MEI Malaria Elimination Toolkit

The global burden of Plasmodium vivax is estimated to be approximately 14.3 million cases (WHO World Malaria Report, 2022), and the highest burden is in the Latin America and the Caribbean (LAC) and South-East Asia regions, where P. vivax is the dominant malaria species. Unlike Plasmodium falciparum, P. vivax has the ability to remain latent in the liver-stage (hypnozoites) and can cause relapses for weeks to years, making control and elimination of this species a major challenge. First-line treatment in LAC countries is chloroquine and the 8-aminoquinoline, primaquine (PQ), to kill the hypnozoites. A major challenge of the PQ administration is adherence and safety. Regarding safety, there are challenges in the assessment of glucose-6-phosphate dehydrogenase (G6PD) deficiency, an X-linked condition and the most common metabolic condition. In individuals with G6PD deficiency, treatment with 8-aminoquinolines can induce hemolysis.

The P. vivax radical cure risk benefit assessment tool provides decision-making guidance to support national malaria programs in the selection of P. vivax radical cure schemes in consideration of the local epidemiology of malaria and G6PD deficiency, effectiveness of different treatment regimen to prevent relapses, supervision or no supervision of treatment, and availability of point-of-care G6PD testing.

Chemoprevention strategies have been shown to be effective in reducing the burden of malaria, and are frequently deployed in both control and elimination settings. There are numerous chemoprevention strategies available for national malaria programs to choose from, depending on programmatic objectives, specific transmission dynamics, local contexts, and resources available. The CHOICE framework provides decision-making guidance to support national malaria programs in the selection, implementation, monitoring and evaluation, and iterative adaptation of chemoprevention strategies in consideration of local transmission dynamics, programmatic objectives, and resource constraints. The CHOICE framework supports decision making specifically around the use of Mass Drug Administration, and screen and treat strategies for which policy level guidance is not available.

The Entomological Surveillance Planning Tool (ESPT) is a decision-support tool for planning entomological surveillance activities, foci investigations, interpreting and integrating entomological data with epidemiological data, and guiding programmatic vector control strategies. The ESPT includes practical approaches and minimum essential indicators to help answer programmatic questions about local transmission drivers, effectiveness of current vector control interventions, and how to address gaps in protection, among others.

LEAD supports national health programs in approaching operational problem-solving in a systematic, participatory manner while also building capacity for leadership and management at any level and across levels and ensuring sustainability. LEAD also supports health programs to improve teamwork and the quality of service delivery, make data-informed decisions to improve operations, and take critical action.

DREAM-IT is a series of modules designed to systematically collect information from different levels (from community to national level) on a range of operational capabilities and thematic areas determined to be necessary for malaria elimination, such as human resources, supply chain management and supervision mechanisms, among others. Results of DREAM-IT can be used to identify areas of improvement across and within different levels of the health system, informing malaria operational planning and supporting reorientation toward elimination.

The Malaria Elimination Guide to Targeted Surveillance and Response in High-Risk Populations (HRP Guide) provides practical operational guidance to identify and characterize populations at highest risk of malaria and design and implement data-driven and targeted surveillance and response activities for these populations. This guide is designed for national malaria program managers and their implementing partners, including non-governmental organizations and researchers.

Reactive case detection (RACD) is a commonly used strategy implemented in low malaria transmission settings to identify and treat infections as early as possible. To support national malaria programs to evaluate and improve their malaria case investigations and RACD activities, a standardized monitoring and evaluation (M&E) tool has been developed. The RACD M&E Tool provides support to national malaria programs in making evidence-based decisions to strengthen their malaria case investigation and RACD strategies.

Strong domestic leadership, management, and financing are critical to achieving malaria control and elimination goals. The Malaria Budget Advocacy (MBA) Framework is a step-by-step guide for national malaria programs and their partners to characterize financial and political challenges that affect the country’s malaria response, identify barriers and opportunities that can be leveraged, and develop an advocacy strategy to enable a sustainable malaria response through subnational advocacy and leadership, tailored to program needs and capacity. This Framework also provides some key considerations for successful advocacy strategy implementation, monitoring, and subnational capacity building to mobilize and manage malaria budgets.

SUSTAIN helps countries manage the transition from donor-supported to fully country financed and managed health programs. National malaria programs are facing declines in or the end of donor financial support, precipitating changes in a program’s finances, governance, management, and implementation. Without adequate planning, such a transition can disrupt essential program activities and undermine progress towards elimination. SUSTAIN is an assessment and planning tool that guides country programs and their donor partners through the process of preparing for transition. SUSTAIN facilitates a multi-stakeholder consultative process to generate the evidence and political commitment needed to ensure a sustainable transition from donor support.

This surveillance and response tool is an active pharmacovigilance surveillance data collection tool that monitors the safety of WHO-recommended single low-dose (0.25 mg/kg) primaquine (SLD PQ) for the treatment of P. falciparum malaria. PROMPT supports the roll out of SLD PQ in malaria-eliminating countries by providing national malaria control programs and healthcare providers with the methods to track and respond to hematologic response to SLD PQ and to generate evidence on the safety of SLD PQ in treating P. falciparum malaria. PROMPT provides step-by-step instructions for healthcare providers to monitor potential adverse events related to SLD PQ treatment, as well as guidance for national malaria control programs on how to compile safety monitoring data from multiple health facilities.