Researchers and Donors Collaborate to Ensure the Fight Against Malaria is Informed by Quality Data

Cover photo: Accurate data is important for planning malaria control activities, such as distribution of medicine to young children in Nigeria to prevent malaria. Photo credit: Valentine Edoziem, Breakthrough Action Nigeria

“The goal for the National Malaria Elimination Programme is to reduce malaria burden to pre-elimination levels and bring malaria-related mortality to zero” says Dr. Perpetua Uhomoibhi, the National Coordinator at the Nigeria National Malaria Elimination Program.

Malaria surveillance, which collects and analyzes data on malaria cases and deaths, is a critical tool in the effort to fight malaria. National malaria programs and their partners use surveillance data to design programs, target high-need geographies, and evaluate the impact of their activities.

However, the utility of malaria surveillance data largely depends on the correct recording and reporting of rapid diagnostic tests (RDT) results. RDTs are the most commonly-used tool for diagnosing malaria in Sub-Saharan Africa.

According to Dr. Uhomoibhi, “Nigeria expects to see a gradual reduction in malaria incidence due to interventions the country is implementing like distributing insecticide-treated bed nets and providing preventive medicine to children to protect them from malaria during peak transmission seasons. However, in looking at the data in our health management information system, it seems as if the number of individuals testing positive for malaria has not recorded a considerable decrease.”

This challenge is not unique to Nigeria. Malaria RDTs were introduced over two decades ago and are now widely used throughout Sub-Saharan Africa with 255 million suspected malaria cases tested by RDT each year. Despite the widespread use of RDTs, many countries have reported challenges with the interpretation, recording, and reporting of test results that lead to erroneous results and reports. There are several factors suspected of contributing to the discrepancies including healthcare workers providing antimalarial medicines to individuals with negative test results due to a lack of other medications to treat fever, provider caution due to the deadly nature of malaria, and distrust of RDT results. To date, there have been few studies that directly measure the discrepancy between actual RDT results and what is recorded in health facility registers.

Nigeria is one of four countries, alongside Benin, Côte d’Ivoire, and Uganda, implementing a study co-funded by the U.S. President’s Malaria Initiative (PMI) and the Bill & Melinda Gates Foundation to assess the accuracy of malaria surveillance data captured within public health facilities, potential root causes of data inaccuracies and reporting of RDT results, and design solutions in two focus countries.

The need for research in this area initially emerged through a country-driven research prioritization process. Multiple national malaria programs and experts from malaria-affected countries identified the importance of research to test and evaluate different approaches for improving health management information system data quality. PMI and the Bill & Melinda Gates Foundation were both interested in supporting a study that would address the research priorities of malaria-affected countries. Coming together to co-fund this research has allowed the two organizations to expand the geographic and technical scope of the study, while avoiding duplicative efforts.

“The PMI resources allocated to this research topic would have supported the study in two to three countries. With the co-funding from the Bill & Melinda Gates Foundation, we were able to expand the study to cover four countries and incorporate a second phase where we will test potential solutions that emerge from the first phase,” said Frank Burkybile, Senior Malaria Technical Advisor at PMI. By researching the question across four different countries, the research team will be able to better assess the scale of the issue, as well as the root causes and drivers of the problem in different contexts.

With joint support from PMI and the Bill & Melinda Gates Foundation, the PMI Insights project is partnering with research institutions in each of the four countries to lead the malaria rapid diagnostic test capture and reporting assessment (MaCRA) study in their respective countries. “The research partners selected for this study bring decades of experience conducting research in the countries they live and work in,” explained Burkybile.

“With demonstrated scientific expertise and leadership within their respective countries, our research partners are well-positioned to produce evidence that is trusted, owned, and acted upon at the national level,” said Kim Lindblade, PMI Insights Technical Director.

Results from the study are anticipated in early 2024. The uptake and use of research findings will follow, including an anticipated study to evaluate the impact of an evidence-based intervention drawn from the first phase of the study. The intervention will be implemented in partnership with the national malaria programs in one or more study countries.

Looking towards the potential use and impact of the results in Nigeria, “we hope that the study findings will inform policy decisions and guide us on interventions to address the root cause of this issue across various states and health facilities,” said Mr. Onyebuchi Okoro, Monitoring and Evaluation Officer at the Nigeria National Malaria Elimination Program.

Collaborators

Centre de Recherche Entomologique de Cotonou, Benin

Institut National de Santé Publique, Côte d’Ivoire

Sydani Group, Nigeria

Makere University, Uganda

Programme National de Lutte contre le Paludisme, Benin

Programme National de Lutte contre le Paludisme, Côte d’Ivoire

National Malaria Elimination Program, Nigeria

National Malaria Control Program, Uganda

 

Launched in October of 2020 by the President’s Malaria Initiative, PMI Insights works to generate evidence and data to inform the global malaria community of best practices; to identify and facilitate stakeholder alignment around the most pressing gaps in malaria control and elimination policy, strategy, and implementation guidance; and to disseminate of results in a clear and actionable way.