MCD Inc.

Malaria Control

Bioko Island Malaria Control Project (BIMCP) Phase III

Country: Equatorial Guinea

Funders: The Government of Equatorial Guinea, Marathon Oil, Noble Energy, Sonagas, GEPetrol and Atlantic Methanol (AMPCO)

Duration: 2014-2018

When Marathon Oil Corporation began operating its oil and gas operations Equatorial Guinea, its workforce and that of the surrounding community on Bioko Island was greatly impacted by malaria illness and deaths. As a result, Marathon Oil came to lead a consortium funding local malaria control efforts through a production-sharing agreement with the Government of Equatorial Guinea, and with participation by other generous donors (AMPCO, Noble Energy, GEPetrol and Sonagas). MCDI has implemented a series of integrated malaria control measures to substantially reduce morbidity and mortality caused by malaria on Bioko Island, Equatorial Guinea since 2003 under the Bioko Island Malaria Control Project (BIMCP). Currently in its third five-year phase (2014-2018), the project’s interventions build on those established during Phase I (2004-2008) and Phase II (2009-2013) and are centered on indoor residual spraying, the distribution of long-lasting insecticidal nets, intermittent preventive therapy for pregnant women, malaria case management, epidemiological surveillance, vector monitoring, advocacy, informative, education and communication (IEC) and behavior change communication (BCC), and other focal activities stratified according to geographic areas of higher or persistent transmission. In the past, the BIMCP has also served as a proving ground for novel approaches such as mass screen and treat (MSAT), focal screen and treat (FSAT), larval source management, and environmental management. In coordination with the national malaria control program, the project has made a strong commitment to investing in human resource development, capacity building and horizontal integration, so as to prepare the Ministry of Health and Social Welfare to assume responsibility for sustaining the malaria control activities. The BIMCP is implemented with technical assistance from the London School of Hygiene and Tropical Medicine (LSHTM) on serological analysis and the design of an annual Malaria Indicator Survey, the Liverpool School of Tropical Medicine (LSTM) for metabolic resistance to insecticides and a disease data management system, and Texas A&M University as a partner in molecular-level analysis of mosquito samples collected on the island. Operational research has been conducted in a variety of technical areas, with regular publication of results.

Key Achievements as of 2016:

Health Outcomes

  • Since 2003, the prevalence of malaria among children ages 2-14 has decreased by 76%
  • Anemia in children ages 2-14 decreased by 80%

Vector Control

  • 23 rounds of indoor residual spraying were completed. After the detection of pyrethroid resistance among the local mosquito population, an insecticide resistance management plan was developed and is currently being executed, with the alternation of insecticides in order to slow the development of additional resistance
  • More than 80% of households in communities targeted for indoor residual spraying were protected, per WHO guidelines
  • 584,450 long-lasting insecticidal bed nets were distributed in mass campaigns in 2007 and 2015
  • Bed net keep-up campaigns have been carried out door-to-door in high risk areas between mass distributions; limited bed net distributions have occurred on the mainland of Equatorial Guinea and the Island of Annobon

Case Management

  • Over 250,000 treatments with artemisinin-based combination therapies (ACTs) have been delivered free of charge through public health facilities
  • 211,335 rapid diagnostic tests for malaria have been provided free of charge at public health facilities
  • 80% of pregnant women received Fansidar (sulphadoxine-pyramethamine) for prevention of malaria during their last pregnancy; thousands of pregnant women attending antenatal care clinics have received long-lasting insecticidal bed nets

Disease Surveillance

  • A national health information system (NHIS2) was developed, and the process of entering patient data from all public health facilities’ registries was handed off to the Ministry of Health and Social Welfare in 2016
  • An Annual Malaria Indicator Surveys have been carried out since 2003
  • All Bioko Island communities have been stratified according to levels of malaria prevalence to allow for better targeting of interventions

Entomological Surveillance

  • The malaria vector Anopheles funestus was eliminated from the island, verified by rigorous monitoring at 20 sentinel sites
  • A larval source management pilot was conducted in rural areas from 2015-2016

Capacity Building

  • Malaria diagnostic capacity has been strengthened through continuous training and re-training of more than 64 laboratory technicians; in 2011, a National Archive of Malaria Slides (NAMS) was delivered for continuous diagnostic training
  • The Ministry of Health and Social Welfare has been trained in quality assurance and quality control of antimalarial medicines, as well as in inventory management for antimalarials and diagnostic supplies
  • A Human Resources Development Committee for Malaria Control has been established

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