Bioko Island Malaria Control Project (BIMCP) (2003 - 2008;
2008 - 2013)
The Bioko Island Malaria Control Project (BIMCP) is the result of an innovative partnership involving the Government of Equatorial Guinea (GoEG) and a consortium of private sector and non-profit organizations, led by Marathon Oil and MCDI respectively. The project seeks to reduce malaria transmission on Bioko Island.
Malaria is a serious public-health challenge for the people of Equatorial Guinea (EG). Until recent years, due to lack of resources, limited capacity, and few viable intervention options, no effective program was in place to reduce the malaria infection rates. Marathon Oil and its partners responded to this challenge by pledging $6 million in 2004 to design and mount an ambitious malaria-control initiative. This initial investment was followed by subsequent increments based on evolving needs, resulting in a final five-year commitment of $12.1 million (through 2008).
Working closely together, the GoEG, Marathon, and MCDI decided that a sustained investment in malaria control would confront a major challenge to developing the country, a public health crisis among its citizens, and a business hurdle for Marathon Oil.
MCDI and its partners helped establish a mosquito vector-control program based on widespread indoor residual spraying (IRS), which was coupled with an improved case-management approach to promote early and effective treatment of malaria.
Indoor Residual Spraying
By the end of 2006, the BIMCP had completed 5 rounds of spraying, covering some 120,000 structures. The program expanded after two additional spray rounds in 2007 to cover 150,000 structures. Recent results from household surveys show a reduction of 42% (from 45% to 26%) in the infection rate of children under the age of 15, and a 13% reduction of anemia (77% to 67%) in the same target group after four rounds of spraying. MCDI monitoring reveals that one kind of malaria vector was reduced to 7% of pre-spray numbers after four rounds of spraying, and another was not found after the third round.
MCDI worked with government and international partners to determine the appropriate choice of insecticide for IRS and were careful to proceed in an environmentally sensitive manner. Also established was a system to monitor and respond to the development of vector resistance to insecticide. When monitoring revealed that resistance to the first insecticide was emerging, MCDI changed the insecticide it was using between the second and third rounds.
The BIMCP recruits and trains spraying teams and develops behavior-change strategies and materials that support IRS spraying. In addition, MCDI has procured all IRS-related equipment and commodities, including insecticides, protective gear, and spraying equipment.
Case Management
In the second year of BIMCP, MCDI and its partners improved malaria case management by developing guidelines, training materials, and job aids for health personnel and community groups in an effort to increase care-seeking behavior among vulnerable populations and promote rapid and correct diagnoses and treatment at community health facilities.
MCDI facilitated the production of training materials in order to order to ensure timely and proper treatment at all levels. MCDI and its partners also developed drug-management protocols, inventory-management systems, storage and distribution protocols, logistics-management plans, and supervisory protocols for the quality control of case management.
MCDI worked with the National Malaria Control Program (NMCP) and other partners to successfully introduce the use of artemisinin combination therapy (ACT), replacing chloroquine as the first line anti-malarial on Bioko Island. 2006 data from sentinel survey sites showed a reduction of 63% in malaria incidence among oil workers and a 69% reduction among children under the age of five. Health facility surveys demonstrated that over 90% of health providers were dispensing the proper dosage of anti-malarials in accordance with MCDI-developed protocols.
Behavior Change Communications (BCC) and Information, Education, and Communication (IEC)
MCDI developed comprehensive BCC approaches as part of BIMCP, including radio spots and short programs, pictorial job aids (flipcharts, posters, etc.), pictorial reminder materials for caretakers (on ACT doses and schedules), IEC materials promoting IRS, and educational games and scripts for use in community drama presentations. Materials were improved with feedback from focus groups of users and health providers.
In addition, MCDI prepared IEC materials, training curricula, and supervisory-system protocols to improve the recognition of malaria signs and symptoms at the household level, promoted timelier care-seeking behavior, and improved the quality of treatment at facility and community levels. Furthermore, MCDI trained sprayers to increase the awareness of mothers about malaria prevention and detection, as well as to educate them about the best practices for treatment of fever.
Monitoring and Evaluation (M&E)
MCDI implemented a rigorous and extensive M&E program to track results and document the impact of BIMCP. This effort included monitoring changes in mosquito populations and sporozoite rates as IRS was implemented, testing and documenting the continuing effectiveness of IRS insecticides, tracking changes in malaria parasitemia and anemia rates in children and pregnant women in IRS-covered areas, and tracking reported malaria cases treated in government health facilities.
This comprehensive M&E system was set up with Ministry of Health participation and includes data that measures the results and impact of the project, improves supervision of health facility staff, and streamlines the process of data entry.
The M&E system provides data and feedback to facilities from the MoH health information system, as well as a complete drug management system that includes purchasing, logistics, and monitoring.
Capacity Building
Under BIMCP, MCDI is strengthening the MoH's capacity to manage the National Malaria Control Program (NMCP) with support from the President's Malaria Initiative (PMI) and the Centers for Disease Control and Prevention (CDC). Government counterparts work together with MCDI and partner staff in all aspects of BIMCP's planning, implementation and evaluation.
BIOKO ISLAND MALARIA CONTROL PROJECT - VIDEO (ENG SUBS)
FACTORS INFLUENCING THE EFFECTIVENESS OF MALARIA CONTROL IN BIOKO ISLAND, EQUATORIAL GUINEA (PDF)
