CDC's Malaria Work Began in 1984
The CCCD Era
CDC first became engaged in working on malaria in Malawi during a USAID-supported project from 1984 through 1998 called the Africa Child Survival Initiative—Combatting Childhood Communicable Diseases (ACSI-CCCD).
Highlights of this work include:
- Assisting the country in testing for the efficacy of the first-line antimalarial, chloroquine, as well as other antimalarial drugs
- Assisting in establishing a framework for a national malaria control program, including a national malaria control committee, a malaria coordinator and then manager, locally appropriate policy, and plan
The Mangochi Malaria Research Project (through 1990) and Promoting Health in Child Survival Project from 1988-1993, both supported by USAID, helped continue the work begun through ACSI-CCCD. Through these projects, CDC conducted studies to evaluate the effectiveness of the then current intervention for pregnant women, weekly chemoprophylaxis with chloroquine, and effectiveness of intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine.
Blantyre Integrated Malaria Initiative
From 1998-2002, a district-wide malaria-control effort called the Blantyre Integrated Malaria Initiative (BIMI) promoted sustainable and effective strategies to manage and prevent malaria-related disease and death. BIMI was supported by the Government of Malawi, USAID, and CDC.
Its activities were conducted in Blantyre District and aimed to improve use of three important malaria interventions—case management, IPTp, and insecticide-treated nets (ITNs)—as well as to improve data collection and use of health management information systems.
Initially, information was collected to identify gaps in malaria control activities and serve as baseline measurements to monitor success of interventions. Implementation strategies were then created. Pilot projects in this one district to increase use of IPTp and ITNs eventually led to national scale-up of IPTp and ITNs.
2002 To Date
During the next 5 years, 2002 – 2007, CDC's work in Malawi focused on providing technical assistance to Malawi's national prevention and control program with CDC and USAID funding. In collaboration with Malawi's National Malaria Control Program, CDC assisted Malawi in policy and guideline development, design and conduct of operations research to improve the delivery of malaria treatment and prevention interventions, implementation of intervention scale-up, and monitoring and evaluation efforts. Major activities included drug efficacy studies, operations research for anemia and parasitemia surveys, IPTp scale-up tool development, and feasibility of distributing long-lasting insecticide-treated bed nets through routine immunization services. Malawi's transition from piloting interventions to national scale-up of those efforts, aided by monitoring and evaluation activities, helped make Malawi a regional success story.
CDC's Malaria Branch has engaged in a cooperative agreement with Malawi's College of Medicine/Malaria Alert Centre (COM/MAC) since 2004. The College of Medicine is the only medical school in Malawi and was established in 1991. The Malaria Alert Centre, established in 2001 as part of the College of Medicine, was created to provide a foundation and focus for malaria prevention and control activities involving operations research, monitoring and evaluation, and training of health care workers and public heath students. The Malaria Alert Centre has provided a strong foundation and platform for malaria operations research in a highly malaria-endemic area.
Importantly, the Malaria Alert Centre has successfully engaged a variety of other external collaborators. The collaborations have included CDC's Global Measles Program, National Institutes of Health, the Integrated Vector Control Consortium, Michigan State University, UNICEF, WHO, and the Liverpool School of Tropical Medicine. Malaria Alert Centre activities are prioritized on an annual basis with guidance and direction from an advisory board. The Malaria Alert Centre has developed a close collaboration with the Ministry of Health and in particular the National Malaria Control Program, the Expanded Program on Immunizations (EPI), and the Integrated Management of Childhood Illnesses (IMCI). MAC is a recognized partner of the National Malaria Control Program and is a member of the National Malaria Advisory Committee (NMAC) and the task force overseeing the development and implementation of the malaria plan of action.
In 2007, Malawi became a focus country for the President's Malaria Initiative (PMI). The Malaria Alert Centre was a natural partner for PMI given the on-going malaria activities and relationship with CDC. Since 2007, the Malaria Alert Centre funding through the CDC cooperative agreement has included support for PMI activities as well as non-PMI CDC malaria activities. Since 2006/2007, CDC has also supported the NMCP through the U.S. President's Malaria Initiative.