Intervention Studies and Implementation Research

Malaria interventions that have been tested in laboratory studies and randomised controlled trials are candidates for large-scale implementation to reduce the burden of malaria and eventually achieve elimination. These may can be it vaccines, drugs, diagnostics, vector control measures, or even surveillance-response systems. However, whether or not an intervention will make a useful contribution on a large scale depends on additional considerations, particularly on the intervention’s effectiveness and cost-effectiveness in the “real world”.

At Swiss TPH, we validate promising malaria interventions in large-scale field studies, and conduct implementation research to understand what is required to make an intervention work effectively in a particular health and social system. In doing so we generate scientific evidence to support decision makers at local, national and global levels.

Children with severe malaria need immediate injectable treatment to prevent death and disability. For children living in remote areas, the World Health Organization recommends artesunate suppositories to bridge the time until the sick child reaches a hospital. This emergency treatment has shown promising effects in a clinical trial. In a large-scale study in DR Congo, Nigeria and Uganda, we found that the protective effect of pre-referral rectal artesunate was undermined by shortfalls in referral systems, and in post-referral treatment at higher-level health facilities. The findings led to a review of WHO guidelines. Read more

In countries approaching malaria elimination, individual case-based surveillance and targeted response to individual malaria cases becomes a cornerstone of malaria control and elimination efforts. We investigated to what extent Reactive Case Detection implemented by the Zanzibar Malaria Elimination Programme (ZAMEP) can detect and eliminate malaria infections and contribute to malaria elimination on the islands of Zanzibar, Tanzania. We found that low-density infections in the community, and imported cases from outside of Zanzibar require additional complementary interventions to progress towards local malaria elimination. Read more about the project and the related publication

Treatment of severe malaria due to Plasmodium falciparum with injectable artesunate has been shown to be superior to treatment with injectable quinine. A series of implementation studies in the DR Congo investigated the operational and clinical adaptations required to change local treatment guidelines and practices from quinine to artesunate. The project provided descriptive evidence of greater operational simplicity and lower cost of injectable artesunate for treating severe malaria, in addition to the drug’s higher efficacy. The findings supported a policy change by the Programme National de Lutte contre le Paludisme in DR Congo. Read more

Long-Lasting Insecticidal Nets (LLIN) are the primary malaria vector control tool in sub-Saharan Africa. Understanding the effective life-span of different LLINs under real use conditions is essential to select the best products and help plan repeated distributions to ensure maximal health gains. The ABCDR study investigated LLIN durability in eight districts of Tanzania. Findings suggest that LLIN functional survival is less than 3 years and differs substantially between net products. LLIN procurements should therefore consider cost per year of functional life and not only unit price. Read more

Since 2000, Swiss TPH supports the Tanzanian National Malaria Control Programme (NMCP) with extensive technical advice. This is possible through a grant from the Swiss Government to the “Towards Elimination of Malaria in Tanzania” (TEMT) project. Since 2021, TEMT implements a large-scale larviciding programme in Tanga Region to investigate the impact of larviciding on malaria transmission and on malaria incidence. TEMT also assesses the operational feasibility of a government led programme and its cost. Read more

A 20-years follow-up study of an insecticide-treated bednet programme carried out in the Kilombero Valley, Tanzania, in the 1990s by Swiss TPH and its partner IHI, demonstrated that the child survival benefit afforded by treated bednets in the first years of life lasted into adulthood. Read more