Tackling malaria

Almost every minute a child dies of malaria. This disease claimed 619,000 lives in 2021, 77% of which were children under five. Caused by a parasite, malaria is spread through infected mosquito bites and quickly becomes fatal without appropriate medical intervention. The African continent is most heavily-affected and preventative measures (such as insecticide-treated nets around sleeping areas) form a large part of the anti-malarial strategy in these regions. Strong global investment has reduced the mortality rate by almost half over the last 20 years, with over 2.2 billion nets distributed across sub-Saharan Africa since 2004. But despite these measures, this devastating disease continues to take a heavy toll on countries across the continent, with significant health and economic consequences trapping many families in a cycle of poverty and illness.

"Malaria incidence is socially-patterned, with a statistical correlation between the prevalence of the disease and income level," explains Kevin Deane, a public health economist at The Open University. "Despite significant resources being invested in malaria prevention and control, progress towards eliminating malaria has stagnated, in part due to the lack of engagement with the social determinants of malaria. This further undermines efforts to eliminate poverty, and continues to impede social and economic development at both the community and national levels."

Supported by the Open University's Open Societal Challenges programme, Deane and Dr David Musoke of Makerere University, Uganda and an international team of collaborators are working to understand and disseminate these important social elements, focusing initially on the Wakiso district of Uganda. Uganda bears the third-highest burden of malaria worldwide, its tropical climate providing the ideal breeding ground for the mosquito carriers. In partnership with the Ugandan Ministry of Health, the team will investigate environmental quality and livelihood activities within the Wakiso district, probing how these factors contribute to the transmission of malaria in the region.

"The existing literature is overly descriptive [and] fails to shed [any] light on the underlying social drivers of malaria. It has done little to influence the policy agenda or change the narrative around malaria and poverty which [instead] continues to focus on poor health-[related] decision-making and [a] lack of education [in the local community]," says Deane. "[We want to explore these overlooked social components to help inform more effective prevention and control measures in these communities.]"

In the first stage of the project, the team will systematically analyse existing reports and data points addressing the known social factors related to malaria transmission. This knowledge will then act as the foundation for a week-long workshop to co-produce the design of a new research project. Through a series of interactive sessions, the research team will meet with politicians, local health workers, community leaders, and representatives from the local community, and will seek to understand each group's differing perspectives on current anti-malarial measures in the region.

Future iterations of the project will hopefully be able to translate these findings into new interventions designed to reduce the transmission of this deadly disease. Tailored to stakeholders at both national and community levels, the team hope that this will provide a framework for changes in policy and practice which will ultimately lead to a sustained reduction in malaria cases across the most vulnerable areas in sub-Saharan Africa.

"The social determinants of malaria transmission need to be addressed in order to tackle the bold vision of global eradication,’ says Deane. ‘[We hope that our findings from this work] will subsequently cascade to global malaria prevention efforts [to make this vision a reality]."