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Coconut Surveillance

Improving Surveillance and Response for Malaria Elimination

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Malaria Is a Global Killer

1. Source: World Health Organization, Global Health Observatory Data Repository

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But Malaria Is Preventable, CurableMalaria-Free, Eliminating, and Controlling Countries, 20121

1. Source: UCSF Global Health Group, Malaria Elimination Group

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The Case of Zanzibar

East Africa

2 large islands (Unguja, Pemba)

A semi-autonomous part of the United Republic of Tanzania

Malaria Control Phases in ZanzibarHealth facility trends: Malaria confirmed cases and positivity rate, 1999–2014

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

0

500

1000

1500

2000

2500

Positive slides Positivity rate

Po

sit

ivit

y r

ate

(%

)

# o

f p

os

itiv

es

Gain after ACT introduction and

before scale-up of mosquito control

Gain before ACT introduction

Zanzibar Is Nearing Elimination

1. Source: Zanzibar Malaria Elimination Program

– for the Third Time

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But There Are Challenges

Decreasing effectiveness of mosquito control

Population resistance to behavior change

Case importation from mainland Tanzania

An effective surveillance and rapid response system is essential

Using dwindling resources more effectively

A Proven Mobile Malaria Surveillance and Rapid Response System

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Collecting Data at the Facility

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Collecting Data at the Household

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Testing and Treating Household Members

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Monitoring the Process and Targeting Resources

1,328 new cases,including asymptomatic cases, detected and treated

Rapid diagnostic tests administered and data collected from more than

22,350 household members

Used to respond to more

than 5,132 new malaria case reports

All 20 district malaria surveillance officers use Coconut Surveillance

All 154 government primary care units use the case alert system

78% of private clinics use the case alert system

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Social Impact

584,000 people died of malaria in 2013

500,000 died in Africa

400,000 were children under 5 years old

Nearly half the world’s population are at risk1

It costs Africa $12 billion each year2

1. World Health Organization, World Malaria Report 2014. 2. Gallup JL, Sachs JD, 2001. The economic burden of malaria. AJTMH 64 (Suppl 1–2): 85–962.3. World Health Organization, Malaria Fact sheet No94, April 2015.

Stronger malaria surveillance systems are urgently needed3

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Scaling Up

Unique

Free and open source

$350 / year for cloud hosting

$510 / year for each mobile user

$10,200 / year total for 20 users

Easy to adopt

Adaptable and Scalable

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2014 – World Health Organization establishes vision for “A world free of malaria”

Scaling Up

35 countries are pursuing malaria elimination

2005 – U.S. President’s Malaria Initiative launches $1.265 billion expansion to reduce malaria in Africa

2013 – U.S. $2.7 billion funding for malaria control and elimination

2014 – Bill & Melinda Gates Foundation sets goal of eradicating malaria by mid-21st century and boosts anti-malaria funding by 30 percent.

Questions – ict@rti.org

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“We must remain committed to the eradication of malaria. Small steps won’t get the job done.” – Bill Gates