Malaria elimination

Course information

What you'll learn

• To explain how the epidemiology of malaria changes as areas approach elimination;
• To describe the principles, goals, key activities and dynamic strategies required to achieve interruption of transmission, prevent re-establishment and achieve WHO certification;
• To describe the key components of elimination programmes across the principal technical areas including case management, vector control and entomological surveillance, surveillance and response, chemoprevention and stratification to tailor malaria interventions;
• To explain how to manage and plan an elimination programme, engage communities, develop multisectoral collaboration and build political commitment for elimination.

Course contents

• Overview of the Malaria Elimination Training Course:

  This introduction presents the objectives and targeted audience for the course, as well as the different topics/units to be covered.

• Unit 0: The Rationale for Malaria Elimination:

  By the end of this unit, participants should be able to describe how the geographical distribution and burden of malaria has changed over time; explain how their country will benefit from the elimination of malaria, and describe what may happen to malaria if countries come close but fail to achieve malaria elimination.

• Unit 1: Principles and Goals of Malaria Elimination:

  By the end of this unit, participants should be able to explain the difference between malaria control, elimination, certification, re-establishment and eradication; list the malaria elimination milestones and targets of the Global technical strategy for malaria 2016–2030 (GTS); and explain the concept of the malaria transmission continuum and its relation to elimination; describe the key principles of malaria elimination.

• Unit 2: Malaria Parasite Biology, Immunology, and Epidemiology in Areas Approaching Elimination:

  This module consists of two units: A: Parasite Biology and Immunity and B: Changing Epidemiological and Geographical Patterns. By the end of Unit 2A, participants should be able to describe the basic life cycle of Plasmodium spp. parasites; state the length of key intervals in the life cycles of P. falciparum and P. vivax; specify the unique biological characteristics of P. vivax and P. falciparum that favour or hinder elimination; describe how immunity is acquired and the differences between innate and adaptive immunity to malaria. By the end of Unit 2B, participants should be able to describe changes in the population at risk of infection and disease from malaria as areas approach elimination; explain how the geographical distribution of malaria changes as transmission declines to very low levels; explain why malaria transmission becomes more concentrated along border regions as transmission declines.

• Unit 3: Malaria Case Management in Areas Approaching Elimination :

  This module consists of two units: A: Diagnosis and Treatment and B: Diagnostic Quality Assurance and Drug Efficacy Monitoring. By the end of Unit 3A, participants should be able to: explain case management adaptations along the transmission continuum; explain the difference between sensitive and specific suspected case definitions; specify the two diagnostic methods recommended for elimination settings; understand and describe the reasons why a single, low dose of primaquine is used for P. falciparum in elimination settings. By the end of Unit 3B, participants should be able to: state the critical elements of quality control and quality assurance systems for diagnostics in elimination settings; explain how to conduct cross-checking for malaria microscopy slide results; state the elements of a process to check rapid diagnostic test results; and describe the system for integrated drug efficacy surveillance in elimination settings.

• Unit 4: Vector Control and Entomological Surveillance in Areas Approaching Malaria Elimination:

  This module consists of two units: A: Mosquito Biology and Vector Control; B: Entomological Surveillance and Monitoring and Evaluation of Vector Control. By the end of Unit 4A, participants should be able to: explain the life cycle of mosquito vectors and how different vector control interventions exploit or take advantage of various mosquito behaviours; explain how the concepts of vectorial capacity and receptivity are related; explain which vector control interventions are recommended for large-scale deployment and which ones are considered supplementary; explain how insecticide resistance develops and the impact it may have on vector control interventions; and describe the analysis countries should undertake before focalizing vector control. By the end of Unit 4B, participants should be able to: describe the key elimination programmatic questions that require entomological data; state the priority indicators for entomological surveillance in elimination and post-elimination settings; explain the main design elements of an entomological surveillance system; and explain how to monitor and evaluate the effectiveness of indoor residual spraying (IRS) and insecticide-treated nets (ITNs).

• Unit 5: Surveillance and Response in Areas Approaching Malaria Elimination:

  This module consists of five units: A: Overview of Surveillance Strategies and Characteristics; B: Case Detection; C: Case Notification, Investigation and Classification; D: Reactive Strategies; E: Focus Investigation, Classification and Response. By the end of Unit 5A, participants should be able to: compare the objectives for surveillance as they change across the transmission continuum; describe how certain characteristics of surveillance systems change along the transmission continuum; and describe the basic steps of surveillance as an intervention in elimination settings. By the end of Unit 5B, participants should be able to: specify the role of passive and active case detection in malaria elimination; describe the key considerations for constructing a suspected case definition; differentiate between proactive and reactive case detection approaches; and identify populations for which active case detection may be required to achieve elimination. By the end of Unit 5C, participants should be able to: state the objectives of case notification and case investigation; describe the key elements of the case investigation process; explain how to determine the likely period of infection using knowledge of the parasite species and incubation period; and classify cases according to the likely location of infection determined during the case investigation. By the end of Unit 5D, participants should be able to: explain how malaria cases cluster together at very low levels of transmission; describe the strategies recommended near or around confirmed malaria cases; and explain how to add reactive case detection to other reactive strategies. By the end of Unit 5E, participants should be able to: describe the objectives of focus investigations and when a focus investigation is needed; define a focus of malaria transmission in your country; state the components of a focus investigation that informs preparation of a microresponse plan designed to interrupt transmission; and define the different types of foci and describe the purpose of a focus register.

• Unit 6: Chemoprevention to Accelerate Malaria Elimination:

  By the end of this unit, participants will: explain how chemoprevention both cures existing infections and prevents new ones; describe why and under what circumstances different chemoprevention strategies are recommended for elimination; and specify the critical factors that optimize the impact of chemoprevention for transmission reduction in elimination programmes.

• Unit 7: Community Engagement for Malaria Elimination:

  By the end of this unit, participants will: describe the different attributes of communities that are stakeholders in malaria elimination; explain the different roles that communities may play in malaria elimination; identify the four community-engagement approaches and provide examples of each; and explain how malaria elimination can be achieved without stigmatization.

• Unit 8: Multisectoral Collaboration and Political Commitment for Malaria Elimination:

  By the end of this unit, participants will: explain how sectors outside of health relate to malaria elimination and prevention of re-establishment; describe the purpose of multisectoral collaboration with respect to malaria elimination and prevention of re-establishment; and explain how to develop a strategy to build political commitment.

• Unit 9: Prevention of Re-establishment of Malaria Transmission:

  By the end of this unit, participants will: explain the concepts of receptivity, rate/risk of importation, malariogenic potential and re-establishment of malaria transmission; explain the different methods to estimate receptivity and rate or risk of importation; explain how to maintain vigilance for malaria after elimination; and describe the ABCDEs of traveller health programmes.

• Unit 10: Stratification to Tailor Intervention Mixes in Areas Approaching Elimination and Preventing Re-Establishment:

  By the end of this unit, participants will: describe the differences between epidemiological stratification and stratification to tailor interventions;specify the purpose of stratification and important attributes; explain how stratification allows different areas of a country to move towards elimination at their own rate; and explain how stratification for prevention of re-establishment requires information on malariogenic potential.

• Unit 11: Planning and Management of a Malaria Elimination Programme:

  By the end of this unit, participants will: explain the key management challenges that are unique to, or more important in, malaria elimination programmes; name the key elements of good management practices in elimination programmes; specify the potential roles served by national committees; and describe the planning and learning cycle and development of key plans, technical policies and guidelines for malaria elimination programmes.

• Unit 12: Innovation and Research for Malaria Elimination :

  By the end of this unit, participants will: describe the importance of innovation and research for malaria elimination and eradication; specify the objectives of operational and implementation research ; describe the role of the national malaria control programme in research activities; and identify key challenges in malaria elimination that may require new tools and/or new approaches.

• Unit 13: WHO Certification of Malaria Elimination:

  By the end of this unit, participants will: name the two criteria for certification of malaria elimination; describe the procedure for certification of malaria elimination; define subnational verification and explain how it is similar to and different from WHO certification; and summarize requirements of countries after certification.

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Certificate Requirements

• Gain a Confirmation of Participation by completing at least 100% of the course material.