Malaria is the disease caused by the single celled parasites of the Plasmodium genus, with five species causing illness in humans, the severest caused by P. falciparum. The parasites are spread through mosquito bites, primarily carried by mosquitos in the Culex and Anopheles genera. Together, these two genera of mosquito capable of carrying the malaria parasite are distributed globally in all but the cooler temperate and arctic zones. With radical and comprehensive public health programmes, many areas which used to suffer malaria endemically are now free of the disease; however, Central and South America, Sub-Saharan Africa, and South / Southeast Asia remain severely affected, with increasing instances of drug-resistant parasites emerging. This troubling trend emphasises the continuing importance of traditional forms of malaria prevention, such as: mosquito eradication, use of repellents and netting, and community education.
In 2017 there were almost 220 million cases of malaria reported globally, with 435,000 proving fatal. Five countries [Nigeria, the Democratic Republic of the Congo (DRC), Mozambique, India and Uganda] accounted for almost half of these cases. Over half of deaths were in children under the age of five. Malaria treatment and prevention programmes are already well established, especially in these disproportionately affected countries. However, it has been recognised that community engagement especially in more rural areas is lacking, with many of the same challenges faced as when combatting more acute infectious disease outbreaks, such as Ebola virus outbreaks in West Africa in 2013-16 and the ongoing outbreak in the DRC. We have learned much from these acute outbreaks, namely that communities must be integrated into the response, and that careful, respectful understanding of cultural practices is essential to gaining trust and facilitating community acceptance of the response.
Baltzell et al. reviewed ten community engagement approaches over several diseases and issues, both infectious (e.g. Ebola virus outbreaks) and non-infectious (e.g. sanitation) and applied the findings to improve the methodology for tackling malaria across several countries in Africa. Three main areas were concluded to be beneficial for effective malaria responses: communities must see engagement of the responders beyond only tackling a single acute problem; existing community engagement practices must be strengthened (e.g. community ‘town hall’ meetings and focus groups and integrating sociologists and anthropologists with healthcare professionals); and community empowerment must be promoted (e.g. training community members to as community health workers).
These community-centric approaches are now successfully being integrated into a variety of anti-malaria programs. For example, Malaria No More and the JC Flowers Foundation running the Isdell: Flowers Cross Border Malaria Initiative and have worked to engage communities in Zambia with round table meetings involving groups from the government, community leaders, international NGOs, and more. These community-orientated conversations are demonstrating the potential impact of these approaches while also identifying unmet needs, such as the need to expand outreach to include more rural communities. These findings echo issues faced when attempting to control other, more acute, disease outbreaks, highlighting the more ‘universal’ need for community understanding and engagement in humanitarian aid responses.
