The war against malaria has racked up some significant successes over the past half century. The testing of a new vaccine and the possibility of genetically modifying malaria-carrying mosquitoes to prevent them from reproducing have some people hoping we will soon be able to eliminate the disease. That’s likely still a long way off. It needn’t be, though, if we embrace a powerful but untapped resource for fighting malaria: the communities affected by it.
“What will really move malaria control forward is going to be the work by the unsung heroes at the community level and in district health facilities. That’s where the battle will be won or lost,” said Robert Newman, the former director of the World Health Organization’s Global Malaria Program.
As an African entomologist and malaria researcher, I could not agree more.
The World Health Organization recorded 212 million cases of malaria in 2015 (the last year with complete statistics) and 429,000 deaths from it. The burden of this disease is mostly borne by people living in sub-Saharan Africa. While we did see a 29 percent reduction in deaths from malaria worldwide between 2010 and 2015, such gains could be reversed by the rise in drug resistance in malaria parasites and insecticide resistance in mosquitoes. We need new ways to control the Anopheles mosquito that transmits malaria to humans.
Community engagement is one of them. To date, the people most affected by malaria have played only marginal roles in control efforts. And these usually end when a local control project ends. Yet communities can, and should, be more deeply involved and can actually lead the way in mosquito-control programs.
One such initiative is happening in Malindi, a town of about 200,000 residents along the southwestern coast of Kenya. It supports malaria-control activities through a program called “Mosquito Scouts.” Volunteer mosquito scouts are recruited from the community and trained how to capture and identify Anopheles mosquitoes, how to monitor the habitats where they lay their eggs, and how to kill the larvae by applying environmentally friendly insecticides. The scouts drain ditches and dispose of used and abandoned car tires — both important breeding grounds for mosquitoes. They also help distribute bed nets to households that need them. Such nets are an effective way to prevent being bitten by mosquitoes at night.
These activities have improved community awareness and built lasting relationships between the mosquito scouts and the Malindi community. Equally important, they have reduced the overall burden of malaria there. In 2002, malaria was the number one disease in Malindi, with the district hospital treating some 10,000 malaria patients. Thanks in large part to the Mosquito Scout program, malaria has dropped to the fifth most frequent disease, and the hospital treats only 500 to 600 cases a year.
In Zambia, the Malaria Communities Program trains community volunteers and gives them the tools they need to promote key messages about malaria prevention and treatment. This effort, begun in 2006, has helped the country make great progress towards eliminating malaria.
In other tropical regions where mosquito-borne diseases such as yellow fever, Rift Valley fever, Zika, chikungunya, dengue fever, and lymphatic filariasis are common, engaging local communities could contribute toward their control.
No specific guidelines exist to help governments and organizations actively involve communities in malaria control. But they could easily be established if we draw on examples of how communities have joined the fight against the disease.
The World Health Organization and other major players in malaria control could consider developing guidelines similar to the WHO guidelines for community health workers. These could offer ideas for recruiting and training mosquito scouts in communities hard hit by malaria and other mosquito-borne diseases. Involving and educating communities will lead to better understanding of disease, improve local knowledge, and help people own the malaria-control process.
In an era where there are greater resources, innovation, and political will to fight malaria, it is important that we make progress on a number of fronts — from high-tech solutions like gene drives to scaling up the involvement of communities and their citizens. Making community participation a routine and integrated component of control programs would affect not only malaria but also help bring down populations of other mosquitoes that transmit diseases such as dengue and filariasis.
Equipped with knowledge and the right tools, and supported by local and international stakeholders as well as in-country national malaria control programs, communities can lead the way towards eliminating malaria in Africa and around the world.
Janet Midega is a scientist at the KEMRI-Wellcome Trust Research Program in Kilifi, Kenya, a research associate at the University of Oxford’s Center for Genomics and Global Health, and a 2017 Aspen New Voices Fellow.