The scale-up of interventions such as insecticide-treated nets, indoor residual spraying, intermittent preventive treatment during pregnancy, and case management with effective diagnostics and treatment has been proven to drive down levels of parasite prevalence and mortality in areas where they’ve been deployed. But elimination isn’t possible until we can treat asymptomatic people who unknowingly carry the parasite, inadvertently facilitating its transmission to others.
To confront this challenge, the malaria community is piloting new approaches, with the aim of building on the significant progress made so far to move from malaria control to malaria elimination.
One approach, known as “active case investigation,” occurs exclusively in areas of lower parasite prevalence. An investigation is triggered by local health authorities when a patient who visits a health center or is visited by a community health worker tests positive for malaria. Health care workers will then investigate to see if there’s a new pocket of infection, treating everyone in the house where the case occurred as well as everyone in surrounding households. The goal of case investigation is to keep transmission low and prevent potential outbreaks before they happen.
In Zambia, another approach is currently being piloted in both high and low transmission areas where health workers go to a community and give every community member a dose of parasite-killing drugs whether or not they have visible symptoms of malaria. This reduces the chances that a mosquito will bite one person and transmit the parasite to someone else. This approach has worked well for other infectious diseases like trachoma and river blindness and it is currently being tested malaria in parts of Zambia. If successful, it could be scaled up nationally and then across sub-Saharan Africa.
Other approaches being piloted to find asymptomatic infections and cure them include the evaluation of new drugs and the development of more sensitive diagnostics, all while continuing to scale up existing coverage with nets, spraying, and better case management.
In the fight against malaria history teaches us that the malaria parasite is very adaptable. To defeat it, our tools and approaches must be too. But tools alone are not enough—we need to mobilize a team, including community members.