Malaria Control and Elimination - Elimination

Development of Standard Operation Procedures (SOPs), policies and guidelines

In Equatorial Guinea under the BIMCP, MCDI is supporting the Government in its malaria elimination efforts. Our elimination strategy for Equatorial Guinea focuses on the use of surveillance and M&E data analysis and information use for the deployment of a tailored-based-made, stratified combination of interventions. Our evidence-based model allow us to prioritize areas based on

(1) Transmission intensity where parasite prevalence is the highest,

(2) Vulnerability to mosquito infiltration where the quality of housing is the poorest,

(3) Risk of importation where a high proportion of residents travel regularly to the Continent, and

(4) Demand for interventions, where control interventions will be most impactful.

A geo-referenced risk map of the Island has been developed, which enables MCDI to focus additional control interventions in hot spot communities and to restructure and de-intensify control interventions in areas where transmission is very low.

Mass Screening and Treatment

MCDI received the recognition of the Government of Equatorial Guinea for its support in reducing malaria prevalence among 2-14 year olds from a high of 73% in 2005 to 52% in 2011 through the BIMCP project. Given malaria heterogeneity, the northwest part of the island persisted as a major focus of infection. This was addressed through the implementation of Mass Screening and Treatment (MSAT) campaigns, screening 60% of the population with RDTs in an area of 1500 people, conducting BCC interventions, spraying houses and providing ACTs to positive cases. Over a six-month time frame, from March 2012 to August 21012, MCDI was able to reduce malaria prevalence from 47.7% to 24.4% in the group of 2-14 year olds, using this comprehensive strategy. BIMCP’s measurable results that have dramatically reduced the risk of death in children on Bioko Island were reported in the American Journal of Tropical Medicine and Hygiene.

Polymerase Chain Reaction (PCR) and Loop-mediated Isothermal Amplification (LAMP)

PCR and LAMP are techniques that are critical to achieving malaria elimination goals in pre-elimination and elimination settings. PCR is capable of detecting malaria parasites at levels well below the threshold that can be detected through microscopy or using currently available Rapid Diagnostic Tests (RDTs), including in pregnancy. LAMP is a simpler alternative to PCR.

Under MalariaCare, MCDI has provided policy guidance and support to the Ministries of Health to support PCR capability building in pre-elimination zones of MalariaCare countries. PCR has been used by MCDI to validate MCDI’s WHO-compliant slide sets, and as the gold standard in assessing malaria microscopy competence.

In Equatorial Guinea, MCDI is introducing PCR for the detection of parasitemia in low transmission areas where a new malaria vaccine (PfSPZ manufactured by Sanaria Inc.) is being evaluated in clinical trials conducted with MCDI’s operational support under the Equatorial Guinea Vaccine Initiative. Quantitative PCR has also been used within the Bioko Island Malaria Control Program since 2004 for entomological monitoring purposes (i.e. for species identification, sporozoite analyses, and detection of markers for resistance to insecticides).