We’re pioneering a method to eliminate the malaria parasite

A maze of dirt footpaths snakes between remote villages in Zambia, crossing rivers and fields and connecting communities of straw-roofed huts. During the country’s hot and dry season, before the rains hit and the mosquitoes begin to breed, pairs of health workers and data collectors shoulder backpacks full of supplies and cover many kilometers of trail by foot each day in search of malaria.

Their search centers on malaria hotspots where high numbers of people are infected with the most deadly malaria parasite, Plasmodium falciparum. In each hotspot, they test everyone for malaria infection and, for those who are infected, provide treatment right away to eliminate the parasite from the blood and reduce the number of people who serve as reservoirs for malaria transmission. Their goal: create zones within the country that are completely free of malaria.

Moving past control to elimination

The health worker and data collector are part of an effort between the Zambia Ministry of Health and the Malaria Control and Evaluation Partnership in Africa, a program at PATH. PATH has partnered with Zambia and other African countries with endemic malaria to control the disease by strategically deploying a variety of lifesaving tools: insecticide-treated bednets, indoor spraying of insecticides, new diagnostics to find the infection, and effective medicines to treat it. The results have been dramatic. In Zambia, the rate of malaria among children under age 5 was cut in half in just two years. Now, the success of these aggressive malaria control tactics has opened the gates for a new and very real goal: to make malaria history.

PATH is partnering with Zambia, one of the most successful countries in controlling malaria, to become a testing ground for innovative steps to eliminate the parasite.

Treating malaria right away

The two-person teams continue their journey from hut to hut, spending about 40 minutes with each household. Families welcome them inside for a bowl of steaming sweet potatoes or a drink of water while the teams begin asking questions and collecting information.

When was the last time you or your child had a fever? When was the last time you slept under a bednet? They record the answers and household statistics and document the house’s geographic location in a handheld computer. Now, they have the data at their fingertips to help them track the disease and target resources effectively.

The health worker pricks each person’s finger and places a blood sample and a few drops of buffer solution on a three-inch-long plastic cassette. In about fifteen minutes, two red lines will appear if the test is positive for malaria infection, one if it’s negative. Some people who are infected may already have a fever and other symptoms, while others may be asymptomatic carriers, showing no outward signs of the illness. The health worker gives them bednets and pills for treatment, which will rid them of infection within a few days.

In this mosquito-rich climate, no one is surprised if they test positive for malaria. But it may be the last time they do, as Zambia moves toward zero transmission.

Three-step process

The mass test-and-treat approach is one part of a unique three-step process developed by PATH that is being field-tested in close collaboration with health districts in Zambia and Senegal. It includes collecting data each week on confirmed malaria cases to identify malaria hotspots and direct the delivery of diagnostic tests, malaria therapies, and other resources; helping districts plan for testing and treatment; and actively surveying catchment areas once they have achieved low malaria transmission. During active surveillance, health workers investigate all remaining positive malaria cases and test everyone in and near that household for malaria to clear up any pockets of infection.

The three-step process is just one of the methods PATH is using to fight and eventually eliminate malaria. We’re focused on controlling malaria transmission at every stage of the fight. In addition to continuing support for the delivery and best use of malaria-control tools such as bednets, insecticides, and treatment, PATH teams contribute information for decision-making on prevention and treatment approaches, and advocate for more global investment to keep the pressure on malaria and push the parasite toward elimination.

In Zambia, with the commitment of district health offices, volunteer health workers, and residents throughout the country, we’re building a new strategy for communities to stamp out a deadly parasite—and move a nation toward eliminating malaria altogether.

Photo: PATH/Laura Newman.