malERA: an updated research agenda for health systems and policy research in malaria elimination and eradication

Health systems underpin disease elimination and eradication programmes. In an elimination and eradication context, innovative research approaches are needed across health systems to assess readiness for programme reorientation, mitigate any decreases in effectiveness of interventions ('effectiveness decay'), and respond to dynamic and changing needs. The malaria eradication research agenda (malERA) Refresh consultative process for the Panel on Health Systems and Policy Research identifies opportunities to build health systems evidence and the tools needed to eliminate malaria from different zones, countries, and regions and to eradicate it globally. The research questions are organised as a portfolio that global health practitioners, researchers, and funders can identify with and support. This supports the promotion of an actionable and more cohesive approach to building the evidence base for scaled-up implementation of findings. Gaps and opportunities discussed in the paper include delivery strategies to meet the changing dynamics of needs of individuals, environments, and malaria programme successes; mechanisms and approaches to best support accelerated policy and financial responsiveness at national and global level to ensure timely response to evidence and needs, including in crisis situations; and systems' readiness tools and decision-support systems

Evaluation De La Qualité Physico-Chimique et Microbiologique Des Eaux De Puits Consommées Dans Le Quartier Kombé À Brazzaville

La présente étude vise à évaluer la qualité physico-chimique et microbiologique des eaux de puits consommées dans le quartier Kombé à Brazzaville. Quatre puits ont été identifiés et caractérisés. La caractérisation a montré trois puits équipés des mêmes systèmes de protection et de remontée d'eau et, un seul point de prélèvement diffère des autres par le système de remontée d'eau. Trente-trois paramètres physico-chimiques et neuf paramètres microbiologiques ont été évalués par des méthodes normées et référencées. Les résultats obtenus révèlent du point de vue physico-chimique que, les eaux de puits étudiées sont faiblement minéralisées et tous les paramètres physico-chimiques répondent aux normes de l'OMS, excepté le pH, la concentration des ions cadmium, chrome, phosphate ainsi que de la silice dans certains cas. La projection des points d’eau sur le diagramme de Piper montre deux familles chimiques : les eaux chlorurées sodique et potassique et les eaux bicarbonatées sodique et potassique. Par contre, les eaux consommées par la population de quartier Kombé sont fortement chargées en E.coli, salmonella et shigella, coliformes totaux, pseudomonas aeruginosa, germes totaux, staphylocoques et, levures et moisissures et sont impropres à la consommation humaine. Avant leur consommation ces eaux doivent subir quelques traitements préliminaires comme la correction du pH à la chaux et la désinfection à l’hypochlorite de sodium.   This study aims to assess the physico-chemical and microbiological quality of well water consumed in the Kombé district in Brazzaville. Four wells have been identified and characterized. The characterization showed three wells equipped with the same protection and upwelling systems and only one sampling point differs from the others by the upwelling system. Thirty-three physico-chemical parameters and nine microbiological parameters were evaluated by standardized and referenced methods. The results obtained reveal from the physico-chemical point of view that the waters of the wells studied are weakly mineralized and all the physico-chemical parameters meet WHO standards, except the pH, the concentration of cadmium, chromium and phosphate ions as well as than silica in some cases. The projection of the water points on the Piper diagram shows two chemical families: sodium and potassium chlorinated waters and sodium and potassium bicarbonate waters. On the other hand, the water consumed by the population of the Kombé district is heavily loaded with E.coli, salmonella and shigella, total coliforms, pseudomonas aeruginosa, total germs, staphylococci and yeasts and molds and is unfit for human consumption. Before being consumed, this water must undergo some preliminary treatments such as pH correction with lime and disinfection with sodium hypochlorite

Evaluation De La Qualité Physico-Chimique et Microbiologique Des Eaux De Puits Consommées Dans Le Quartier Kombé À Brazzaville

La présente étude vise à évaluer la qualité physico-chimique et microbiologique des eaux de puits consommées dans le quartier Kombé à Brazzaville. Quatre puits ont été identifiés et caractérisés. La caractérisation a montré trois puits équipés des mêmes systèmes de protection et de remontée d'eau et, un seul point de prélèvement diffère des autres par le système de remontée d'eau. Trente-trois paramètres physico-chimiques et neuf paramètres microbiologiques ont été évalués par des méthodes normées et référencées. Les résultats obtenus révèlent du point de vue physico-chimique que, les eaux de puits étudiées sont faiblement minéralisées et tous les paramètres physico-chimiques répondent aux normes de l'OMS, excepté le pH, la concentration des ions cadmium, chrome, phosphate ainsi que de la silice dans certains cas. La projection des points d’eau sur le diagramme de Piper montre deux familles chimiques : les eaux chlorurées sodique et potassique et les eaux bicarbonatées sodique et potassique. Par contre, les eaux consommées par la population de quartier Kombé sont fortement chargées en E.coli, salmonella et shigella, coliformes totaux, pseudomonas aeruginosa, germes totaux, staphylocoques et, levures et moisissures et sont impropres à la consommation humaine. Avant leur consommation ces eaux doivent subir quelques traitements préliminaires comme la correction du pH à la chaux et la désinfection à l’hypochlorite de sodium.   This study aims to assess the physico-chemical and microbiological quality of well water consumed in the Kombé district in Brazzaville. Four wells have been identified and characterized. The characterization showed three wells equipped with the same protection and upwelling systems and only one sampling point differs from the others by the upwelling system. Thirty-three physico-chemical parameters and nine microbiological parameters were evaluated by standardized and referenced methods. The results obtained reveal from the physico-chemical point of view that the waters of the wells studied are weakly mineralized and all the physico-chemical parameters meet WHO standards, except the pH, the concentration of cadmium, chromium and phosphate ions as well as than silica in some cases. The projection of the water points on the Piper diagram shows two chemical families: sodium and potassium chlorinated waters and sodium and potassium bicarbonate waters. On the other hand, the water consumed by the population of the Kombé district is heavily loaded with E.coli, salmonella and shigella, total coliforms, pseudomonas aeruginosa, total germs, staphylococci and yeasts and molds and is unfit for human consumption. Before being consumed, this water must undergo some preliminary treatments such as pH correction with lime and disinfection with sodium hypochlorite

Evaluation de la Qualité Physico-Chimique et Microbiologique des eaux de Puits Consommées dans le Quartier Kombé à Brazzaville

Naturellement, les eaux souterraines sont potables de façon générale et devraient être consommées sans aucun traitement préalable. Malheureusement, ces eaux sont soumises actuellement à une forte pression anthropique. Cette étude vise d’évaluer la qualité physico-chimique et microbiologique des eaux de puits consommées dans le quartier Kombé à Brazzaville. Quatre puits ont été identifiés et caractérisés. La caractérisation a montré trois puits équipés des mêmes systèmes de protection et de remontée d'eau et, un seul point de prélèvement diffère des autres par le système de remontée d'eau. Trente-trois paramètres physico-chimiques et neuf paramètres microbiologiques ont été évalués par des méthodes normées et référencées. Les résultats obtenus révèlent du point de vue physico-chimique que, les eaux de puits étudiées sont faiblement minéralisées et tous les paramètres physicochimiques répondent aux normes de l'OMS, excepté le pH, la concentration des ions cadmium, chrome, phosphate ainsi que de la silice dans certains cas. Une seule famille chimique est mise en évidence : les eaux chlorurées sodique et potassique. Malheureusement, ces eaux sont fortement chargées en Escherichia. coli, Salmonella et Shigella, coliformes totaux, Pseudomonas aeruginosa, germes totaux, staphylocoques, levures et moisissures. Elles sont impropres à la consommation humaine et doivent subir quelques traitements préliminaires comme la correction du pH à la chaux et la désinfection à l’hypochlorite de sodium. Naturally, groundwater is generally drinkable and should be consumed without any prior treatment. Unfortunately, these waters are currently subject to strong anthropogenic pressure. This study aims to evaluate the physicochemical and microbiological quality of well water consumed in the Kombé district of Brazzaville. Four wells were identified and characterized. The characterization showed three wells equipped with the same protection and water rise systems and only one sampling point differed from the others by the water rise system. Thirty-three physicochemical parameters and nine microbiological parameters were evaluated using standardized and referenced methods. The results obtained reveal from the physicochemical point of view that the well water studied is poorly mineralized and all the physicochemical parameters meet WHO standards, except pH, the concentration of cadmium, chromium, phosphate ions as well as than silica in certain cases. Only one chemical family is highlighted: sodium and potassium chloride waters. Unfortunately, these waters are heavily loaded with Escherichia. coli, Salmonella and Shigella, total coliforms, Pseudomonas aeruginosa, total germs, staphylococci, yeasts and molds. They are unfit for human consumption and must undergo some preliminary treatments such as pH correction with lime and disinfection with sodium hypochlorite

malERA: An updated research agenda for characterising the reservoir and measuring transmission in malaria elimination and eradication.

This paper summarises key advances in defining the infectious reservoir for malaria and the measurement of transmission for research and programmatic use since the Malaria Eradication Research Agenda (malERA) publication in 2011. Rapid and effective progress towards elimination requires an improved understanding of the sources of transmission as well as those at risk of infection. Characterising the transmission reservoir in different settings will enable the most appropriate choice, delivery, and evaluation of interventions. Since 2011, progress has been made in a number of areas. The extent of submicroscopic and asymptomatic infections is better understood, as are the biological parameters governing transmission of sexual stage parasites. Limitations of existing transmission measures have been documented, and proof-of-concept has been established for new innovative serological and molecular methods to better characterise transmission. Finally, there now exists a concerted effort towards the use of ensemble datasets across the spectrum of metrics, from passive and active sources, to develop more accurate risk maps of transmission. These can be used to better target interventions and effectively monitor progress toward elimination. The success of interventions depends not only on the level of endemicity but also on how rapidly or recently an area has undergone changes in transmission. Improved understanding of the biology of mosquito-human and human-mosquito transmission is needed particularly in low-endemic settings, where heterogeneity of infection is pronounced and local vector ecology is variable. New and improved measures of transmission need to be operationally feasible for the malaria programmes. Outputs from these research priorities should allow the development of a set of approaches (applicable to both research and control programmes) that address the unique challenges of measuring and monitoring transmission in near-elimination settings and defining the absence of transmission

malERA: An updated research agenda for combination interventions and modelling in malaria elimination and eradication.

This paper summarises key advances and priorities since the 2011 presentation of the Malaria Eradication Research Agenda (malERA), with a focus on the combinations of intervention tools and strategies for elimination and their evaluation using modelling approaches. With an increasing number of countries embarking on malaria elimination programmes, national and local decisions to select combinations of tools and deployment strategies directed at malaria elimination must address rapidly changing transmission patterns across diverse geographic areas. However, not all of these approaches can be systematically evaluated in the field. Thus, there is potential for modelling to investigate appropriate 'packages' of combined interventions that include various forms of vector control, case management, surveillance, and population-based approaches for different settings, particularly at lower transmission levels. Modelling can help prioritise which intervention packages should be tested in field studies, suggest which intervention package should be used at a particular level or stratum of transmission intensity, estimate the risk of resurgence when scaling down specific interventions after local transmission is interrupted, and evaluate the risk and impact of parasite drug resistance and vector insecticide resistance. However, modelling intervention package deployment against a heterogeneous transmission background is a challenge. Further validation of malaria models should be pursued through an iterative process, whereby field data collected with the deployment of intervention packages is used to refine models and make them progressively more relevant for assessing and predicting elimination outcomes

malERA: An updated research agenda for combination interventions and modelling in malaria elimination and eradication

This paper summarises key advances and priorities since the 2011 presentation of the Malaria Eradication Research Agenda (malERA), with a focus on the combinations of intervention tools and strategies for elimination and their evaluation using modelling approaches. With an increasing number of countries embarking on malaria elimination programmes, national and local decisions to select combinations of tools and deployment strategies directed at malaria elimination must address rapidly changing transmission patterns across diverse geographic areas. However, not all of these approaches can be systematically evaluated in the field. Thus, there is potential for modelling to investigate appropriate 'packages' of combined interventions that include various forms of vector control, case management, surveillance, and population-based approaches for different settings, particularly at lower transmission levels. Modelling can help prioritise which intervention packages should be tested in field studies, suggest which intervention package should be used at a particular level or stratum of transmission intensity, estimate the risk of resurgence when scaling down specific interventions after local transmission is interrupted, and evaluate the risk and impact of parasite drug resistance and vector insecticide resistance. However, modelling intervention package deployment against a heterogeneous transmission background is a challenge. Further validation of malaria models should be pursued through an iterative process, whereby field data collected with the deployment of intervention packages is used to refine models and make them progressively more relevant for assessing and predicting elimination outcomes

malERA: An updated research agenda for insecticide and drug resistance in malaria elimination and eradication

Resistance to first-line treatments for Plasmodium falciparum malaria and the insecticides used for Anopheles vector control are threatening malaria elimination efforts. Suboptimal responses to drugs and insecticides are both spreading geographically and emerging independently and are being seen at increasing intensities. Whilst resistance is unavoidable, its effects can be mitigated through resistance management practices, such as exposing the parasite or vector to more than one selective agent. Resistance contributed to the failure of the 20th century Global Malaria Eradication Programme, and yet the global response to this issue continues to be slow and poorly coordinated-too often, too little, too late. The Malaria Eradication Research Agenda (malERA) Refresh process convened a panel on resistance of both insecticides and antimalarial drugs. This paper outlines developments in the field over the past 5 years, highlights gaps in knowledge, and proposes a research agenda focused on managing resistance. A deeper understanding of the complex biological processes involved and how resistance is selected is needed, together with evidence of its public health impact. Resistance management will require improved use of entomological and parasitological data in decision making, and optimisation of the useful life of new and existing products through careful implementation, combination, and evaluation. A proactive, collaborative approach is needed from basic science and the development of new tools to programme and policy interventions that will ensure that the armamentarium of drugs and insecticides is sufficient to deal with the challenges of malaria control and its elimination

malERA: An updated research agenda for diagnostics, drugs, vaccines, and vector control in malaria elimination and eradication

Since the turn of the century, a remarkable expansion has been achieved in the range and effectiveness of products and strategies available to prevent, treat, and control malaria, including advances in diagnostics, drugs, vaccines, and vector control. These advances have once again put malaria elimination on the agenda. However, it is clear that even with the means available today, malaria control and elimination pose a formidable challenge in many settings. Thus, currently available resources must be used more effectively, and new products and approaches likely to achieve these goals must be developed. This paper considers tools (both those available and others that may be required) to achieve and maintain malaria elimination. New diagnostics are needed to direct treatment and detect transmission potential; new drugs and vaccines to overcome existing resistance and protect against clinical and severe disease, as well as block transmission and prevent relapses; and new vector control measures to overcome insecticide resistance and more powerfully interrupt transmission. It is also essential that strategies for combining new and existing approaches are developed for different settings to maximise their longevity and effectiveness in areas with continuing transmission and receptivity. For areas where local elimination has been recently achieved, understanding which measures are needed to maintain elimination is necessary to prevent rebound and the reestablishment of transmission. This becomes increasingly important as more countries move towards elimination

malERA: An updated research agenda for basic science and enabling technologies in malaria elimination and eradication

Basic science holds enormous power for revealing the biological mechanisms of disease and, in turn, paving the way toward new, effective interventions. Recognizing this power, the 2011 Research Agenda for Malaria Eradication included key priorities in fundamental research that, if attained, could help accelerate progress toward disease elimination and eradication. The Malaria Eradication Research Agenda (malERA) Consultative Panel on Basic Science and Enabling Technologies reviewed the progress, continuing challenges, and major opportunities for future research. The recommendations come from a literature of published and unpublished materials and the deliberations of the malERA Refresh Consultative Panel. These areas span multiple aspects of the Plasmodium life cycle in both the human host and the Anopheles vector and include critical, unanswered questions about parasite transmission, human infection in the liver, asexual-stage biology, and malaria persistence. We believe an integrated approach encompassing human immunology, parasitology, and entomology, and harnessing new and emerging biomedical technologies offers the best path toward addressing these questions and, ultimately, lowering the worldwide burden of malaria