Malaria is prevented through use of many tools, one being the management of larval breeding areas, also known as “larval source management” (LSM). The objective of LSM is to reduce the number of mosquito larvae and pupae so as to reduce the potential for malaria transmission.
Today, there is renewed interest in LSM, especially in areas where other interventions may not be as effective—for example where mosquitos are biting outside (versus indoors during sleeping hours when ITNs are most effective) or where insecticide resistance is growing.
Akros has contributed significantly to geo-enabling disease surveillance and response activities, including malaria interventions. Some of this work has included microplanning and delivery of health campaigns to ensure they achieve the highest coverage for impact. Through this work, Reveal, a digital global good, has been conceived and deployed across 10 countries. The robust Reveal datasets have facilitated enhanced microplanning and analysis of operational and programmatic performance to identify gaps, improve targeting and resource mobilization, and increase vector control coverage over time.
Malaria elimination requires consistent high coverage of effective malaria prevention and treatment interventions—and high coverage is challenging to achieve particularly in developing countries where highly urban or highly rural areas may not have address systems, limited maps, and challenging access due to rains, poor infrastructure, flooding, or severe events or conflict.
In order for insecticides, such as Fludora Fusion or other chemicals, to most effectively kill mosquitoes and reduce malaria burden, high coverage is required. Envu, in collaboration with Akros and the National Malaria Control Program (NMCP) in Zambia conducted an exciting rollout of geospatial planning and delivery of indoor residual spray (IRS) in Luanshya District Zambia during the 2022 spray season. The open source platform, Reveal, was used to support the planning of the campaign, including target areas, households which would be visited and sprayed, as well as the human resources and commodities required to deliver the campaign. Spray teams, including each team lead, were outfitted with the Reveal application on their smartphones or tablets. Through this application, each team was able to clearly see which settlements in Luanshya District were targeted during microplanning prior to navigating to these areas and could clearly visualize on their phone where they were in relationship to each sprayable structure and whether it had been visited or not.
Akros is pleased to announce its successful partnership with Digital Square at PATH in promoting the shelf-readiness of Reveal. Over the last 12 months, efforts have been made to ensure Reveal is scale-ready through delivery of three separate workpackages. First, Reveal is now available for download on the Google Play store—this allows quick over-the-air updates, as well as provides opportunity for new users to install Reveal onto their own mobile devices to prepare for campaign delivery.
Second, a number of new resources are available for end-users of the platform, particularly training videos on the microplanning module in Reveal, as well as the mobile client and web dashboards. Also, written end-user documentation is available to all—these can be readily accessed through Reveal community resources. And finally, a screencast which shares the benefits of Reveal, and walks interested viewers through the end-to-end platform, where country and local managers develop microplans and then use mobile technology to ensure field teams are not “operating in the dark” but rather understand where they are in relation to all houses and villages requiring each intervention.
Akros, with support from the END Fund through the Deworming Innovation Fund, worked with the Division of Vector Borne and Neglected Tropical Diseases (DVB NTD) of Kenya’s Ministry of Health (MOH) to improve the quality of neglected tropical diseases (NTD) microplanning in routine deworming programs.
During this project, Akros applied several tools to the microplanning process to support the six-step WHO microplanning strategy. Four counties in Western Kenya used the tools for schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) mass drug administration (MDA) campaigns in Kenya in 2021 and 2022. Vihiga County also deployed Reveal to track campaign resource usage and coverage outcomes at the community catchment level. Qualitative feedback through focus groups and survey responses showed that use of the geo-enabled process successfully guided teams through deeper population analysis, and led to more efficient allocation of drug resources and human resources for the MDA, as well as improved coverage and reach of the MDAs. Drawing upon user feedback on the microplanning process and tools, Akros adapted the microplanning features into the existing Reveal platform, an open source digital global good.
Since its first inception supporting house to house malaria campaigns in southern Africa, Reveal has been through numerous phases of growth. Originally named “mSpray,” the tool debuted in 2015 and was used exclusively to support indoor residual spraying (IRS) campaigns by using geospatial data and a suite of tools to improve coverage rates. In some cases, coverage rates improved by as much as 20-30 percent. (1)
In 2019, Akros received development funding to expand the tool and rebranded mSpray as “Reveal”—a platform to assist in the micro-planning, delivery, and management of a wide variety of health campaigns. Reveal is an open-source digital global good that uses smart maps and technology appropriate for resource-constrained settings to monitor coverage of interventions in real-time and optimize available resources.
Reveal’s mobile application spatially guides field teams to planned areas and households for service delivery. This mobile application allows offline data collection and captures indicators to inform critical field decisions. Reveal also includes a web user interface with real-time dashboards to provide program managers with helpful coverage data that informs current activities and guides teams to achieve true coverage targets.
Reveal was initially built on the OpenSRP trunk, but in late 2021 was shifted to a more appropriate backend solution. Through this monumental phase of growth, now called Reveal 3.0, the efficiency, stability, adaptability, and sustainability has improved significantly.
All in all, Reveal has impacted 3.6 million people across the 10 countries where Reveal has been deployed. (2)
Reveal, an open-source Digital Global Good, claims Southern Africa (specifically Zambia) as the region which nurtured its development throughout its formative years and many phases of expansion. After six years of optimizing the delivery of household-level interventions in Southern and Eastern Africa, 2020 marked the first year that Reveal made its way to the western edge of the continent to augment malaria prevention programming in Senegal. Building on the success of their partnership in Zambia, PATH’s Malaria Control and Elimination Partnership in Africa (MACEPA) alongside Senegal’s Ministry of Health and Social Action collaborated with Akros to conduct enumeration and mapping in 7 districts, 4 of which used these maps to support indoor residual spraying (IRS) microplanning and delivery in 2020. With a better understanding of how granular geospatial data can support IRS planning in the second phase of this collaboration, these 4 districts used the Reveal mobile application to enhance their ability to deliver an effective IRS campaign and to more accurately understand spatial gaps in achieving campaign effectiveness. Notably, this was also the first opportunity for Reveal’s user interface to be made available in French so that francophone teams in Senegal could effortlessly make use of its features.
No matter the health campaign or tools used to implement the campaign, “mopping-up”–that is, bringing health resources to those people that did not receive them during the primary campaign–is critical.
“Mop-up” can be necessary for a variety of reasons, but the most common causes are inclement weather that impacted the ability to achieve the desired level of coverage, people not being at home when the field teams came knocking, or field teams ending delivery too soon. Mop up campaigns can be costly, so the need for accurate, real-time spatial data to inform these mop ups and protocols to drive them is critical. Reveal, a digital Global Good that equips field teams to reach the last mile, assists in these efforts by providing digestible maps and tables to mid- and high-level managers in near real time. Managers use these maps to understand areas which were missed in order to redeploy teams to those areas that did not receive sufficient coverage before the campaign concludes. For interventions such as indoor residual spraying (IRS) for malaria and immunization campaigns, this can mean the difference between a community attaining “herd immunity” or having gaps in coverage that render the intervention less effective.
Nigeria encompasses a unique and significant role in Africa. Not only is it the continent’s most populous country, clocking in at 206 million people, but it also is also the continent’s largest economy (with a total GDP of $441 billion in 2021). However, it also maintains a less desirable superlative title, which is that it bears the highest burden of malaria deaths on the continent, and 27% of all malaria deaths worldwide in 2020. In raw numbers, this amounts to an estimated 64.5 million cases annually. As a result, the public health challenge of malaria in Nigeria is enormous, and the stakes are high. Though Nigeria’s National Malaria Elimination Program (NMEP) has risen to meet this challenge consistently throughout the years, attaining the goal of reducing malaria morbidity to less than 10% parasite prevalence and mortality attributable to malaria to less than 50 deaths per 1,000 by 2025 is far from guaranteed. One key in realizing this goal is seasonal malaria chemoprevention (SMC), which typically consists of routine administration of two antimalarial drugs to children 3 to 59 months of age during the peak months of malaria transmission. Malaria Consortium and Akros worked with the Nigeria NMEP to support the planning, tracking, and delivery of SMC in six rural health facility catchments in the Shagari local government area of Sokoto State, Nigeria in 2021.
Last month, the World Health Organization (WHO) sent joyous shock waves through the global health community and the Global South by officially recommending that the new RTS,S/AS01 (RTS,S) malaria vaccine be adopted into widespread use among children in sub-Saharan Africa and other regions with moderate to high P. falciparum malaria incidence. Now the international community, through Gavi, the Vaccine Alliance, has just stepped forward to help finance the rollout of the world’s first malaria vaccine.
It has been true for some time that sub-Saharan Africa bears the largest malaria burden in the world, with children shouldering the largest proportion of deaths. Over 90% of global cases are on the continent, with children under the age of 5 years constituting a staggering two-thirds of all malaria deaths. This is due to a confluence of factors, not least because of the widespread prevalence of P. falciparum (the most deadly species of malaria parasite), and a very efficient mosquito that spreads it (Anopheles gambiae). The economic impact of malaria is estimated to cost Africa $12 billion every year—a figure that also factors in costs of healthcare, absenteeism, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism. The introduction of an effective vaccine offers a beam of hope in the fight to mitigate the massive toll this centuries-old disease inflicts on Africa.
In recent years, countries within the Southern African Development Community (SADC) region of Africa have been making outstanding strides toward the challenging goal of malaria elimination. This commitment to elimination is the guiding mandate of Elimination 8 (E8), which focuses on the following countries: Angola, Botswana, Eswatini, Mozambique, Namibia, South Africa, Zambia, and Zimbabwe. Through E8, these ministerial bodies have resolved to coordinate their efforts to collaboratively work toward the shared regional goal of malaria elimination.
To that end, in 2017, E8 contracted with MENTOR to deliver indoor residual spray (IRS) in border districts of southern Angola. The MENTOR Initiative is a registered nonprofit organization devoted to reducing deaths and suffering from tropical diseases. In Angola, MENTOR has been a stable National Malaria Control Program (NMCP) partner supporting vector control, case management, and surveillance activities since 2004. MENTOR has established offices across Angola and has full country reach in its operations, making it the ideal partner for E8 to engage for expanded IRS interventions. Since 2017, MENTOR has implemented IRS with reported high coverage rates in all campaigns conducted. For its 2020 campaign, MENTOR aimed to improve IRS reporting systems and increase accountability to donors and NMCP. To realize this goal, they chose to pilot Reveal—a digital global good and open source spatial intelligence platform used to drive the delivery of life-saving interventions. MENTOR collaborated with Akros to configure and support the field pilot of Reveal v. 1 in Menongue District (Cuando Cubango Province).