Digital Pulse - Ch 3 - Sec 1 - Mapping Malaria Risk in Africa / Atlas du Risque de la Malaria en Afrique (MARA/ARMA)

Development Issues: Malaria, Epidemiological Modelling

Programme Summary

Sub-Saharan Africa carries the highest per capita burden of disease in the world of which malaria is the single most important cause. Of global deaths attributed to malaria 90% now occur in sub-Saharan Africa. Recent advances in public health are offering new opportunities to make significant reductions in the burden of disease. However, many factors, especially endemicity, affect the choice of control methods. There is a need to rethink how endemicity is defined, and the ways to map malaria risk in order to better support planning and programming of malaria control.

MARA/ARMA collaboration was initiated to provide an Atlas of malaria for Africa, containing relevant information for rational and targeted implementation of malaria control. The MARA/ARMA initiative is non-institutional and runs in the spirit of an open collaboration. A group of dedicated African scientists, based in sites across the continent, work co-operatively towards achieving the overall objectives.

Detailed mapping of malaria risk and endemicity has never been done in Africa. Accurate estimates of the burden of malaria at regional or district level remain largely unknown. In the absence of such data it is impossible to rationalize allocation of limited resources for malaria control. The organizations objectives are to:

1. To map malaria risk in Africa.
• Through collection of published and unpublished malaria data.
• Through spatial modelling of malaria distribution, seasonality and endemicity.
2. To disseminate relevant information to national and international decision makers and other end users, in a range of useful formats.
3. To develop capacity in malaria / health GIS.

Summary of ICT Initiatives

The heart of the MARA programme is a massive information collection and data-basing project that has to date over 10 000 data points that have been collected from published and unpublished sources, through literature searches and country visits. The intellectual and monetary value of the collated data-base alone is hard to appreciate. It represents decades of malaria research in Africa, much of which was on the verge of being lost and forgotten, and certainly not being used. MARA/ARMA has provided the first continental maps of malaria distribution and the first evidence-base burden of disease estimates. There is currently hardly any major document on malaria in Africa that does not make use of MARA maps and the BOD figures produced by MARA/ARMA are now universally used.

MARA/ARMA is at the cutting edge of, and has made significant steps forward in, the geographical modelling of malaria using eco-physiological / climate / GIS (geographical information systems), as well as spatial statistical approaches. Highly original spatial statistical methods are being developed currently to strengthen the analysis of the MARA/ARMA data. The scientific aspect of the project is exemplified by no less than 13 scientific publications, largely in prestigious medical and scientific journals. MARA/ARMA maps and data allow:

• Appropriate selection of malaria control tools (different control tools are appropriate in different endemic settings);
• Evidence-based planning (a base-line estimate of people at risk or infected is needed to plan interventions and assessment studies);
• Spatial targeting (eg. where are the high-priority areas);
• Rational budgeting (eg. how many cases of malaria can be expected per administrative area).
• Adequate timing (eg. when in the year do bed-nets need to be insecticide-treated);
• Empirical assessment of control interventions (eg. how many people need to be surveyed to demonstrate a certain reduction in malaria).

MARA has made its results widely available through the regular publishing of technical reports in English and French which are available on their website - click here. They also publish and regular update a large collection of maps demonstrating the endemicity, density and seasonality of Malarial infections. Some 3000 poster sized maps of malaria models and population distribution were produced and sent to malaria control programmes, departments of health, and research institutions in all endemic African countries. All the maps are readily available by downloading them from the website and can act as invaluable resource tools

It has also developed an innovative CD-ROM – the MARA LITe CD – which is a user-friendly tool designed to access products of the MARA project. The tool was developed and produced within the Malaria Research Programme of the South African Medical Research Council, which operates as the main MARA/ARMA investigating centre.

Observations

MARA's future plans are well thought out and will continue to enhance their contribution to this pressing health problem. The following future initiatives have been presented:

• Firstly, the data collection will still be continuing for at least two more years until all avenues have been exhausted. Several countries have not yet been visited and some of the collected data have not been abstracted. The database is the major resource in this project and the collection process has to take a high priority until its completion.
• Secondly, environmental malaria models for the whole continent will be further developed and refined. This should lead to better overall malaria maps. The model could also be a useful start for predicting the possible extension of malaria as a result of global climate changes.
• The final product of the MARA/ARMA collaboration will be an atlas of malaria risk for the whole continent, both in a book version and in digital format, that will contain country maps of endemicity, seasonality, as well as available vector distribution maps. It is envisaged that other related data, such as drug resistance or bed net use could also be included, when available. Eventually, the electronic version will be placed on the Internet for general use. The aim is that the digital atlas will allow for constant updating, extracting, querying and refining of malaria risk distribution in Africa.
• Finally it is hoped that this collaboration serves as a model for other large-scale disease information systems in Africa and in other developing countries.

Partners: International Development Research Centre of Canada (IRDC), South African medical Research Council, The Wellcome Trust – UK, Swiss Tropical Institute, WHO, Multilateral initiative on Malaria, Roll Back Malaria.

Source:MARA website.

For More Information Contact:

Administrative Support

Main Coordinating Centre

South African Medical Research Council

P.O. Box 17120, Congella, Durban, 4013, SOUTH AFRICA

(Tel) +27-31-2043600 (Fax) +27-31-2043601

martinc@mrc.ac.za