Mozambican Alliance Towards Elimination of Malaria (MALTEM)
The objective of this project is to generate scientific evidence and provide technical, operational and economic support to assist the Mozambican National Malaria Control Program (NMCP) to design and evaluate new strategies to eliminate malaria in the south of the country (provinces of Maputo, Inhambane and Gaza).
Three provinces in Southern Mozambique (around 4M people) will be supported to eliminate indigenous cases of malaria by creating sustainable mechanisms to support the national government in elimination planning, advocating for additional resources, improving surveillance systems, and using mass drug administration targeting the parasite reservoir.
Mozambique is among the ten countries with the highest burden of malaria worldwide, with a prevalence of infection in the population that ranges from 3% to more than 50% depending on the area. In 2016, an estimated 8 million cases and 14,000 malaria deaths occurred in the country. The main tools to control malaria include the use of mosquito nets impregnated with long-lasting insecticide, indoor spraying with insecticides and the diagnosis and adequate treatment of cases, and have been shown to achieve a significant decrease in transmission. However, these strategies are not sufficient to achieve malaria elimination.
1. Preparatory phase (September 2014 to August 2015) a census and a malaria infection prevalence survey were conducted to obtain community baseline data. Epidemiological and entomological surveillance systems were established. During this phase, two studies were performed in the neighbouring district of Manhiça to evaluate the efficacy of chloroquine and the prevalence of G6PD deficiency for the use of primaquine, to inform about their potential use in future elimination interventions.
2. Phase I (August 2015 to June 2017) implementation of the first set of interventions aiming at interrupting transmission. One round of IRS followed by two rounds of MDA were implemented during two consecutive rainy seasons. A community engagement campaign was also conducted to increase the use of LLINs and maximize acceptance of IRS and MDA. The census was updated in 2016 and two more malaria infection prevalence surveys were conducted at the end of each transmission season (May 2016 and May 2017).
3. Phase II and transition to programmatic mode (July 2017 to September 2019) implementation of a second set of interventions aiming at sustaining the gains achieved during phase I through the deployment of three more annual rounds of IRS at the end of the dry season of 2017, 2018 and 2019, coupled with rfMDA established in July 2017; a universal LLIN distribution conducted by the NMCP in December of 2017; two parasite surveys in May of 2018 and 2019; and another census update at the end of 2018.