Title: Smart surveillance towards malaria elimination in Mpumalanga: novel approaches for mapping antimalarial resistance
Funder: Medical Research Council

Abstract: BACKGROUND: Antimalarial drug resistance is one of the biggest threats to the control & eventual elimination of malaria. Resistance is confirmed to all currently available antimalarials. Resistance to the most pivotal antimalarial group, the artemisinins, has spread from Cambodia to, or emerged in, another five neighbouring countries across South-East Asia, nearing the Indian border - from where global spread is considered inevitable. Areas of lowest malaria transmission intensity, like South Africa, are at the highest risk of antimalarial drug resistance. In these very low transmission areas, the incidence of infection is too infrequent for development of the partial malaria immunity needed to compensate for failing treatments, & drug pressure is increased as all cases are symptomatic. Thus, the areas of lowest intensity transmission most need efficient, up to date & effective targeted information system, such as our proposed “Smart Surveillance 4 Elimination”, in order to rapidly detect & respond to emerging drug resistance, before it increases malaria transmission, morbidity & mortality & derails elimination efforts. GOAL: To develop a draft strategic plan, that can be pilot tested in Mpumalanga Province to improve malaria treatment & surveillance approaches to advance malaria elimination in South Africa & beyond. MAIN OBJECTIVE: To develop & pilot our “Smart Surveillance 4 Elimination” approach for real-time mapping of antimalarial drug resistance using novel technologies to scale up assays for molecular markers of antimalarial resistance (assayed from positive malaria rapid diagnostic tests) & integrate these data with data from individual malaria case notifications (active & passive detection), in order to identify the foci that require more intensive investigation & additional interventions to further reduce malaria transmission, as well as inform changes to malaria treatment policy & effective targeting of single low dose primaquine treatment for malaria transmission blocking. IMPORTANCE: New approaches, knowledge & skills sharing are urgently needed to advance malaria elimination in South Africa. The key challenges that need to be overcome include fragmented malaria information systems & health information systems, & very high levels of cross border migration from areas of high intensity malaria transmission, as well as the ever-present threat of antimalarial drug resistance. Developing & evaluating novel technology to consolidate & exp& current surveillance activities will provide the information needed to underst& & address these challenges. Leveraging existing resources to amplify their impact through data integration will be of great value not just for South Africa, but also for other countries working towards malaria elimination, particularly neighbouring countries within southern Africa & regional collaborations such as MOSASWA & the Elimination8. Such smart surveillance approaches could also be applied more broadly to geospatial mapping of antibiotic & other antimicrobial resistance.


Research activity codes: 2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT;5.1 PHARMACEUTICALS
Health categories: INFECTION