Making malaria history: An interview with Megan Littrell

Megan LittrellMegan Littrell is a malaria research specialist for the Malaria Control and Evaluation Partnership in Africa (MACEPA), a program at PATH. Making Malaria History sat down with Megan to discuss her work in the malaria field.

As a malaria researcher for MACEPA, how would you describe your job in a nutshell?

At MACEPA, we work with national malaria control programs on taking steps towards malaria elimination. My job is to help programs track progress and identify what is most effective by looking at the program data.

How did you become interested in this kind of work?

I studied social work and international health and development at Tulane University. At Tulane I had opportunities to work on research that had practical implications for programming. After finishing my PhD, I wanted to continue working in research that would have practical applications for global health programs. I started out with the NGO Population Sciences International (PSI), working as a research advisor for child health programs, including malaria. I learned a lot about the practical information that is needed to inform, monitor, and evaluate public health programs. I also had chance to participate in global networks such as the Roll Back Malaria Monitoring and Evaluation Reference Group. I was excited about the opportunity to join the MACEPA team and focus on malaria elimination.

What have you enjoyed most about your position so far?

I am inspired by the vision and passion for malaria elimination among the MACEPA team and its national control program partners, and I appreciate the focus that MACEPA has on working through “steps” to elimination. This is a very practical approach to implementing the right strategies for rapidly reducing transmission, until we have reached zero transmission. Where national malaria control programs have the goal of malaria elimination, these steps provide a starting point and a progression towards success. In my position, I enjoy the chance to work with data and provide information with practical implications for this progression towards elimination.

What are some key data points you look for when you analyze a malaria elimination program?

In 2005, MACEPA began with implementing the SUFI (scale up for impact) strategy, which focuses on rapid scale-up of life-saving interventions such as insecticide-treated bednets to rapidly reduce malaria deaths. These efforts were tracked at the national level through population-based surveys called Malaria Indicator Surveys. To track progress, we looked at national intervention coverage, such as percentage of households that owned at least one bednet, and on reduction of health burden—looking at changes in all-cause child mortality and malaria parasite prevalence among children under five.

Several malaria-endemic countries achieved great successes in increasing malaria intervention coverage and reducing malaria burden at national levels. Now some countries are aiming for malaria elimination. As malaria transmission reduces, it becomes more focal—which means that we find communities with substantial ongoing malaria burden next to communities with very little or even no malaria burden. So our units of data analysis must also become more focal. Instead of looking at national trends, we focus on data from much lower levels—such as health facility catchment areas.

It is also important to focus on data that is available on a regular basis. Ongoing information about malaria cases and commodities can guide rapid program action. We focus on strengthening the quality and availability of this routine data as a first “step” to elimination. We’ve done this by supporting weekly reporting of malaria case and commodity data from health facilities via mobile phones. The data go into the DHIS2—which is a common platform used for routine health systems data in Africa. These data can inform decisions about targeting responses, and making sure that malaria case management commodities are in stock at health facilities.

We also collect data as part of community-based activities, including mass test and treat (MSAT) and case investigation. This information tracks our progress towards clearing malaria infections from people, and gives us information about ongoing risk factors for infection—such as recent travel to areas with higher malaria burden, or lack of appropriate malaria prevention—such as using bednets.

We place a lot of emphasis on evidence to inform our work and track the progress, so that we can provide the evidence on what is most effective for malaria elimination in different contexts.

MACEPA is working in Western Kenya, Ethiopia, Senegal, and Zambia—all very different settings in terms of malaria disease burden. How has this created unique challenges or opportunities?

Where we work in northern Senegal, there is very little malaria burden. In western Kenya there are very high levels of ongoing malaria transmission. Where we work in Ethiopia—in Amhara Region—there are pockets of malaria transmission within areas with little to no malaria. In southern Zambia we’ve seen declines in malaria burden in recent years but there are still areas with a lot of infection. Working with this diverse portfolio is an opportunity to gain experience and learn what works for malaria transmission reduction in many contexts. As MACEPA and malaria control program partners across Africa gain experience with rapid transmission reduction, we will have the information we need to be successful in eliminating malaria across the continent.

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