MARA/ARMA

MARA/ARMA (Mapping Malaria Risk in Africa / Atlas du Risque de la Malaria en Afrique)

MARA/ARMA Logo

The MARA/ARMA collaboration was initiated to provide an atlas of malaria for Africa, through the use of a Geographic Information System (GIS), by integrating spatial malaria and environmental datasets, and producing maps of the type and severity of malaria transmission.

Funding

During the first two years of its existence the MARA/ARMA initiative has essentially been funded by the International Development Research Centre of Canada (IDRC). The South African Medical Research Council (SAMRC), the Wellcome Trust, UK, The Swiss Tropical Institute and the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) also contributed significantly. Recently MARA/ARMA has been awarded funding from the Multilateral Initiative on Malaria (MIM) of the UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases (TDR).

Background

Malaria is a serious problem in some 90 countries or territories. Over 2 400 million people, or 40% of the world's population, currently live in regions where there is a malaria risk. Each year, there are an estimated 300 to 500 million clinical cases of malaria and an estimated 1.5 to 2.7 million deaths. Studies in Africa indicate that as much as 20% to 30% of infant and childhood mortality may be attributable to malaria. The safe and cheap drugs that used to provide effective protection against malaria are no longer dependable in many parts of the world since in many areas the parasite responsible for the severest form of the disease, known as Plasmodium falciparum, has developed resistance. The mosquitoes that transmit the parasite to humans have also developed resistance to insecticides in many areas. (WHO)

Very recent advances in public health technology offer, for the first time in decades, real opportunities to make significant reductions in this important burden of disease. This is achieved by the use of insecticide-treated bednets. Mortality reductions between 17 and 63 % have been recorded in a variety of endemic settings in Africa, making this intervention extraordinarily cost-effective. However, the range of measured impact might be related to the level of endemicity and may necessitate the implementation of supplementary techniques. Many factors affect the choice of control methods for a region (vector species and behaviour, seasonality, regional infrastructure, etc.) and many of these have a spatial component. These factors necessitate that researchers revise their definition of endemicity, and how they should map malaria risk in order to better support planning and programming of malaria control.

Detailed mapping of malaria risk and endemicity has never been done in Africa. Accurate estimates of the burden of malaria mortality at the regional or district level remain largely unknown. The lack of diagnostic tools for the reliable definition of malaria-specific mortality and the previous lack of any attempt to define populations truly exposed to risk of death have led to the paucity of basic data. In the absence of such data, it is impossible to rationalise allocation of limited resources for malaria control.

The Objective of MARA/ARMA Initiative

To collect comprehensively available malaria data and also to characterise risk categories in terms of non-malaria data (e.g., climatic, environmental data);
To develop a mask layer of factors which exclude malaria (e.g., absence of population, high altitude, deserts, etc.);
To highlight areas of no data and provide further work on geographical modelling to extrapolate to such areas of no data, using among others the environmental stratification outlined in '1' above;
To develop a base-map of malaria risk in Africa, down to second administrative unit (district), from available geographic, demographic and malariometric data using a GIS and make this available to national, regional and international organisations.

Data Collection

Five regional centres, at existing institutions throughout Africa, and supervised by the co-investigators at those institutions are responsible for gathering malaria data (parasite ratios and incidence data) and incorporating them into the MARA/ARMA database.

The main MARA/ARMA malaria data collection is yielding numerous data points across the continent. Many of these originate from unpublished reports and were obtained through country visits. A separate highland malaria data collection, by the Highlands Malaria Project which relates to MARA/ARMA, has acquired many reports of malaria epidemics outside the stable malaria areas. A collection of mosquito surveys has also been incorporated and is providing information on vector distribution.

Relevance

The data and maps produced by the MARA/ARMA initiative will:

Allow regions of transmission type and severity to be defined and to be targeted for appropriate control measures;
Play a significant role in the geographic focussing of control resources (human, financial and technical) to areas of most need;
Spatially define the continent into regions of similar type and severity of transmission and should encourage regional (as opposed to national) application of appropriate and uniform control strategies;
Be of significant value to all future country specific, regional and continental research on malaria transmission dynamics;
Be valuable for the study and control of other diseases, for which MARA/ARMA can serve as a model, and for which the non-malaria information platform can be used in a similar manner.