Category Archives: Capacity Building

Guinea: The Challenge of Malaria Control in a Post-Ebola Context

The preliminary 2018 Demographic and Health Survey (DHS) data have been released for Guinea (Conakry). Since the last DHS in 2012, Guinea and its neighbors experienced the largest Ebola outbreak in history, an event that damaged already weak health systems.

The previous DHS showed very weak malaria indicators. Only 47% of households had at least one ITN, which averages to 0.8 ITNs per person (compared to the universal coverage of 2.0). Among vulnerable groups only 26% of children below the age of 5 years slept under an ITN, as did 28% of pregnant women. Very few, 18%, pregnant women got two doses of IPTp, and only 5% of febrile children received ACTs (testing was not reported then).

Not much has changed concerning ITN coverage as reported in 2018. Slight improvements are seen in IPTp (which now requires 3 or more doses) and malaria testing and treatment for children. Ironically none of the indicators has passed the original 2006 Roll Back Malaria target of 60%, let alone 80% for 2010 and not of course the drive for universal coverage.

DHS has released a preliminary report for 2018 and the malaria component is summarized in the charts posted here. The national coverage for ITNs is 44%, slightly lower than 2012, but the average per household member is slightly higher at 1.1. Again, these numbers do not mark significant progress. Looking at wealth and ITN ownership there is a slight benefit in terms of equity in net possession among those with lower income, but this must be seen in the overall context of very low basic coverage.

Having a net in the household and using it are different challenges as seen in the reports of sleeping under the net on the night prior to the survey among children under 5 years of age and pregnant women. The sad finding is that even in households that own a net, the coverage of these two groups remains very low. This is reflected in the low net per person ratio nationally (1.1).

One would almost wonder if malaria is a neglected disease in Guinea. The reality is that since 2003, Guinea has received around $172 million US dollars in malaria project funding from the Global Fund. Its most recent annual funding from the US President’s Malaria Initiative (PMI) is around $14 million.  Of that PMI funding 24% was designated for nets and related activities, while 52% was to be spent on medicines, diagnostics and pharmaceutical management. These investments include systems strengthening and capacity building in addition to commodities.

PMI provides the needed context: “Since the country was declared Ebola-free in in June of 2016, Guinea continues to make positive advances towards building a strong health system in line with the health recovery plan. The government continues to mobilize internal and external resources for rolling out the health system recovery plan, but much remains to be done if this plan is to yield the intended results.” Areas in particular need of strengthening within the National Malaria Control Program include coordination, health information systems, leadership, supervision and logistics.

Three years have passed since the last Ebola case in Guinea. Hopefully the country can stave off another outbreak and at the same time strengthen its health system. Guinea may not yet be targeted for malaria elimination, but until systems are strengthened, the resources going into malaria control will not be able to push malaria indicators toward saving more lives.

Multilateral Initiative for Malaria: Posters Range from Prevention to Cost to E-Learning and Beyond

A major feature of all conferences are the poster sessions. These are often overlooked due to timing and placement. Fortunately at the recent 7th Multilateral Initiative for Malaria Conference in Dakar, tea breaks and lunch were made available in the poster tent ensuring more people came to view. Even so some people may have missed the valuable knowledge shared through this medium. We tweeted many of the posters during the event, but below are six posters in more detail.

These range from evaluating a malaria surveillance system to financing systems to sustain malaria drug supplies, including through community pharmacies. The potential of E-Learning for malaria capacity building was explored, and the process pf establishing a national malaria operations research agenda was presented. Several posters examined the seasonal malaria chemoprevention (SMC) program in the Sahel of West Africa including one from Mali as seen below.

Please contact the authors for additional information and updates. Readers who presented a poster at MIM are welcome to share their findings with us.

 

MIM – Fostering the next generation of malaria researchers in Africa – gaps and emerging opportunities

Dr Olumide Ogundahunsi of the of the Unicef-UNDP-World Bank-WHO Tropical Disease Research Program (best known as TDR) helped organize a symposium on the history and future goals of the Multilateral Initiative for Malaria (MIM) at the current MIM Conference. He describes the symposium, efforts to launch a MIM Society, and related issues below.

Dakar is hosting the 7th Multilateral Initiative for Malaria (MIM) Pan Africa Malaria Conference 21 years after the first such gathering of malaria researchers in the city in 1997. At that time Northern research and development organizations including NIH/Fogarty, WHO/TDR, Wellcome Trust, SIDA and others sought to take measure of the malaria research experience and needs of African scientists and scientific institutions. It was challenging at that time to find strong and representative core of malaria researchers across the continent. Arising from that first conference was the development of MIM and a plan for building the capacity of African researchers through a series of malaria research grants that included both postgraduate training as well as support for applying the acquired skills in undertaking malaria research.

Dr John Reeder, Director of TDR and Prof Fred Binka

Between 1997 and 2007 MIM supported Fifty six (56) research capacity strengthening (RCS) grants through the Special programme for research and training in Tropical diseases (TDR) for an aggregate amount of $12.9 million from 1997 to 2007.  The grants responded to basic gaps in capacity, research tools/commodities/supplies and communication. The latter reflected a major need for researchers to connect with the global malaria research community to learn and share.

These grants under the aegis of the MIM/TDR task force on Malaria RCS addressed the following broad research themes: Pathogenesis and Immunology of Malaria, malaria vector control (including insecticide resistance), Chemotherapy and antimalarial drug resistance, research and development of new tools from natural products, and research to facilitate malaria control interventions. At the Symposium Representatives of the 56 MIM grantees from West, Central, East and Southern Africa shared experiences during and after completion of their MIM grant. These included –

  • Professor Francine Ntoumi, Malaria immunology and pathogenesis research capacity in Central Africa, University Marien Ngouabi, Brazzaville, Republic of Congo
  • Professor Lizette Koekemoer, Malaria vector research capacity in Africa, University of the Witwatersrand, Johannesburg, South Africa
  • Professor Abdoulaye Djimde, Malaria treatment and antimalarial drug resistance in West Africa., Univerity of Bamako, Bamako, Mali
  • Professor Wilfred Mbacham, Malaria treatment and antimalarial drug resistance in Central Africa, Univeristy of Younde 1, Younde, Cameroon
  • Professor Kwadwo Koram, Malaria epidemiology research capacity for elimination and control in Africa, Noguchi Memorial Institute for Medical Research and University of Ghana,  Accra, Ghana

These speakers demonstrate MIM’s and their own specific achievements in following areas:

  • -Capacity built with infrastructure, technology transfer, skill acquisition and graduate students and postdocs trained (including their current status/subsequent contribution to malaria research and (or) control)
  • -Resources/other grants leveraged
  • -Collaborations established and sustained
  • -Contributions to national and regional malaria research capacity, control and elimination.

MIM ‘alumni’ speaking at the Symposium

Since that time those receiving the MIM RCS were able to benefit from further TDR and other malaria research grants and in the process have themselves helped develop new generations of malaria scientists in the universities and institutes where they work. MIM has continued to address the original research gaps. The holding of six subsequent Pan-African conferences.  Grants were also provided for establishing satellite communications systems at three institutions where grantees were based.

Participants in this process who attended the current conference (MIM2018) were able to help achieve on of the objectives of the symposium that is “highlighting the importance of continuous investment in training and monitoring of young African scientists.” The symposium also articulated the unmet and emerging gaps in research capacity of particular relevance to malaria control and elimination.

Visiting the TDR booth to discuss MIM experiences and research opportunities

MIM started and continues as a partnership among Northern and African research organizations with a rotating secretariat. For the past 10 years the MIM secretariat has been based in Africa, and most recently in Cameroon in the Biotechnology Centre of the University of Yaoundé.

Going forward the MIM is evolving into the MIM Society, a broad-based society which will focus among others on organizing regular MIM conferences, promoting research capacity strengthening and foster and unite the different initiative on the continent and worldwide. The MIM society will also invigorate the young African scientist to emerge as outstanding researchers and leaders with ground breaking innovation in science and its applications to development.

The MIM Society will be a global non-profit organization whose mission is to unite all human resources, young and experienced, working on malaria (from researchers over implementers, teachers, producers, funders, policy makers) to strengthen and sustain the capacity of malaria affected countries and to be an umbrella organization for all malaria related initiatives. The MIM Society through its members will guarantee capacity building goals for malaria researchers set by MIM 20 years ago will be carried forward for another 20 years and more.