Monthly Archives: September 2014

Maps of Malaria Hotspots to Save Lives

30 September 2014

Major Progress in Malaria Fight

Malaria is one of the world’s biggest killers. In 2010, an estimated 660,000 people lost their lives to the disease – most of them children in Africa, where a child dies from malaria every minute.

Until recently, however, it was difficult to access information about the locations of Africa’s malarial hotspots or how they are influenced by the weather there. Information about the continent’s malaria distribution was scattered across published and unpublished documents, often gathering dust in libraries.

But now, thanks to a digitised malaria mapping database that brings together all available malaria data, the disease no longer has the ‘blind killer’ status of past decades. MARA – Mapping Malaria Risk in Africa – was launched in 1996, with initial support of US$10,000 from the WHO’s Special Programme for Research and Training in Tropical Diseases to map information on malaria prevalence across Africa. The project’s first phase (1997-1998) aimed to produce an accurate atlas of malaria risk for Sub-Saharan Africa.

The project was set up as a pan-African enterprise, not owned by any specific organisation but coordinated by South Africa’s Medical Research Council, in the spirit of open collaboration.

A group of scientists, based at institutions across Africa and Europe, worked together on the project. Further funding came from donors including Canada’s International Development Research Centre, the Wellcome Trust, TDR and the Multilateral Initiative on Malaria (MIM), and the Roll Back Malaria Partnership. African institutions contributed through expertise, staff time and facilities.

Five regional centres – each using a standardised data collection system, were established across Africa. French-speaking West had an office in Bamako, Mali, while English-speaking West had a base in Navrongo, Ghana. Yaoundé, Cameroon hosted the Central Africa office; Nairobi, Kenya hosted the East Africa post and Durban in South Africa became home to the Southern Africa centre.

The project built expertise among local malaria control staff to enable them to reference the collected data, and it trained epidemiologists, medical doctors and researchers. In total it trained: 33 people to use GIS (geographic information systems) and databases, 23 to study climate change effects on the spread of the disease and 45 to interpret the results for people who might want to use them. Eight people got master’s degrees and PhDs on malaria.

The mapping project tracked down information on malaria prevalence from both published and unpublished sources to identify malarial mosquito hotspots, disease prevalence and the weather conditions that fuel transmission.

The MARA database contains more than 13,000 malaria prevalence surveys collected over 12,000 locations: with 37 per cent in Southern Africa, 33 per cent in West Africa, 25 per cent in East Africa and five per cent in Central Africa. The data remains live but no new material is being added.

The project then disseminated this information to national and international policymakers, distributing 3,000 poster-sized malaria distribution maps to malaria control programmes, health departments and research institutions in malaria endemic countries.

Whereas previously the absence of centralised records had made choosing appropriate solutions very difficult, the new data systems help countries identify transmission periods, implement control programmes and tailor control measures according to individual contexts – which also saves valuable resources. Rajendra Maharaj, director of the Malaria Research Unit at South Africa’s Medical Research Council, says the project has a strong legacy in the support it provides for the planning of malaria control programmes.

Konstantina Boutsika, an epidemiology and public health researcher from the Swiss Tropical and Public Health Institute (Swiss TPH), in Basel, Switzerland, where the database is now hosted, says the original maps are still available as downloads from the MARA website, as is a CD-rom developed by South Africa’s Medical Research Council to enable easy access to MARA project data.

Boutsika, who has been at MARA’s helm from 2006, says a project highlight is the first accurate assessment of the malaria burden in Africa, which has been made possible by advances in geographical modelling. “We can now give useful answers with regards to malaria,” she says.

MARA has made its results available through the technical reports published regularly on its website in both English and French.

The programme’s main beneficiaries have been identified as scientists, malaria control programme staff and local communities.

Maharaj says the scheme helps alleviate disease and death, especially in children and pregnant women, and has contributed to the efforts to reach the sixth Millennium Development Goal on combating HIV/AIDS, malaria and other diseases.

MARA was also one of 700 projects – selected for their exemplification of practical solutions to challenges – presented at the EXPO2000 world fair in Hanover, Germany. The programme owes its success to its strong team of investigators from participating organisations, Maharaj says: “The big lesson was inter-country collaboration, which is essential for malaria control”.

It has not all been smooth sailing, however. The main challenge was the collection of non-digitised data, explains Maharaj.

“But this was overcome by teamwork, whereby malariologists from all walks of life worked within ministries, academic and scientific institutions to source data that was stored in archive boxes, university libraries and government storerooms,” he says. And Boutsika adds that obtaining funding to sustain the programme was difficult because harmonising various databases required a heavy investment.

When funding for research ran dry in 2006, the project was given a new lease of life by the Bill & Melinda Gates Foundation and Swiss TPH, and moved from Durban to Basel, where phase II was launched. In 2009, the software team at Swiss TPH merged the MARA databases from phases I and II and developed a new web interface.

Since then, the MARA database has been in the public domain accessible to registered users and can be downloaded in different formats. Boutsika says researchers individually continue to collect data in Africa and use the MARA database as a sounding board.

[Courtesy AllAfrica News]

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Liberia: Ebola Hits Family – Personal Stories

International news reports about Liberia leave the impression of overwhelming irrationality in response to the Ebola crisis. It’s true that fear has provoked unfortunate incidents. But many Liberians are working hard and courageously – despite the lack of an international response that would supply the equipment and medical help to stem the virus.

Ebola hit close to home – hard – this month. Two members of my church – one a nun and the other a social worker who had been under 21-day quarantine and observation – both died.

My cousin Enid, an emergency nurse with the health ministry, was under surveillance as well, after coming into contact with an Ebola patient. She was assigned to Kakata, a densely populated trading town in Margibi County, where several health workers had already died and health facilities didn’t have enough personal protective supplies. Our family was worried about her.

Now, she, too, has died. On her Facebook page a few weeks ago, she posted, “Ebola has hit Margibi again. More health workers are being affected this round 2 and some are even dying. Oh God have mercy.” Our family and friends will remember that she caught the virus trying to save others. Rest In Peace, Enid.

But personal losses aren’t stopping Liberians from trying to help ourselves and each other. Whatever you hear about the situation, you should know that people may be frightened, but most of us are working hard to stop the virus.

Ebola has become a household word. When the first case was reported in the northern Lofa area in late March, the chief medical officer, Dr. Bernice Dahn, warned that “the disease is reported to be spreading along the border” Liberia shares with Guinea and Sierra Leone.

Almost every Liberian citizen now knows what Ebola is. Many believe that the virus is real and are taking preventive measures, while others are in denial. But these people who are denying the existence of the Ebola virus in the country still follow the preventive measures, which baffles me.

“I don’t understand some Liberians”, said one of my friends, Derek Berlic. When I asked him why, he said, “Some people go around saying that the virus isn’t real, but yet still they join us and wash their hands and use sanitizers as frequently as those of us that believe that the virus is real.” He said it pleases him when he sees these individuals taking preventive measures, because it signals that somewhere in these people minds, they believe the virus is real, even if they don’t want to admit it.

Most churches have joined the fight against Ebola by carrying on awareness campaigns, talking about it during sermons and placing buckets of water at entrances of the church buildings for members to wash their hands before entering for service. Both Christian and Muslim religious leaders have called on all Liberians to pray for the country – and, at the same time, to take their own preventive measures.

Supermarkets, shops and other business centers are following suit. The three mobile phone companies in Liberia have been using SMS to sensitive their subscribers by sending daily text messages about the virus. Across cities and towns, Liberians have organized themselves in various communities and are promoting awareness.

It seems that almost every Liberian has now become his or her ‘brother’s keeper’ by carrying on sensitization in taxis, clubs, and market places – wherever they find themselves. On Facebook, many Liberians have made their profile pictures Ebola related and their statuses feature awareness messages on a daily basis. Liberian groups on Facebook discuss the situation.

Liberians in the diaspora have organized themselves into mini-groups to send aid, such as gloves and other personal protective equipment, back home to fight this deadly disease. The Liberian ambassador in Washington DC, Jeremiah Sulunteh, announced that the embassy had established an account for those who want to donate.

The alarmingly high death rate from the Ebola virus among health workers has left citizens wondering how they will get medical care for many common illnesses, which can be deadly also, such as malaria. Bodies of suspected Ebola victims being left in the streets or in houses adds to the anxiety.

In this situation, it’s hard to prevent suspicion and misinformation. There were stories of some individuals going around putting dangerous chemicals such as formaldehyde in wells in various communities. The result is that Liberians had to worry about poisonous chemicals being put into water sources as well as about the Ebola virus; but Police Director Col. Chris Massaqoui has since denounced the rumor. He said the police found no evidence that the stories were true.

The president of Liberia, Madam Ellen Johnson Sirleaf, has addressed the nation multiple times, including announcing a three-month state of emergency. She said, “Under the State of Emergency, the Government will institute extraordinary measures, including, if need be, the suspension of certain rights and privileges.”

The government has passed a regulation for only three persons to sit in the back of a taxi to avoid close contact, but even at that, one can’t possibly avoid touching or rubbing against other passengers. On a daily basis, securing transport is a rush-and-fighting thing, which involves considerable contact with other people who are also trying to get a taxi or bus. In my case, the trip to work usually takes two different commercial vehicles. So movement from place to place has become worrisome. Still, people have no choice but to do it.

And there are positive things every Liberian can do. So this is how I spent my weekend. With the organization Girls As Partners, I managed to reach out to ten different churches in the Gardnersville area of Monrovia, giving them buckets, chlorine and soap so their members could adhere to one of the Ebola preventive measures – washing hands. We also gave out leaflets containing facts about Ebola and its prevention.

We’re in the rainy season now, and we had to walk through small rivers to get to some churches, but it was really fun reaching out to others. Would you believe someone was brave enough to ask me whether I had a political motive for doing this? Nevertheless, I say let’s all be our brothers’ and sisters’ keepers and kick Ebola out of Liberia!

[Courtesy AllAfrica News]