Impact of 1,7-malaria reactive community-based testing and response (1,7-mRCTR) approach on malaria prevalence in Tanzania

Abstract

Background Progress in malaria control has stalled in recent years and innovative surveillance and response approaches are needed to accelerate malaria control and elimination efforts in endemic areas of Africa. Building on a previous China-UK-Tanzania pilot study on malaria control, this study aimed to assess the impact of the 1,7-malaria Reactive Community-Based Testing and Response (1,7-mRCTR) approach implemented over two years in three districts of Tanzania. Methods The 1,7-mRCTR approach provides community-based malaria testing via rapid diagnostic tests and treatment in villages with the highest burden of malaria incidence based on surveillance data from health facilities. We used a difference-in-differences quasi-experimental design with linear probability models and two waves of cross-sectional household surveys to assess the impact of 1,7-mRCTR on malaria prevalence. We conducted sensitivity analyses to assess the robustness of our results, examined how intervention effects varied in subgroups, and explored alternative explanations for the observed results. Results Between October 2019 and September 2021, 244,771 community-based malaria rapid tests were completed in intervention areas, and each intervention village received an average of 3.85 rounds of 1-7mRCTR. Malaria prevalence declined from 27.4% at baseline to 11.7% at endline in the intervention areas and from 26.0% to 16.0% in the control areas. 1,7-mRCTR was associated with a 4.5-percentage-point decrease in malaria prevalence (95% confidence interval: − 0.067, − 0.023), equivalent to a 17% reduction from the baseline. In Rufiji, a district characterized by lower prevalence and where larviciding was additionally provided, 1,7-mRCTR was associated with a 63.9% decline in malaria prevalence. Conclusions The 1,7-mRCTR approach reduced malaria prevalence. Despite implementation interruptions due to the COVID-19 pandemic and supply chain challenges, the study provided novel evidence on the effectiveness of community-based reactive approaches in moderate- to high-endemicity areas and demonstrated the potential of South-South cooperation in tackling global health challenges. Graphical Abstract

Development of innovative tripartite partnership for China’s engagement in global health: recommendations from China-Tanzania Cooperation Project on Malaria Control

“…Impressive achievements were made through the pioneering efforts of triangular stakeholders of the project: (1) 1,7-malaria Reactive Community-based Testing and Response (1,7-mRCTR) was successfully derived from local context sharing Chinese 1-3-7 norm through the field implementation; (2) malaria prevalence in the intervention wards declined by 81% from 2015 to 2018 and further declined by 55% from 2018 to 2022 [ 3 ]; (3) a local team composed of 37 Tanzanian community health workers were built to be paired with Chinese on-site technical staff to ensure the project implementation and sustainability[ 3 ]; (4) the project’s effectiveness and achievements contributed to the scaling up of 1,7-mRCTR in three other African countries including Burkina Faso, Senegal, and Zambia for sustainable development [ 4 ].…”

“…The China-Tanzania Cooperation Project on Malaria Control was conducted by National Institute of Parasitic Diseases at China CDC and Chinese Center for Tropical Diseases Research, Ifakara Health Institute in Tanzania and funding agencies from 2015 to 2022, with an aim to explore the applicability of Chinese experience on malaria control to reduce malaria disease burden in the local context of Tanzania. In the tripartite project funded by the former UK Department for International Development (DFID) and later the Bill & Melinda Gates Foundation (BMGF), China’s partners were expected to share the extensively parallel practices achieved from the control and elimination of malaria for over 70 years, UK’s partners were to deliver resources and design global health strategies, while Tanzanian local staff collaborated with triangular partners to ensure the project implementation [ 3 ]. In the project, the trilateral cooperation has transparent management mechanism to ensure the concrete management and implementation of the project [ 4 ] (Additional file 1 : Figure S1).…”