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#MF2024: Stakeholders strategize for a malaria-free future

April 30, 2024 08:00
#MF2024: Stakeholders strategize for a malaria-free future
Professor Tumaini Nagu, the Chief Medical Officer, delivers a keynote address at the 2024 Malaria Forum, where she was honored as a distinguished guest. Photograph courtesy of IFAKARA Communications.

The 2024 Malaria Forum, organized by Ifakara Health Institute in partnership with the National Malaria Control Program and the Zanzibar Malaria Elimination Program took place at the White Sands Hotel in Dar es Salaam.

Under the theme "Malaria-Free Future: Integrated Strategies for Malaria Elimination," this year's forum served as a hub of collaboration and innovation as stakeholders from government ministries, research institutions, academia, and innovative sectors came together to shape the path toward a future free from malaria.

Ifakara director welcomes stakeholders
The forum kicked off with a welcoming remark from the host, the Ifakara Chief Executive Director Dr. Honorati Masanja. “As we convene in this esteemed gathering, we unite in our shared commitment towards a common goal – the elimination of malaria from our communities and the realization of a malaria-free future,” he said.

Dr. Masanja expressed optimism that the forum “will serve as a platform for dialogue and exploration of technologies and approaches that hold promise for enhancing malaria control efforts. From innovative diagnostics and treatment modalities to cutting-edge vector control measures, we will examine the pipeline of tools and strategies that are poised to revolutionize our approach to malaria control and propel us closer towards elimination.”

“Each of you plays a crucial role in the fight against malaria, and your presence here today underscores the importance of collaboration and collective action in tackling this global health challenge,” remarked the Ifakara chief.

Forum officially opened by CMO
The guest of honor at the forum, the Chief Medical Officer, Prof. Tumaini Nagu, officially opened the event with a powerful speech that detailed where Tanzania stands in the fight against malaria. She also outlined opportunities to use innovative strategies for malaria control as well as challenges.

Prof. Nagu noted, "Tanzania has made significant strides in scaling up affordable and cost-effective preventive and curative interventions for malaria control and elimination, resulting in a notable shift in the country's malaria epidemiological profile." 

She pointed out the success of recent interventions, citing data from the 2023 School Malaria Parasitological Survey (SMPS) which revealed a decline in malaria prevalence among primary school children, dropping from 21.6% in 2015 to 11.3% in 2023. This significant reduction aligns with broader trends observed in Tanzania's health facilities, where malaria cases have decreased by 55% from 2015 to 2023. Additionally, malaria-related hospital admissions and deaths have declined by 61% and 69%, respectively, over the same period.

Despite these achievements, Prof. Nagu emphasized the need for intensified efforts to address emerging challenges, including climate change impacts, floods, insecticide and drug resistance, and the spread of specific mosquito strains carrying malaria namely, Anopheles stephensi.

“Despite the progress we've made, there's still a lot of work ahead to solidify these achievements and speed up our journey toward a malaria-free society...These obstacles have been slowing down our efforts to eliminate malaria, and it's vital to address them with the right tools and approaches,” she said.

Science director sets the tone
The Director of Science at Ifakara Health Institute, Dr. Ally Olotu, gave a keynote address – titled, Malaria Free-Future: Integrated Strategies for Malaria Elimination - set the tone ahead of panel discussions focusing on updating malaria control efforts, highlighting innovations for malaria elimination and financing options to fund malaria control efforts.

Dr. Olotu discussed the history of malaria eradication efforts, highlighting the Global Malaria Eradication Program (GMEP) of 1955. The program aimed to stop transmission in endemic areas using indoor residual spraying (IRS) with DDT, case detection, treatment, and surveillance. With an investment of around US$20 million, covering 40% of the world population, only 37 countries, mostly in Europe and the Americas, successfully eliminated malaria while Africa saw disappointing results, leading to the program's abandonment in 1969.

Fast forward to today, Dr. Olotu underlined the progress made through the Global Technical Strategy for Malaria (2016-2030) endorsed by the World Health Assembly in 2015. This strategy aims to significantly reduce malaria death cases, setting a bold target of reducing the malaria burden by 90% by 2030.  Guided by three pillars, the strategy's goals include ensuring universal access to prevention, diagnosis, and treatment; accelerating efforts towards elimination; and transforming malaria surveillance into a core intervention.

Dr. Olotu also emphasized the importance of customized strategies in combating malaria, stating, “There is no “one size fits all” strategy. National malaria programmes should determine the appropriate package of interventions for an area based on the stratification of transmission intensity, as well as a good understanding of the epidemiological, ecological and social features of an area. Interventions should be adapted and tailored to specific geographical areas within a country.”

The malaria situation in Z'bar

Next, the malaria situation in Zanzibar was addressed by Dr. Shija Shija of the Zanzibar Malaria Elimination Program (ZAMEP), who provided an overview of current progress, highlighting both achievements and challenges. 

"Zanzibar has made significant progress toward malaria elimination over the past 15 years, with an overall malaria prevalence of less than 1%. However, recent challenges, especially the dramatic shift in 2023 recording more than 19,174 cases, demand urgent action," remarked Dr. Shija.

To address the surge in malaria cases, Dr. Shija emphasized the need for comprehensive strategies, including increased community engagement through health workers, integrated district-level approaches covering surveillance, vector control, and case management, as well as universal monitoring of malaria case management services at all points of care.

The malaria situation in Tanzania
Dr. Samwel Lazaro, Program Manager of Tanzania's National Malaria Control Program (NMCP), presented a thorough analysis of the malaria situation in Tanzania. 

Key highlights of the presentation included discussions on program goals and performance indicators, trends in malaria prevalence, biological threats associated with malaria, the influence of climate on malaria, and advancements in malaria vaccine development.

During his presentation, Dr. Lazaro highlighted the significant progress in malaria control indicators. He noted that confirmed malaria cases in Tanzania decreased by 55%, from 7.7 million in 2015 to 3.5 million in 2023. Dr. Lazaro emphasized the importance of integrating multiple interventions, stating, "One intervention alone is not enough; we need to integrate several interventions in order to achieve our goal of a malaria-free country by 2030."

"An urgent response is needed to address challenges and stop people from dying of malaria. With current tools – such as vector control, preventive chemotherapies and malaria case management – it is possible to lower malaria case incidence and significantly reduce mortality; All we need is improving access to quality preventive and clinical care," he said.

In Tanzania, Dr. Lazaro presented data demonstrating remarkable reductions in malaria prevalence across different population groups. Among children under five years old, prevalence decreased from 18.1% in 2008 to 8.1% in 2022. Similarly, among schoolchildren, prevalence decreased from 21.6% in 2015 to 11.3% in 2023. Prevalence among pregnant women, however, has remained stable over the past five years.

Insights from panelist on actionable solutions
In another session during the forum, titled "Bottlenecks of Implementing Malaria Control Elimination Strategies" a panel of experts gathered for a critical discussion. The session was facilitated by Dr. Zawadi Mageni Mboma and Dr. Prosper Chaki from Ifakara.

The panel was comprised of a diverse range of specialists who included Dr. Susan Rumisha, Dr. Abdallah Lusasi, Dr. Safia Mohamed, Mr. Aloyce Urassa, Dr. Emmanuel Kaindoa, and Miss Jubilet Minja. Together, they shared insights on the challenges of integrating new malaria innovations and possible solutions and the current challenges facing malaria surveillance and control.

Prioritizing policies that transcends borders

"Changes in policy implementation must transcend borders," Dr. Mohamed from ZAMEP remarked emphasizing the necessity of policy changes modeled after successful strategies seen in regions like Zanzibar. "There is a need for changes in policy implementation that transcends cross border issues which will work in both parties - in Zanzibar and Tanzania, in order to eliminate malaria in both regions," she said.

Another issue discussed was the lack of adequate funds and resources required to implement effective malaria control tools and interventions throughout Tanzania. Dr. Dunstan Bishanga, Chief of Party for the PMI Shinda (Defeat) Malaria Program, emphasized this concern and shared a successful experience in addressing a similar challenge—specifically, discrepancies between reported drug dispensation and actual malaria cases.

Addressing challenges in surveillance, control

In addressing the current challenges of malaria surveillance and control, Dr. Susan Rumisha emphasized the importance of recognizing the cultural value of data. She highlighted this as a fundamental issue that requires attention, noting that data plays a critical role in providing essential information for decision-making in malaria surveillance.

For his part, Dr. Emmanuel Kaindoa discussed various innovative approaches, such as spatial repellents, eaves ribbons, and gene drive technologies, currently being explored by Ifakara for malaria vector control. He emphasized the importance of building internal technological capacity to manage these new technologies effectively, rather than relying solely on funders. Dr. Kaindoa highlighted the key role of collaboration in the development, validation, and testing of these technologies.

"It is better to understand an enemy to be able to fight against them; in this case, our enemy is the mosquitoes that is why we should try understanding the basic biology and develop interventions targeting specific components of their biology," remarked Dr. Kaindoa.

Exploring groundbreaking innovations, technologies

During another session, Ifakara scientists showcased their latest innovative projects and technologies for malaria control in a rapid-fire presentation. These projects included Emmanuel Mwanga's research on Mid-Infrared Spectroscopy, Dr. Said Jongo's advancement of monoclonal antibody technology, and Dr. Brian Tarimo's research on vector surveillance using drones and genetically modified mosquitoes. The session explored the potential deployment of these innovative approaches. The session also explored the potential deployment of these innovative approaches.

Deployment of the approved innovations

In yet another panel discussion led by Ms. Namwaka Omari, experts including Drs. Leah Ndekuka, Salim Abdullah, Samson Kiware, Geofrey Makenga, Mwaka Kakolwa, and Bill Ngasala shared perspectives on vaccines, modelling, and targeted community-based case management.

The discussion highlighted the strategic necessity of deploying approved innovations effectively within communities, with the experts emphasizing the importance of ensuring accessibility, targeted interventions, and community engagement to unlock the full potential of these innovations. 

They also stressed the critical need to prioritize local solutions and integrate the latest innovations into community-based initiatives. Specifically, the panel highlighted the significance of deploying cutting-edge tools such as WHO-recommended malaria vaccines efficiently and equitably within communities through community-based strategies.

Global and regional malaria financing 

As part of the closing panel discussion for the 2024 Malaria Forum, Dr. Masanja, the Ifakara Director, led a compelling discussion with representatives from the public and private sectors on funding malaria research and interventions, and associated policy implications.

The conversation highlighted the essential role of innovative funding approaches, encouraging stakeholders to adopt creative approaches in financing projects. Panelists included Viviane Hasselman from SDC, Dr. Faustine Ndungulile from TAPAMA, Dr. Zacharia Kafuko from 1Day Sooner, and Dr. Adiel Mushi from End Malaria Council.

For more photos from the event click here.