MCD Inc.

Malaria Control and Elimination

Background

Medical Care Development International has been working to reduce and eventually eliminate the burden of malaria for decades. In 2015, there were 212 million new cases of malaria and 429,000 deaths. MCDI's work in prevention through vector control, intermittent preventive therapy in pregnancy, and malaria vaccines, as well as in malaria diagnostics and case management, monitoring, evaluation and surveillance has helped significantly reduce the burden of malaria in populations served by MCDI-supported work.


Prevention: Integrated Vector Control

Integrated vector control is one of MCDI's core competencies, with experience in various malaria endemic countries. MCDI's integrated vector control work, beginning in 1986, has helped to significantly reduce the prevalence of malaria infection and incidence of malaria cases in beneficiary populations by dramatically suppressing transmission through reductions in vector abundance, infectivity, and human blood-feeding contact.


MCDI has substantial operational experience and technical expertise in planning, managing, monitoring and evaluating the following vector control strategies: (1) mass top-up distribution and hang-up campaigns for Long Lasting Insecticide Treated Bednets (LLINs); (2) keep-up of LLINs through antenatal care and school-based distribution; (3) Indoor Residual Spraying (IRS); and, (4) Larval Source Management (LSM).


Additionally, MCDI assessed the effectiveness of incorporating other vector control interventions such as insecticide-treated durable wall linings, Bti plus sugar-based traps and patches and genetically-modified mosquitoes into an integrated strategy, and has extensive experience in developing and utilizing mHealth and GIS technologies for integrated vector control planning, management, monitoring, evaluation and surveillance. MCDI also recently developed and deployed stratification methods for integrated vector control within elimination contexts that ensure that vector control is cost-effectively targeted at transmission hot-spots while preventing resurgence in low-transmission or elimination settings.


Read more about our extensive vector control experience.


Prevention: Intermittent Preventive Therapy in Pregnancy

MCDI works to improve the provision of Intermittent Preventative Treatment in pregnancy (IPTp) as part of antenatal care services in several countries MCDI works in. Most recently, MCDI has provided extensive support to the National Malaria Control Programs and Ministries of Health in Benin and Equatorial Guinea to strengthen and increase coverage of IPTp. MCDI has trained health workers in providing IPTp and conducted health situation analyses on IPTp coverage in order to improve antenatal care. MCDI has worked with governments to provide IPTp in public health facilities since 2005.


Learn more about MCDI's experience in preventing malaria in pregnancy.


Prevention: Vaccines

MCDI has been a core implementing partner of the Equatorial Guinea Malaria Vaccine Initiative (EGMVI), conducting clinical trials of Sanaria Inc.'s whole sporozoite Plasmodium falciparum malaria vaccine candidate (PfSPZ). Sanaria's objective is to develop a PfSPZ vaccine that confers at least 80% protective efficacy for at least 6 months. The EGMVI's goal is to provide clinical evidence of the safety, tolerability and efficacy of the PfSPZ vaccine in subjects residing in Equatorial Guinea as a basis for bringing the PfSPZ vaccine to licensure and eventual use in conjunction with standard malaria control interventions to eliminate malaria on Bioko Island and other endemic settings.


The EGMVI is currently in its third stage, during which four clinical trials – three in Equatorial Guinea and one in Tanzania – are being conducted. If these and other trials being conducted simultaneously by Sanaria and other partners elsewhere in Africa, Europe and the United States are successful, and if the PfSPZ vaccine is ultimately licensed, MCDI anticipates assisting the Government of Equatorial Guinea in deploying the vaccine through mass vaccination campaigns along with on-going standard malaria control measures to demonstrate the feasibility of eliminating malaria from endemic settings.


Read more about EGMVI


Diagnosis

Malaria diagnosis is another core competency in which MCDI has assumed a technical leadership role internationally. MCDI has helped the World Health Organization in setting global standards for diagnostics, and has been a key innovator in developing, testing and deploying systems to train and provide supportive supervision to laboratory and clinical staff on proper diagnosis of malaria. In addition to providing technical and operational support to various countries through bilateral agreements, MCDI was the prime contractor under the USAID-PMI centrally funded Improving Malaria Diagnostics (IMaD) project from 2007-2012, and is currently the lead technical sub-contractor for malaria diagnostics under the follow-on USAID-PMI centrally funded MalariaCare project led by PATH (2013-2017), operating in 12 countries.


MCDI's expertise lies in laboratory technical assistance and in microscopy training and supervision. Among the key innovations that MCDI has introduced include Outreach Training and Support Supervision (OTSS) and Malaria Diagnostics Refresher Training courses (MDRT). MCDI has also supported training in rapid diagnostic test implementation and the development of national malaria slide archives in various countries.


Read more about MCDI's experience in diagnosis


Case Management

Malaria case management at the health facility and community levels is another main capability of MCDI. Under various bilateral agreements, MCDI has supported national malaria control programs and national health systems in providing quality treatment of malaria, both in the public and private health sectors. Training on case management of uncomplicated and severe malaria as well as malaria in pregnancy has been an essential component of MCDI's projects. MCDI has also helped to develop training courses to improve the quality of case management systems.


Learn more about treatment methods


Monitoring, Evaluation and Surveillance

Malaria monitoring, evaluation and surveillance is one of MCDI's key strengths. According to independent international experts, MCDI has established, in Equatorial Guinea, one of the most comprehensive and robust malaria information monitoring systems in existence today. Since 2004, MCDI has led the efforts to develop and implement PDA and later Tablet-based data collection tools to collect, process, analyze, disseminate and act upon data from annual malaria indicator surveys, from passive case reporting through the National Health Information System (established and operated with MCDI's support), from active case reporting through focused screening and treatment (FSAT) interventions, from IRS, LLIN and LSM data management systems, and from sentinel-site based entomological monitoring. MCDI's entomological monitoring systems include measuring vector abundance by species, infectivity, target site and metabolic resistance to insecticides, and behavioral resistance.


Read more about our monitoring, evaluation and control experience.


Supply Chain Management

MCDI has extensive experience in supply chain management for malaria control acquired through various means. MCDI adheres to international best-practice and standards for the procurement and management of malaria supplies. These supplies include Rapid Diagnostic Tests, Artemisinin Combination Therapies for uncomplicated malaria, injectable and other anti-malarials for severe malaria, medication for the prevention of malaria in pregnancy, vector control supplies including insecticides, larvacides, LLINs, spray pumps, etc., microscopes and reagents for laboratories, and supplies and equipment for vaccine clinical trials.


MCDI specializes in international procurement and the use of customized software and mHealth applications to quantify supply requirements, order, manage and track the distribution and consumption of supplies.


Learn more about our supply chain management systems


Elimination

MCDI's goal is to help eliminate malaria from endemic settings and ultimately to help eradicate malaria globally. In this regard, MCDI has supported the development of standard operating procedures, policies and guidelines for elimination. MCDI's elimination-related strategies have included data analysis to deploy stratified and targeted interventions that respond most cost-effectively to local transmission contexts, and the deployment of mass screening and treatment campaigns. MCDI is currently in discussions with the Government of Equatorial Guinea over border interdiction methods to prevent the importation of malaria to Bioko Island. MCDI also uses Polymerase Chain Reaction (PCR) and Loop-mediated Isothermal Amplification (LAMP) to detect lower levels of malaria parasite infections than traditional diagnostic methods permit - methods that are critical to achieving elimination in pre-elimination settings.


Read about our elimination strategies