ENSURE: Enhanced surveillance for control and elimination of malaria in the Philippines

Malaria remains a problem in many parts of the world. Even in countries where the level of infection is low, malaria can still cause death and there is the constant threat that drug and insecticide resistance may undermine any ongoing control attempts such that malaria comes back. 

A major complication for control programmes when infections are rare is identifying where transmission is actually occurring. This is because the current methods used to diagnose malaria are not sensitive enough to detect all infections and miss a substantial proportion. Although these infections that are missed may not cause illness, they can still lead to infections in mosquitoes and therefore maintain malaria transmission in the area. It is an expensive process for many poorer countries to try and actively find all these cases, and so more flexible approaches need to be used to identify where infections are happening so that they can be targeted effectively. 

The Philippines is a prime example of a low transmission setting. The country has recently experienced a reduction in annual malaria cases (from over 36,000 local cases in 2000 to fewer than 5,000 in 2014), but despite this progress, 54 out of the 81 provinces remain endemic of malaria, putting 14 million people at risk of the disease. Novel approaches and more sensitive methods are needed to detect if and where any remaining transmission might occur. With drug resistant parasites circulating in some countries in South East Asia, targeting transmission in the Philippines through an integrated surveillance system is particularly important and probably the most effective approach to address this issue. 

The study we will use molecular and serological analysis of samples collected from regular surveys of facility attendees in three areas of the Philippines to generate data on infection and exposure in the community. These data will be combined with routinely collected epidemiological data, which we will embellish using enhanced tablet computer-based maps to create iteratively improved maps of areas where transmission is occurring. The researchers will work closely with the malaria control programme on laboratory and facility aspects to ensure successful implementation, training and include improvements or changes identified as work progresses. 

UKRI project details

Health Systems
Surveillance

Jan 2016 — Dec 2018

$561,849

Philippines

Malaria Molecular Surveillance (MMS)