Malaria elimination

Course information

Overview: The curriculum aims to equip participants with the knowledge and skills to plan, implement, monitor and evaluate a programme for malaria elimination and prevention of re-establishment of transmission. The training curriculum is designed for health professionals responsible for planning, managing, implementing or evaluating malaria programmes or malaria elimination programmes.

Certificates: A Confirmation of Participation is available to participants who complete 100% of the course material.

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. y 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. y 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. y 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: ame 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.