The promise of precision in global health
India has the fourth highest malaria burden in the world. Yet, among the 11 countries with the highest burden, India was the only one to have reported a reduction of 24% in malaria cases between 2016 and 2017.1
This recent progress was largely due to substantial reductions in malaria cases in Odisha. Through persistent efforts and innovative approaches, Odisha achieved an 80 percent reduction in cases in less than one year.2 Its success is due to innovative approaches in expanding access to diagnostics and treatment, strengthening data collection, distributing 11 million bed nets and improving health care worker skills. For example, Odisha trained 47,000 Accredited Social Health Activists (ASHAs) to reach its most vulnerable citizens with rapid diagnostic tests (“RDTs”) and other life-saving malaria interventions.3
Sustaining this progress to achieve malaria elimination will require robust and accurate data. With strategic use of data, health officials can make better decisions about where to deploy the most effective malaria control tools. And rapid diagnostic tests are the frontline first step of data collection that can provide baseline information for Odisha's and India’s malaria surveillance system.
Worldwide, the emerging concept of "precision global health," driven by data, is changing the way we combat and ultimately eradicate diseases, including malaria.
Malaria is one of the world's oldest, deadliest diseases. Defeating it will require a new approach that allows us to find and map the parasite using diagnostics and real-time data to develop highly tailored solutions that respond to local conditions. Until recently, fighting malaria has been a guessing game. Without practical, point-of-care diagnostics, in many countries malaria treatment was given to patients based solely on presentation of clinical symptoms — such as fever during a malaria epidemic — and without any test confirming whether or not the patient actually had the disease.
Then, in 2010, the World Health Organization recommended using innovative rapid diagnostic tests or traditional microscopy to confirm all suspected malaria cases before treatment.
Unlike microscopy, where samples need to be sent to a lab and results are often unavailable for several days and even weeks, rapid diagnostic tests are portable and can be administered by frontline health workers in the most remote of locations. Results are available within minutes. Suddenly, it was possible – and practical – to test before administering treatment.
For those who test positive, the benefits of an accurate diagnosis are clear; they can begin treatment immediately, which also helps stem the disease from spreading to others.
Quick, accurate negative diagnoses are just as important. They allow health workers to address other ailments and reserve treatment for those who actually need it. This can help reduce the chances of the malaria parasite developing resistance to anti-malarial drugs.
RDTs, along with other life-saving interventions like bed nets and antimalarial drugs, have helped contribute to one of the best global health success stories to date – 7 million lives saved and more than 1.3 billion malaria cases prevented since 2000.
Sujata Karan, an ASHA in India, recently explained the RDTs revolutionary impact: "It used to take 15 days to complete the test. Using a rapid diagnostic test, we get the test result in 15 minutes. These days, people don't die because of malaria like in the past."
New generation RDTs can accelerate the end of malaria
With the advent of new, more sensitive RDTs, we can be even more precise in combatting this disease. The earlier generation of RDTs detected malaria in people who showed symptoms, but often failed to do so in people who were asymptomatic. New generation RDTs are up to 10 times more sensitive than standard RDTs.
New RDTs can also digitally connect data to central health databases. Using smartphone-based technologies, health workers can log test results, patient demographic information, place, time, and other data.
Armed with this information, health officials can then identify malaria hotspots in near real-time and respond accordingly. They can cross-reference that data with other information — for example with weather or human mobility patterns — to predict where the disease may spread next.
In Uganda, Abbott, a health care technology company, is supporting an extensive pilot program deploying a high-sensitivity RDT with these new smartphone-based capabilities. The technology will log location details for patients who show malaria symptoms and test positive. Then, health workers will visit to test everyone in the household and link all individuals who test positive to treatment. This combination of real-time surveillance and high-sensitivity tests is an exciting prospect for malaria programs worldwide.
If successful, the pilot could provide a template for clinicians and public health workers battling other infectious diseases, including HIV/AIDS and typhoid fever.
Governments, global funders and foundations, together with industry, must provide the underlying investments required to support these new innovations and get them into the hands of health workers on the frontlines of the fight against malaria.
This "precision" approach, coupled with other innovations like next-generation treatments and vector-control technologies, represent a new model for disease elimination and helps support the mission of WHO and Malaria No More that no one has to die from a mosquito bite.
1 WHO World Malaria Report 2018
2 National Vector Borne Disease Control Program data
3 https://www.who.int/malaria/news/2018/india-elimination-odisha/en/
*Originally published on devex.com
