Case Studies

Millions of Africans are killed by malaria each year. Improving malaria control through the early detection and prediction of epidemics saves lives, which is the focus of the Highland Malaria project (HIMAL). The research is managed through the DFID funded Research Programme Consortium on Applied Research to Generate Effective Tools and Strategies for Communicable Disease Control, led by the London School of Tropical Hygiene and Medicine.

Early warning of malaria epidemics

• In Uganda and Kenya, the HIMAL project has helped the national malaria programmes to develop district-level epidemiological monitoring systems, for early-warning of malaria epidemics. Desk-based studies have often concluded that this should be possible in theory, but this was the first attempt to do it in practice. Now the system is being extended to the other epidemic-prone areas of these countries, and may also be introduced in neighbouring countries with similar epidemic malaria problems.
• The HIMAL system incorporates a network of 20 sentinel health facilities which report to their respective districts on a weekly basis. The system provides an efficient flow of surveillance information between sentinel sites, district health management teams, ministries of health and relevant national and international partners.

Novel research system

• In the previous malaria control systems, the ministries of health at the central level were responsible for data analysis and feedback but this system proved too slow to be useful for timely detection of abnormal increases at local levels. The new system relies on a complete analysis and interpretation of data at the district level. HIMAL was designed to build the capacity of pilot districts and control programmes to monitor routinely the malaria situation in key epidemic-prone areas. Extensive training has led to significant improvements in staff capacity to undertake activities related to epidemic monitoring.
• HIMAL reports have already provided early warnings of abnormal case loads and have been used by the districts and centrally to ensure rapid mobilisation and specific targeting of drugs and other resources to prevent epidemics.

Malaria and climate change

• As well as addressing key and pressing operational issues of epidemic control, HIMAL also represents a platform for scientific research on the epidemiology of malaria in highland areas. Better knowledge in this area is especially important in the light of current concern over the potential links between climate change and disease transmission and the fact that malaria is often portrayed as an emerging disease in areas which have traditionally been viewed as non-endemic, including the highlands of sub-Saharan Africa.
• Recent evidence certainly does suggest that there has been an increase in the number of malaria epidemics occurring in highland areas. Various mechanisms for this apparent change in epidemiology have been put forward, of which those implicating climatic and ecological change have been most prominent. Unfortunately the lack of reliable malaria data for most highland areas has made analysis of these issues difficult, and in situations where malaria data are available, it is not always possible to separate out the effects of individual risk factors from those of potentially confounding variables. As such this research lays the foundations for effective monitoring that can help to support the evidence base of climate change as a driver of highland malaria and provide strategies to deal with the problem.

More information on HIMAL can be accessed at www.himal.uk.net.