This is the 23rd post in a blog series to be published in 2021 by the Secretariat on behalf of the AU High-Level Panel on Emerging Technologies (APET) and the Calestous Juma Executive Dialogues (CJED)

African Heads of States and Governments endorsed the “Zero Malaria Starts with Me” campaign to stimulate grassroots malaria eradication efforts in July 2018. This campaign is meant to foster social mobilisation and collective responsibility to curb the infection rate and threat of malaria transmission by 2030. It was based on the Catalytic Framework to End Human Immunodeficiency Virus - Acquired Immunodeficiency Syndrome (HIV/AIDS), Tuberculosis (TB) and eliminate Malaria in Africa by 2030. The “Catalytic Framework” underscored the fact that malaria continues to pose significant threats to Africa’s public health security. As such, the malaria epidemic can potentially derail Africa’s human capital development efforts and subsequently delay the implementation of the African Union’s Agenda 2063’s socio-economic and structural transformation roadmaps.

Noteworthy, malaria transmission cases disproportionately affect poor and young populations; killing a child every two minutes. This accounts for approximately 30% of the malaria mortality rate being in children under the age of five.[1] At the same time, the World Malaria Report has stated that Africa accounts for approximately 94% of the global malaria cases, and these were estimated to be approximately 215 million recorded cases in 2019.[2]

African governments, non-governmental organisations, civic groups, and Africa’s strategic partners have advocated and implemented smart malaria eradication investments through unprecedented partnerships at various levels so to combat malaria in Africa. Fortunately, this has resulted in progressive alleviation of malaria cases across the African continent in the past several years. However, even though there is considerable progress towards eliminating malaria transmission in Africa, there are still some gaps that need immediate attention.

The significant factors that worsen Africa’s malaria burden include increasing drug resistance of plasmodium parasite transmitting mosquitoes, limited access to efficacious interventions and stumbling health services. Unfortunately, malaria transmission cases are straining the healthcare systems in Africa, with approximately between 30% and 50% hospital admissions. This includes up to 50% of hospital outpatient visitations, most particularly in high transmission African communities. Malaria cases are costing Africa approximately US$12 billion annually, and such costs are negatively impacting socio-economic growth within African countries by 1.3% per year.[3]

Demonstrably African countries with high malaria transmission are observing higher household poverty and reduced annual socio-economic growth. For example, because of malaria transmission and infection fears, tourists turn to shy away from highly malaria infectious African countries. Consequently, such a phenomenon discourages local and foreign investments in tourism in those countries. Furthermore, high malaria infections also discourage agribusiness activities and relevant investments because of reduced labour productivity and weakened on-the-job performances.[4]

Traditionally, insecticide-treated nets and indoor residual spraying have been commonly utilised to fight malaria’s transmission cases. In addition, intermittent preventive treatments have been routinely administered to pregnant women under routine antenatal care visits. For diagnostics, rapid diagnostic tests for malaria, also known as dipsticks or malaria rapid diagnostic devices, are being used to test patients suspected to have malaria. However, even though there are positive results in curbing malaria transmission rates through these interventions, more work lies ahead for African countries.

Thankfully, there are emerging tools on the horizon with the potential to complement existing malaria prevention and control interventions. A growing example is genetically-based vector control tools. Institutions such as “Target Malaria” - a non-profit research consortium dedicated to innovative approaches to stopping malaria transmission on the continent - are working towards research and development of new genetically based vector control tools that are to be responsibly implemented. This is accomplished by developing innovative, cost-effective, and sustainable genetic technologies which can supplement existing measures and tools. In Africa, Target Malaria has partnered with governments of Burkina Faso, Cape Verde, Ghana, Mali, and Uganda in their efforts at malaria elimination.

The African Union High-Level Panel on Innovation and Emerging Technologies (APET) continues to support African Union Members States in ensuring that innovations and emerging technologies are effectively harnessed to address Africa’s challenges. Such efforts carefully and strategically consider robust safety requirements for human health and the environment for the benefit of African communities. The panel thus released a report in 2018 titled “Gene Drives for Malaria Elimination[5]”, exploring an emerging technology with the potential to combat malaria and offering recommendations on how to harness the technology effectively.

However, harnessing novel genetic technologies for vector control has presented researchers and stakeholders with several unique challenges. As such, numerous stakeholder engagements have been executed to formulate agreeable genetically based vector control implementation frameworks in partnership with local communities most likely to be directly affected by the release of genetically modified mosquitoes.

Consequently, in West Africa, where there have been high malaria transmission cases, through the support of APET, the African Union Development Agency (AUDA-NEPAD) and the West Africa Health Organization (WAHO) established the West Africa Integrated Vector Management Programme (WA-IVM). The WA-IVM promotes a multi-sectoral approach in building robust regulatory systems for genetically based vector control applications. This programme strengthens the capacity of Africa’s experts from health, environment, biosafety, and ethics to strategically implement emerging tools such as genetically based vector control applications to combat malaria transmission.

Furthermore, to observe an accelerated reduction of malaria transmission, African Member States are encouraged to consider innovative technologies and mechanisms with respect to patient healthcare frameworks and malaria transmission monitoring, evaluation, and management systems in Africa. Fundamentally, APET encourages African countries to reduce the barriers that deter the continent’s capability to monitor malaria transmission cases in rural Africa. This includes improving healthcare systems, enhancing healthcare digital technology infrastructure and reducing widespread poverty. This can be accomplished by improving communication management systems of healthcare services with better digital technologies. Such digital technologies can assist healthcare practitioners taking care of malaria patients to manage patient care better and improve efficient service delivery in malaria treatment protocols.[6]

African countries are also encouraged to adopt digital technologies such as smartphones for the communication and follow-up mechanisms of malaria patients. Fortunately, approximately two-thirds of Africa’s population has access to a mobile network, with a penetration rate of approximately 50%. This rate is reaching approximately half a billion mobile phone subscribers across the African continent.[7] Therefore, healthcare facilities can enhance the widespread utilisation of digital technology applications such as short message service (SMS), among others, to improve the strategic communication frameworks in healthcare delivery services.

Notably, sending text message reminders to malaria patients has been found as a potential intervention strategy for improving patient care adherence to medications and healthcare facility attendance.[8] Such efforts can significantly address the challenge of malaria patient care adherence so malaria patients can complete the full course of malaria treatment. Unfortunately, non-adherence to the complete malaria treatment regimen may increase the risk of drug resistance in malaria patients.

In response to SMS-based malaria-treatment-adherence research findings, a TextDirect organisation scaled up the SMS approach in Sierra Leone.[9] Consequently, simple text message reminders augmented the number of malaria patients to complete the full course of the artemisinin-based combination therapy (ACT) treatment by 5%; i.e., 66.4% completed malaria patients the ACT treatment, as compared to 61.5% of the malaria patients that did not receive any reminder messages.

African countries are also encouraged to harness fast and accurate diagnostic technologies such as the smartphone-enabled point of care testing (POCT) technological systems. The POCT technologies are fundamentally redesigning the malaria transmission and treatment monitoring systems and potentially improving testing and treatment outbreaks of mosquito-borne diseases such as malaria. This is particularly most relevant in Africa’s rural areas with lacking public healthcare infrastructure.[10] Furthermore, Novarum has developed a smartphone-based software suitable for diagnostic test reading that can significantly address challenges posed by geographical accessibility, user demographic frameworks, and limited public healthcare infrastructure. As such, the Novarum smartphone technology is enabling clinical technicians operating in the field to perform malaria tests quickly and easily on at-risk groups by simply using a smartphone. To interpret the results, an intuitive mobile application interface provides results of laboratory quality which are subsequently shared online through a secure data portal. Such intuitive user experience on mobile devices require minimal training, and end-users are effectively assisted throughout the entire testing workflow.

Digital platforms for sharing data via a mobile ecosystem is helping malaria healthcare practitioners monitor the spread of malaria infection disease and subsequently identify the “hot spots” of malaria outbreaks. In this way, African governments can effectively target the most needed medical resources in such areas and help patients monitor their own condition regularly. Furthermore, the spatial epidemiology analysis technologies can significantly help African countries understand the malaria disease’s transmission and inform mitigation processes. In addition, African innovators can consider open-source tools and data to develop technology innovations and mechanisms that can bolster malaria elimination processes. For example, the adoption and upscaling of remote mapping system derived from OpenStreetMap and open-source tools such OpenDataKit, OpenMapKit, and Humanitarian OpenStreetMap Team (HOT) to enable researchers to conduct malaria transmission fieldwork research effectively.

APET recognises the continental impact of malaria in African communities, more especially remote communities. Thus, the high-level panel is encouraging African countries to improve preventative, treatment, and patient care management mechanisms, more especially to inaccessible African communities that are being negatively impacted by the malaria transmission burden. In recognising inaccessibility to basic clinical infrastructure for at-most-risky African communities, APET recommends adopting and implementing fast and accurate diagnostic and management digital technology tools. However, these digital technologies require robust information and communication technology (ICT) infrastructure. Furthermore, there is a need to address the prohibitive expensive internet access for most African countries. APET challenges African governments to reduce the existing digital divide between rural and urban communities that hinders the effective harnessing of technologies.

In conclusion, APET acknowledges that the African continent can best benefit in the medium-to-long term socio-economic development strategies if Member States can bolster investment in the digital technology-related infrastructure to accelerate the uptake of digital technologies. Noteworthy, Africa has progressively developed effective tools for malaria prevention and treatment. With more determination and collaborative technological development efforts, the overall implementation of such tools can help African countries efficiently eradicate malaria. It is time for Africa to end malaria transmission once and for all across the continent.

 

Featured Bloggers – APET Secretariat

Justina Dugbazah

Barbara Glover

Bhekani Mbuli

Chifundo Kungade

 

[1] https://endmalaria.org/sites/default/files/sierra-leone2011-2015.pdf.

[2] http://outbreaknewstoday.com/world-malaria-report-africa-still-accounts-for-bulk-of-cases-and-deaths-68104/#:~:text=The%20World%20Health%20Organization%20(WHO,about%205.6%20million%20in%202019.

[3] http://www.africairs.net/the-malaria-burden-in-africa/.

[4]https://documents1.worldbank.org/curated/en/304221468001788072/930107812_2014082510500822/additional/634310PUB0Yes0061512B09780821387450.pdf.

[5] APET 2018 https://www.nepad.org/publication/gene-drives-malaria-control-and-elimination-africa

[6] https://theconversation.com/what-africa-still-needs-to-do-to-eliminate-malaria-76526.

[7] https://www.gsma.com/r/wp-content/uploads/2020/09/GSMA-State-of-Mobile-Internet-Connectivity-Report-2020.pdf.

[8] Ambrose O. Talisuna, Amos Oburu, Sophie Githinji, Josephine Malinga, Beatrice Amboko, Philip Bejon, Caroline Jones, Robert W. Snow & Dejan Zurovac, Efficacy of text-message reminders on paediatric malaria treatment adherence and their post-treatment return to health facilities in Kenya: a randomized controlled trial. Malaria Journal, 16, 46 (2017). https://doi.org/10.1186/s12936-017-1702-6.

[9]https://www.poverty-action.org/impact/using-mobile-technology-fight-malaria.

[10] https://www.epmmagazine.com/pharmaceutical-industry-insights/new-technology-key-in-the-fight-against-malaria/.