Fighting Malaria Together Newsletter - May 2011

Malaria burden assessment on Likoma Island, Malawi

Research teams assess the disease burden and coverage of interventions in Likoma District prior to implementation of universal coverage interventions on the island.

Likoma Island has high levels of transmission of malaria and, due to its geographical location, distribution of commodities by the Ministry of Health (MOH) is a huge challenge. Surrounded by Mozambican waters, Likoma Island is the larger of two inhabited islands in Lake Malawi. Likoma Island and Chizumulu Island have a combined population of over 10,000 people and are administered by the Malawian government. In 2010, the Government of Malawi launched a universal coverage campaign to distribute bednets to the two islands that was expected to significantly reduce operational costs for the MOH.

The Malawi Malaria Indicator Survey shows that ownership of nets has increased from 38 percent in 2006 to 60 percent in 2010 and use of long-lasting insecticide-treated nets (LLINs) by children under age five has increased 66 percent. Because of this success, the Malawi National Malaria Control Program (NMCP) revised its LLIN policy to expand from targeting pregnant women and children under five to providing universal coverage for all residents. The pilot for universal coverage was planned in three districts: Mwanza, Neno, and Likoma Island. The NMCP planned to distribute LLINs to and do indoor residual spraying (IRS) for all households on the island.

The NMCP conducted an assessment to document baseline coverage of LLINs, IRS, and malaria burden on Likoma and Chizumulu Islands. The assessment aimed to measure the disease burden and coverage rates of interventions in Likoma District prior to implementation of universal coverage interventions. During the assessment, data were collected on the number of confirmed and unconfirmed malaria cases, number of LLINs available at household level, household size, and available sleeping spaces, as well as fever prevalence and parasitemia rates among children under five years of age.

Enumerators, including professional nurses and lab technicians, were recruited from various districts within Malawi to assist with data collection at household and health facility levels. Enumerators were trained to collect data using Personal Digital Assistants (PDAs). Ten groups were formed, consisting of one laboratory technician and one nurse, supervised by the NMCP’s LLIN and M&E officers. On the islands, health surveillance assistants were able to direct enumerators to the various communities throughout the two-week field activity. Data were collected from over 11,000 households, two health facilities, one hospital, and one clinic.

One of the enumerators, Kandaluaone Macnophus Makamo, a laboratory technician based at Dowa District Hospital, shares some of the field challenges and adventures:

“The communities welcomed us very well—the statement about our coming to the island was delivered and received well by their community leaders. It emphasized the benefits of the assessment once we collect the data. Most of the households allowed us to collect the blood samples from the children, although it was hard to get the five-year-olds as most of them were at school when we visited their homes. It was sad to note that some mosquito nets were used for fishing instead by some community members; at the same time some households did have nets hanging in the sleeping spaces as well as outside. It was summer at the time of the visit, therefore the community opted to sleep outside because of the heat. It is also thought that the only vessel which travels between the island and mainland may contribute to high level of malaria on the island, therefore considerations to spray the boat regularly may be ideal.”

With strengthened messaging and communication activities promoting consistent use of LLINs on the islands, malaria cases can be reduced. The NMCP plans to conduct follow up assessments on the island during the high and low transmission seasons and compare the data. Data analysis and finalization of the assessment is currently underway. The first follow-up assessment has been planned for spring 2011 during the high transmission season.