in MiP prevention. Nancy incited and excited us to think about way out ideas. One creative idea: Could tithing be used as a funding source for malaria in pregnancy?

A key factor to tie these presentations together is the need to develop tools to assess and guide not only the public sector, but also private health care providers on malaria services to pregnant women.

Health Systems &Malaria in Pregnancy &Reproductive Health Bill Brieger | 30 Jun 2012

Overcoming Barriers to Eliminating Malaria in Pregnancy

During its final day the Malaria in Pregnancy meeting in Istanbul addressed barriers to achieving malaria in pregnancy (MIP) goals at four levels: community, district/facility, national and global.

The Global Level Group  looked at global issues.  At the Global Level there is need to stress and strengthen multiple intervention package for antenatal care including malaria in pregnancy services. The group stressed that we can learn from the HIV community who promote PMTCT in ANC to and thus better promote MIP interventions in ANC.

The group also emphasized the need revise global guidance on essential drugs so Sulphadoxine-Pyrimethamine (SP) is used only for IPTp in MIP, not for malaria treatment. The group noted that there are many manufacturers of SP, but are not part of WHO pre-qualification (drug quality) process – improve quality of MIP drugs.

The Global Group observed that it takes long time for policies and evidence to filter to local level – need speed up dissemination of MIP information. The group  also pushed for harmonization of MIP guidance needed even within global organizations like WHO. We must also identify and address inconsistencies in MIP policies and messages from global level to health facility level.

They recommended MIP champions to help prioritize high burden malaria and maternal mortality areas and promote scale-up MIP services. This champion or advocacy process should take advantage of global fora and initiatives such as ‘Every Woman, Every Child’, Woman Deliver, ALMA and GMHC to share the latest evidence based information on MIP. Global advocacy should also include  publications in international journals like The Lancet on MIP and ANC packages.

The National level working group pointed out confusing guidelines as a major barrier to IPTp uptake. We cannot always wait for clarification from international partners, they noted – What to do while we wait? We we do update guidelines we need to ensure representation of all programs when updating guidelines (malaria, RH, MCH) for malaria in pregnancy. Also, countries need to simplify MIP guidelines based on learning about their own implementation barriers that can be easily overcome locally.

At national level we must focus on more than guidelines. We also need harmonized training and Monitoring and Evaluation across programs (malaria, RH, MCH) on malaria in pregnancy service delivery. At present there is often ack of coordination and harmonization across programs for that deliver MIP services. We must sit together but also harmonization implementation.

The group addressing district and facility level barriers to MIP service uptake called for user friendly services. They noted that health services must also be ‘friendly’ to the provider. In order to retain providers we must also address quality of life for staff.

Standards based management/performance improvement processes at district and facility level based on incentives including recognition may not only enhance MIP performance but give staff at these levels the tools needed to identify and solve their own problems using locally available resources and ideas.

Better tracking of commodities is needed to ensure that clients are not disappointed. We can redistribute commodities like SP within or among districts to ensure services succeed. We must prioritize SP provision as part of an essential ANC supply package.

The group stated emphatically that traditional cascade training out, that we need innovative and facility based approaches like champions at facility and text based training for malaria in pregnancy instead. Clinical mentoring and checklists can help promote malaria in pregnancy service skills, which can lead to greater consumer satisfaction and utilization.

Even when there has been traditional workshop based training the problem is that staff are often not trained on national guidelines. There is need for supervision that is also based on guidelines, not the personal beliefs and references of the supervisors. Also, without the commodities, staff can not practice what they learned.

The community focused working group started with a recognition that the ‘knowledge’ problem is a two-way street. It is not only that community members may not understand our scientific approach to defining, treating and preventing malaria. We too may fail to communicate with the community and create demand for services because we do not understand their perspectives.

The community group suggested that we combine community resource people and media and private sector actions for comprehensive malaria communication.  Mass medial can reinforce information that is shared by trusted community leaders and health volunteers.

The group debated the cost problems communities face in in accessing MIP servivces. This may include direct costs of services in some countries as well as indirect costs to the family. Women’s access to funds and income need to be considered, hence collaboration withy other sectors of the development community such as micro-finance.

The problem of linear communication from health workers to community without learning community knowledge and dialogue can be overcome if health workers are encouraged to engage in deeper dialogue with mothers, fathers, grandmothers and community leaders and become learners first, before they hope to teach about MIP.

Health Systems &Malaria in Pregnancy Bill Brieger | 28 Jun 2012

New Ideas in Malaria in Pregnancy Service Delivery

Malaria in Pregnancy: A Solvable Problem—Bringing the Maternal Health and Malaria Communities Together – a meeting in Istanbul organized by the Maternal Health Task Force, Harvard University.

Take Away Messages from Day 2 Presentations. Report by James Kisia, Kenya Red Cross.

Innovative approaches to identify and apply context-specific interventions were discussed by Marcia Castro of the Harvard School of Public Health. She looked at the prevention of malaria in pregnancy with a multi-level modeling approach. She also addressed barriers to IPTp uptake spatially (geographic mapping), and considered three levels:

    • Woman:
    • Considered education,
    • bednet ownership and income
    • Facility:
    • Considered access, quality and characteristics
    • Cost is largely not an issue but distance and waiting time are
    • Fewer women per health facility means more uptake
    • She discussed the fact that measurement of quality remains poor—as we don’t understand various perceptions of quality
  • District:
    • Considered the proportion of district area covered by roads, and
    • ANC facilities per 1000 women of childbearing age in district

    dscn1704sm.jpgMarcia pointed out that there is more to the story than access; roads do not equal access but lack of roads could serve as a proxy for isolation. She discussed the process of tracking pregnant women that can be used for planning and supply chain management.

    Intermittent Screening Treatment (IST) offers a promising intervention in low transmission countries as well as high burden countries as they move closer to elimination (Consider the vivax context). In areas where IPTp may be abandoned due to low/decreasing risk and replaced with active case management, screening with RDT is likely to identify most infections in pregnant women

    Ultimately we need to give greater importance of bridging the gap between ANC attendance and actually receiving IPTp.

    Ib Christian Bygbjerg of the University of Copenhagen presented “Malaria in Pregnancy: Threats, opportunities, and new technologies.” He addressed both eHealth and mHealth.

    ehealth is many things including electronic health records, telemedicine, consumer health informatics, knowledge management, and mhealth. WHO Bulletin had a whole issue on eHealth in May 2012, showing the growing importance of technology.

    There is an obvious opportunity for mHealth because phone connections have more than tripled in past 10 years globally. An example of a program is ‘wired mothers’ —good results for maternal health generally, but can it work for malaria in pregnancy?

    Cell phones raise Ethical questions. They were designed for communication, not health. Who picks up the phone? Who reads the text message? Who owns your data?

    mhealth is an under-used and under-researched tool. Ib said his group found no results from pubmed for “malaria” and “mhealth”. More operations research needed!

    Ib Shared an smartphone app on emergency management of post partum hemorrhage—and asked what would an app for management of MIP look like? Would it be useful?

Health Systems &Malaria in Pregnancy Bill Brieger | 28 Jun 2012

What do we know about effective approaches and systems to malaria in pregnancy?

Malaria in Pregnancy: A Solvable Problem—Bringing the Maternal Health and Malaria Communities Together – a meeting in Istanbul organized by the Maternal Health Task Force, Harvard University.

Take Away Messages from Day 2 Presentations. Report by James Kisia, Kenya Red Cross (with Bill Brieger)

dscn8356sm.jpgAssessing the effectiveness of delivery of IPT and ITNs: Lessons from Mali and Kenya was the topic presented by Jayne Webster of the London School of Hygiene and Tropical Medicine as the Malaria in Pregnancy Consortium.

Jayne explained the process by which a woman goes to ANC to get IPT and ITNs. Her presentation looked at the effectiveness of intermediate processes as well as indicators for maternal health programming. Her analysis revealed that delivery for both IPTp and ITN interventions are ineffective in both countries.

Stock outs are not the only issue; even where in-stock, delivery was still ineffective. Providers lack of knowledge; misinformation was a major barrier. Content of IPTp guidelines must be reviewed for inconsistencies and clarity. Supervisors may even contradict national guidelines.

Guidelines themselves may be restrictive. In Mali they confine IPT to 4-8 months of pregnancy only, and health workers are even reluctant to give IPT in the 8th month.

Delivery of ITNs during ANC is better than IPTp. Many missed opportunities – even if women attend, they may not get the SP tablets. Giving IPTp as directly observed treatment rarely practiced.

An analysis of achievements and limitations to meeting women’s comprehensive needs during pregnancy was presented by Rifat Atun of the Imperial College using a systems approach.  He said we need complex systems approach to heath innovation that addresses perceptions, scalability, opportunity, and whether the innovation is desirable or threatening.

Unfortunately health systems tend to suppress innovation. We often ignore consumer perspectives and demand which can drive innovations.

He pointed out the Inequities in funding for malaria control—often not in line with burden of disease. Much of our funding goes into delivery systems, so we need to focus innovation on these systems.

He explained that innovation takes a long time to diffuse into the system using example lemon juice for scurvy which took 200 years for the Royal Navy to adopt. IPTp has been an innovation that has been also slow in adoption – not necessarily in terms of policy, but in terms of actual implementation. Malaria in pregnancy receives only 2% of Global Fund malaria funding.

Some of the key barriers to diffusion of an innovation include a linear view of innovation, limited evidence, imbalance in health and financing policies (not enough emphasis on demand, inadequate incentives, etc.), and institutional logic He explained that integration is a complex process; not binary.

We must consider what is being integrated and why? The communities need to feel that they are part of the solution and then they will join in the delivery of the innovation.

This panel helped us focus on the systems and processes that inhibit MIP service delivery even if women do attend ANC.

IPTp &ITNs &Malaria in Pregnancy Bill Brieger | 28 Jun 2012

Malaria in Pregnancy: Learning from Global and Regional Programs

dscn8947sm.jpgMalaria in Pregnancy: A Solvable Problem—Bringing the Maternal Health and Malaria Communities Together – a meeting in Istanbul organized by the Maternal Health Task Force, Harvard University.

Take Away Messages from Day 2 Presentations by James Kisia, Kenya Red Cross.

The first roundtable of the second day was moderated by Koki Agrawal of MCHIP. Key lessons were the need to strengthen ANC as a platform for IPTp and ITN delivery. We need to address how to get the ANC systems funded—not just the interventions. Dr Agarwal challenged the panel to examine how to better measure processes that facilitate the delivery of care and to consider taking service beyond the walls of the health facility… and building stronger linkages between the facility and the community. We must develop indicators for quality of care and integration of programs

Viviana Mangiaterra of WHO explained that there are systematic issues in MIP; little investment has been realized (Global Fund has been doing most of the funding and is currently getting reorganized to increase technical guidance on MIP interventions as well as delivery mechanisms). There are different entry points – each provides opportunities for improvement in continuum of care. We must strengthen at different levels (for ex: CCM) to influence process

Mary Hamel of CDC demonstrated variations and contradictions in WHO guidelines on IPTp which can translate to country-level and implementation level confusion. She explained that, in the face of confusion, health workers are likely not to want to do harm—and, hence, do nothing. A simple clarifying memo from the Ministry of Heakth to health staff can help reach the desired level of IPT uptake.

Susan Youll of PMI talked about major challenges of poor data availability, stock outs. SP is not included in “tracer” commodity; not tracked in the same way other essential drugs are tracked. She discussed the negative effects of hidden fees for ANC services and the impact of this on IPT uptake and encouraged promoting the role of community to create demand.

Elena Olivi from PSI said of Nets that —“funding, funding, funding!” – is the answer. She reminded us of the overwhelming evidence that the biggest contributor to decrease in malaria cases was nets and cited by World Bank study on Kenya. Net delivery mechanisms are established and known. Nothing fancy about it! ANC is one of many platforms to deliver nets. She cited an example of nets treated like medicine with a prescription, enabling better tracking and forecasting. Behavior not an issue; knowledge about nets not a barrier to usage. There are technical champions for nets (PSI). The Advocacy community has not recognized the severity of the funding crisis—and lack of incentive to make bednets truly longlasting!

In conclusions, international partners have found that malaria in pregnancy cannot be controlled without basic resources and commodities. Advocacy is needed.

ITNs &Malaria in Pregnancy Bill Brieger | 27 Jun 2012

Twitter Posts on ITNs from Malaria in Pregnancy Meeting, Istanbul

dscn7286sm.jpgKeep up with MIP meeting on Twitter #MIP2012

Bill Brieger ?@bbbrieger – #MIP2012 universal coverage of ITNs not just to protect vulnerable groups against #malaria but also reduces mosquito population

Krisztian Magori ?@BiteOfAMosquito -bbbrieger: #MIP2012 MSF has found where no mass distribution of nets give pregnant woman 2… http://goo.gl/fb/xnHkd  – Bill Brieger ?@bbbrieger – #MIP2012 MSF has found where no mass distribution of nets give pregnant woman 2 nets ensure she gets to use at least one to prevent #malaria

bbbrieger: #MIP2012 non-use of nets related to real reduction in ventilation – both a design… http://goo.gl/fb/kdFMA – Bill Brieger ?@bbbrieger #MIP2012 non-use of nets related to real reduction in ventilation – both a design issue and an educational issue on net benefits #malaria

MHTF ?@MHTF – Challenges: Funding. Advocacy. ITN coverage in ANC. Incentives for net producers to make lasting nets.-Olivi Net @PSIHealthyLives #MiP2012

MHTF ?@MHTF – Net challenges: Funding. Advocacy. Limited ITN coverage in ANC. Need to incentivize bednet producers to make longer lasting nets. #MiP2012

Bill Brieger ?@bbbrieger – #MIP2012 Elena Olivi PSI need get manufacturers make stronger nets and new insecticides to deal with resistance #malaria; #MIP2012 Olivi PSI. even before when sufficient fund, not all ANC provided ITNs to protect pregnant women against #malaria

MHTF ?@MHTF We are in the midst of a funding crisis. Nets expire after 3 years & need to be replaced. -Olivi @PSIHealthyLives #MiP2012 #malaria #MNCH

Bill Brieger ?@bbbrieger #MIP2012 Olivi PSI: gap analysis underway to see countries at greatest risk of loosing ITN coverage gains #malaria

MHTF ?@MHTF Take homes: Nets save lives. African countries know how to deliver them. Technical champions exist. -Olivi @PSIHealthyLives #MiP2012 #MNCH

Sam Lattof ?@slattof Olivi: Writing women prescriptions for bednets relieves #ANC nurses of the duty, minimizes stockouts, and strengthens supply chain. #MiP2012

Bill Brieger ?@bbbrieger #MIP2012 Olivi PSI: challenges exist – we are in funding crisis and nets need replacement after 3 years. threat to MIP – risk loosing gains!

MHTF ?@MHTF Olivi @PSIHealthyLives: No need to get overly clever w/bednet distribution. Just do it. #MiP2012 #malaria #pregnancy #maternalhealth #MNCH

Bill Brieger ?@bbbrieger #MIP2012 Olivi PSI: Burundi experiment with ‘prescribing’ ITNs at ANC so woman collects from pharmacy. streamline ANC, better ITN tracking

Bill Brieger ?@bbbrieger #MIP2012 Elena Olivi PSI – ITN campaigns can reach poorer people, especially women who may not attend ANC or not yet start ANC #malaria

MHTF ?@MHTF Olivi @PSIHealthyLives: ANC best distribution channel of bednets for pregnant women. Other channels important for other groups. #MiP2012

Bill Brieger ?@bbbrieger #MIP2012 Elena Olivi PSI understanding of all kinds of ITN distribution channels and while ANC best for pregnant women, others can help

Malaria in Pregnancy Bill Brieger | 23 Jun 2012

Evolution of Intermittent Screening and Treatment for Malaria in Pregnancy Control

Intermittent Preventive Treatment of pregnant women (IPTp) for malaria has been a major, if not terribly well implemented malaria control strategy in countries with high and stable malaria transmission. Combined with use of insecticide treated nets (ITNs) and appropriate case management with artemisinin-based combination therapy (ACTs), IPTp offered an important third prong to protect this vulnerable population who in theory are reachable since most pregnant women in endemic countries attend antenatal care (ANC).

dscn8010-sm.JPGThe area benefiting from IPTp covers the bulk of sub-Saharan Africa, but not countries on the periphery of malaria transmission, like Namibia and Botswana, where transmission is seasonal or epidemic. Here, as well as in countries that have made substantial progress in reducing the burden of malaria like Rwanda, ITNs themselves often carry the burden of protecting pregnant women since case management is dependent of treatment seeking in a variety of formal and non-formal care settings.

IPTp as we know it is threatened. First is the growing resistance of malaria parasites to sulphadoxine-pyrimethamine (SP), the drug of choice. The problem has been compounded by countries’ neglect in curbing the continued and unrecommended use of SP for treatment. Secondly, on a more positive note, as countries reduce their malaria burden and become more like those with low and unstable transmission, widespread IPTp does not make much sense as a strategy.

This reduction in burden does not mean that pregnant women are no longer at risk in malaria endemic countries that are making progress.  It means that aside from continued use of ITNs and other vector management interventions, we must step up the accuracy of timely case detection and case management.

A new study of malaria rapid diagnostic tests during pregnancy in Tanzania sums up the current situation nicely: “Microscopy underestimated the real burden of malaria during pregnancy and RDTs performed better than microscopy in diagnosing PAM. In areas where intermittent preventive treatment during pregnancy may be abandoned due to low and decreasing malaria risk and instead replaced with active case management, screening with RDT is likely to identify most infections in pregnant women and out-performs microscopy as a diagnostic tool.”

dscn7279sm.jpgOthers have suggested an active detection and case management process using ANC as a platform – intermittent screening and treatment (IST). One of the earliest allusions to IST was in a 2008 study in Ghana, where the researchers concluded that RDTs fit easily into ANC procedures and outlined the benefits of “antenatal RDT screening and treatment.” One of the researchers actually used the term IST during a presentation on malaria intervention options for Asia at the 11th meeting of the Roll Back malaria Partnership’s Malaria in Pregnancy Working Group in 2008.

In 2010 the same research team again reported from Ghana on comparing IPTp during ANC with IST using two different drug regimens. All three arms showed a reduction of parasitemia near the end of their pregnancies, but with the benefit of reduced drug use in the two IST arms.

Research continues on IST. Rwanda has recently completed a malaria in pregnancy prevalence study using RDTs and treatment of those with parasitemia during first ANC visit and is in the process of determining guidelines for formalizing this as part of ANC.  School based studies of IST in Kenya have yielded encouraging results. Unicef in collaboration with USAID is piloting IST in selected regions of Indonesia.

Practical issues of integrating the RDT testing and ACT provision need to be addressed including funding and procurement processes to ensure adequate supplies at ANC. Training of ANC workers on the procedures as well as planning on how to ensure IST fits seamlessly into ANC procedures are a few of the operational challenges.

In conclusion, IST offers a promising intervention in low transmission countries as well as high burden countries as they move closer to elimination. As with most malaria interventions, the science will be easier to solve than the logistics and staff attitudes.

Communication &ITNs Bill Brieger | 17 Jun 2012

Changing Behavior or Changing Nets

A new study from Zambia reports that despite mass distribution efforts towards achieving universal coverage only half the children in houses with nets slept under them the night before the survey. When the researchers checked for nets they discovered that, “… ITNs in poor condition are more likely to be observed hanging than ITNs in new or good condition.”

The proposed solution for this dilemma was, “In the context of free mass distribution of ITNs, behaviour change communication and activities are necessary to improve use. Results suggest campaigns and messages that persuade recipients to hang up their ITNs would contribute towards closing the gap between ownership and use.”

net-use-surveillance2-sm.jpgCoincidentally, another study set in several malaria-endemic countries examined the complaints that people often give when explaining why they do not use nets – ‘thermal discomfort’.

The researchers found that, “Bed nets reduce airflow, but have no influence on temperature and humidity. The discomfort associated with bed nets is likely to be most intolerable during the hottest and most humid period of the year, which frequently coincides with the peak of malaria vector densities and the force of pathogen transmission.”

Airflow is crucial because even a little breeze can make one feel cooler even if the temperature is not objectively different inside or outside the net. Not surprisingly denser mesh size reduced airflow even more.

These researchers took a different approach to solving the net use problem – instead of blaming the user, they suggested considering architectural issues like housing ventilation and net design issues that would increase airflow without jeopardizing protection against mosquitoes.

Sometimes it is the scientists, manufacturers and the program managers who need to change, not the community members.

ITNs &Malaria in Pregnancy Bill Brieger | 17 Jun 2012

Women and Nets II – not only during pregnancy

As we have recently noted actual use of insecticide treated bednets (ITNs) by pregnant women in malaria endemic countries is not meeting targets.  In addition to tracking general coverage, we have reviewed Demographic and Health  or Malaria Indicator Survey (DHS/MIS) data showing that even in households that own nets, pregnant women may not be using them.

tracking-itn-use-by-women-15-45-years-of-age-sm.jpgNow we need to take a step back and examine our indicators in light of the need to protect women fully. Two issues arise. First in the context of universal coverage, all women in a household should have access to sleeping spaces that have nets.  Women need strength before they become pregnant, especially younger ones who may be experiencing their first pregnancy.  Nets are one means of ensuring that women do not enter pregnancy already in an anemic state.

The second issue is pragmatic. Since a woman may not know for sure that she is pregnant in the early days and weeks of her pregnancy, she benefits from already being protected from malaria by nets that should have been provided through universal coverage. Intermittent preventive treatment can not be used with current drugs in the first trimester, so nets are the most important preventive measure during that time.

Even if a woman suspects she is pregnant, it is considered in many places culturally inappropriate for her to publicly announce or take public actions (like attending antenatal care) that let people know she is pregnant. If she waits in a culturally appropriate manner until ‘it shows’, she and the unborn child would have already been exposed to life threatening malaria infections. Universal coverage of nets prior to pregnancy maintains both the woman’s confidentiality and health.

To date few of the recent DHS/MIS have reported on net use by women of reproductive age (15-45 years) in general. The graph here shows a similar pattern for this group as observed for pregnant women. Problems of both access and use persist.

Because of the protection offered by ITNs in the earliest stages of pregnancy, it is extremely important not only for malaria endemic countries to undertake and maintain universal coverage that will reach women, but also track this as an important indicator of program success.

Uncategorized Bill Brieger | 15 Jun 2012

Tribute to Professor Celestine O. Onwuliri

Professor Oladele Akogun (akoguno@yahoo.com) of the University of Common Heritage Foundation and the Federal University of Technology, Yola, Nigeria pays tribute to his colleague Professor CO Onwuliri

The death has been announced of one of Nigeria’s leading parasitologists, Professor Celestine Onwuliri in the DANA Air crash in Lagos earlier this month.  Professor Onwuliri taught helminthology at the University of Jos, where he made significant contribution to the epidemiological mapping and control of onchocerciasis in Nigeria.

epid-and-psycho-social-impact-osd-sm.jpgHe also trained many parasitologists who now hold positions in academics and policy both in Nigeria and overseas. Professor Onwuliri has also carried out research on malaria in recent times.

Professor Onwuliri was the President of the Nigeria Society for Parasitology in the mid-90s. He has also served as Commissioner in the government of Imo State, Nigeria. He was a university administrator holding position of Deputy Vice Chancellor and Acting Vice Chancellor at the University of Jos before his penultimate appointment as Vice Chancellor of the Federal University of Technology, Owerri.

His most recent position was at the National University Commission (NUC). He was a fellow of the Parasitology and Public Health Society of Nigeria and a member of the Nigeria Academy of Science.  With his departure the Parasitology community will miss one of its most beloved academics and leaders.

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