In the fight against malaria, quality information is our strongest ally

BY VICTORIA ERINLE AND THOMAS HALL

Nigeria carries the world’s largest malaria burden: 27% of all cases happen here, according to the World Health Organization, as do almost a third of the global malaria deaths.

Efforts to combat the mosquito-borne parasite are in full swing. The Federal Government of Nigeria has made substantial investments toward malaria elimination, and several countries are supporting us in this difficult fight—including the United States through the US President’s Malaria Initiative—and the international financing and partnership organization, The Global Fund to Fight AIDS, Tuberculosis and Malaria.

Despite such tremendous focus and collaboration, more action is required. We know that to end malaria, we cannot use a one-size-fits-all approach. Each region faces different challenges and therefore has different needs. A tailor-made solution is the only way to go, but we’ve found that one of the main problems preventing the creation of more targeted malaria interventions is the lack of quality data, such as indicators about disease incidence, mosquito breeding patterns, availability and efficacy of treatments, and communities with active malaria fighting programs. These are critical pieces of information in determining how best to address the realities and needs of each community.

But as the country continues to build its healthcare data infrastructure, those of us focused on malaria have taken a somewhat circuitous yet effective approach: data triangulation. The practice combines different types and sources of information related to malaria, such as epidemiological, clinical, entomological, pharmacological, sociodemographic, and supply chain data to gain insights into various aspects of the disease and its transmission dynamics. This bird’s-eye view of malaria is fundamental if we are to gain the upper hand in this fight.

To that end, our organisation, Management Sciences for Health (MSH), is working with PMI, the Global Fund, the World Health Organization, and several other partners to support Nigeria’s National Malaria Elimination Programme (NMEP) in strengthening its data management systems.

Together, we built a web-based platform that harmonises and integrates all available malaria-related data in the country into one central place, the National Malaria Data Repository (NMDR). It includes data on disease incidence, efficacy of treatments, distribution of malaria medicines, and preventive measures like insecticide-treated nets.

All this important information in one easily accessible location helps us make better decisions. For example, we compare data on malaria treatment with data on drug distribution to understand where there is more demand for commodities to avoid stockouts. Data on insecticide-treated net campaigns are compared with data on malaria incidence to determine how effective the campaign was in preventing new malaria infections.

We are beginning to see positive results from the NMDR. The platform generates periodic data bulletins that key malaria stakeholders use to make immediate decisions and course corrections. This process has improved decision-making from a hit-or-miss approach to an evidence-driven set of actions. It has optimised the use of scarce resources and improved transparency and accountability by monitoring how resources are used.

Further, it has improved data quality through its interactive dashboard by allowing data from different sources to be compared over a period to establish relationships and detect data quality issues. That, in turn, has enabled us to draw more accurate estimates of malaria burden, rather than estimated figures which was the practice before the creation of the NMDR.

With this central data hub, Nigeria has become one of the first countries to join the global drive to use real-time data to help eliminate malaria. Ghana, Mozambique, Uganda, and Tanzania are also in the process of developing similar data hubs—following WHO’s Global Malaria Strategy.

However, for the NMDR to realise its full potential, make a lasting impact and get us closer to real malaria elimination, Nigeria’s National Malaria Elimination Programme must continue to strengthen its coordination with State Malaria Elimination Programmes to ensure they regularly provide data and content for the NMDR. There should also be similar drives with health facilities to continue providing updated malaria data to the NMEP.

Lastly, the Nigerian government needs to take over the management of the NMDR when donor support ends. We must sustain the momentum we worked so hard to build to ensure quality data plays a central role in decision-making not only for malaria but for other diseases that affect our country.

Erinle is a medical doctor and a technical director for Malaria with Management Sciences for Health (MSH), a global health nonprofit. Hall is MSH’s Senior Principal Technical Advisor for Malaria.