Although new drugs, vaccines and other interventions are always needed, many excellent tools and disease-control strategies already exist. More extensive use of these strategies could have a major impact on the burden of poverty-related infectious diseases in sub-Saharan Africa.

Malaria infection during pregnancy has a devastating impact on health outcomes for mothers and infants, leading to severe maternal anemia, low infant birth weight, preterm delivery and stillbirth. It is one of the most common causes of spontaneous abortion.

IPTp-SP is a clinically proven, safe and cost-effective life-saving medical intervention for the prevention and management of malaria in pregnancy, yet efforts to scale up this intervention have been limited. To achieve effective coverage of IPTp-SP in Kenya, Revive-IPTp will increase the understanding, capacity and willingness of programme implementers and healthcare providers to promote use of SP in IPTp.

The project also aims to increase community engagement on IPTp and promote self-care by pregnant women. A third aim is to strengthen the capacity of county government bodies to deliver and monitor IPTp-SP interventions in the decentralised healthcare system in Kenya.

We will leverage relevant national and regional committees/working groups to promote this work and to facilitate the use of the evidence generated, and similar approaches, beyond Kenya.

The Revive IPT-p project was awarded a grant from EDCTP in 2019. What is the (short- and long-term) expected impact of this project? 

In the short term, we expect to see an increase in uptake of IPTp among vulnerable and hard-to-reach populations in the target counties who are usually unable to access antenatal care services in a timely manner and/or make the recommended number of visits. Increasing the number of pregnant women in malaria-endemic regions of Kenya who receive IPTp routinely will, in turn, contribute to reductions in malaria-related morbidity among all pregnant women in the target counties and communities.

In addition, the project will improve the functioning and delivery of IPTp interventions at the county level. It will also lay the foundation for the revitalisation of IPTp in Kenya and selected countries in sub-Saharan Africa experiencing similar challenges through the uptake of evidence to improve MiP policy implementation and ultimately strengthen delivery of the IPTp intervention.  

The Revive IPTp project aims to revitalise and support the effective delivery and uptake of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment (IPTp) of malaria in pregnancy (MiP) in Kenya. Why is this important and how will the project facilitate the uptake and scale-up of IPTp in Kenya and elsewhere in sub-Saharan Africa?

Malaria continues to be a major public health challenge. In 2018, an estimated 405,000 people lost their lives to the disease (World Malaria Report 2019). Children under the age of 5 are especially at risk, and the most intense malaria transmission occurs in West and Central Africa during and shortly after the rainy season. Seasonal malaria chemoprevention (SMC), an intervention introduced in 2012, is a proven strategy developed specifically for children living in these areas, and is recommended by WHO.

The use of SMC was rapidly expanded through the ACCESS-SMC project and National Malaria Control Programmes (NMCPs) supported by international funders. The project showed marked reductions in the number of uncomplicated malaria cases, severe cases, and deaths in hospital due to malaria when SMC was introduced. Sulfadoxine–pyrimethamine plus amodiaquine (SPAQ), given to children once a month for a 3- to 4-month period each year, do not provide complete protection, but the benefits are clearly visible, and the strategy has been welcomed by communities. Door-to-door delivery has been successful in reaching sections of the community that normally have the poorest access to health care.

In 2019, 85 million treatments were administered in 13 countries, reaching an estimated 22 million children, and in 2020, SMC programmes are targeting 30 million children. The challenge now is to ensure that within the areas where SMC is being implemented, it is done effectively, so that all children are reached and are receiving all their monthly treatments.

How will the project strengthen the implementation of SMC in sub-Saharan Africa? 

Very high coverage is possible through door-to-door campaigns, but this is not being achieved everywhere. The reasons vary, and operational research is needed to understand the local challenges and the steps needed to address them. It is important to keep the interval between cycles to strictly 28 days, and in some areas, four-monthly cycles are not enough to cover the high-risk period, requiring the number of cycles to be increased. There is an urgent need to close these gaps and to optimise SMC delivery to protect all eligible children.  

The OPT-SMC project aims to contribute to this goal by strengthening the capacity of national programmes to conduct implementation research, adapt SMC to the local context, and improve its delivery and impact. The project will support NMCPs in West Africa and Central Africa in the conduct of implementation research on SMC, by providing grants and technical assistance, and by promoting the sharing of information and expertise between countries. The participating countries are Benin, Burkina Faso, Cameroon, Chad, The Gambia, Ghana, Guinea, Guinea Bissau, Mali, Mauritania, Niger, Nigeria, Senegal and Togo, and they will work in partnership with the University of Thiès in Senegal, TDR (WHO’s Special Programme for Research and Training in Tropical Diseases), the Medicines for Malaria Venture (MMV), and the London School of Hygiene and Tropical Medicine (LSHTM).   

Why is seasonal malaria chemoprevention (SMC) important?

The OPT-SMC project was awarded a grant from EDCTP in 2019. What is the (short- and long-term) expected impact of this project?

Maintaining effective malaria prevention is important especially in 2020, as there is a risk that malaria mortality in children could increase due to the COVID-19 pandemic if it restricts access to health care. Steps can be taken to deliver SMC safely; these must include adjusted messaging to keep the community informed while respecting distancing measures during training and during door-to-door delivery. OPT-SMC has produced training videos to show how to deliver SMC safely, which can be shared via Whatsapp as a job aid for drug distributors, and is working with countries to monitor SMC delivery during this year.

In the longer term, the project aims to strengthen capacity of national malaria programmes for implementation research, to improve SMC delivery and impact, contributing to reducing the burden of morbidity and mortality caused by malaria. The skills gained from this project are transferrable to other areas within the health care sector and will contribute to strengthening health systems.

Mozambique used mass drug administration (MDA) in combination with indoor resisual spraying in a low-transmission area in the south (Magude District), which showed that MDA is a major accelerator of malaria elimination in a setting with very similar epidemiological characteristics to the area covered in the current grant. Although there was a huge reduction in malaria incidence and prevalence, elimination was not reached due to several reasons, including suboptimal coverage of the interventions, persistently missed and hard-to-reach populations, importation of infections from surrounding areas, and changes in the vector and vector behaviour.

The current project, being programmatic in nature, will try to overcame these barriers by taking the lessons learnt from the Magude project and designing the implementation strategy accordingly. Also, as implementation is being led by the National Malaria Control Programme (NMCP), this  may elicit greater cooperation from community leaders and participants, increasing coverage and therefore impact.

In addition, we will need to adapt our interventions to the current COVID-19 pandemic. As for the relevance to higher transmission areas, this project is aimed at developing implementation strategies for MDA in low to moderate transmission settings, building on lessons from the Magude project. However, lessons regarding implementation will certainly contribute to improving MDA in higher transmission areas, such as those expected to be covered by emergency MDA in the context of COVID-19-related disruptions to health systems.

The ADAM project was awarded a grant from EDCTP in 2019. What is the (short- and long-term) expected impact of this project?

The anticipated short-term impact, based on previous experiences, is a rapid reduction in the prevalence and incidence of malaria in the implementation area, reducing the expected number of malaria cases by about 75%. This should inform the development of national guidelines for the incorporation of MDA into the Mozambican Malaria Policy.

In the long run, drastic declines in malaria burden in additional districts in Mozambique using MDA will advance progress towards malaria elimination. In addition, as malaria-related fever is one of the main reasons to seek health care, a rapid decline in the burden of malaria at the community level may have indirect benefits for the normally overcrowded health facilities in malaria-endemic areas. This additional benefit may help to focus the attention of the health system on other causes of fever, once malaria incidence is reduced.

What are the current challenges for the implemention strategies needed to eliminate malaria in low transmission areas in Mozambique? How will the project address them? Are these strategies also relevant for medium to high transmission areas in Mozambique?