How training health workers and leveraging data-driven insights are reshaping malaria control efforts in high-burden regions of Mozambique.
The parasite that carries malaria is wily. As it encounters antimalarial interventions, Plasmodium falciparum will often try to evolve to escape defeat.
That's where genomic surveillance comes in handy. Genomic surveillance -- which entails the collection, sequencing, and analysis of the genetic material of malaria-causing parasites -- enables us to keep a watchful eye on the genetic changes of such parasites. In turn, this makes it easier to spot emerging resistance to existing tools and tests. Having this vital information could help stop an outbreak in its tracks.
Should resistance arise, it means that new tests and drugs can be recommended in a timely manner. But creating such a system requires accurate and granular surveillance data so that the most appropriate action can be taken swiftly to identify and contain a malaria outbreak and, ultimately, improve outcomes for the communities most at risk.
Malaria Consortium worked with the National Malaria Control Programme in Mozambique and Manhiça Health Research Centre (CISM) to implement a malaria molecular surveillance (MMS) system at health facilities across Mozambique, under the GenMoz project.
GenMoz sought to strengthen the capacity of health workers and supervisors for genomic surveillance as a way of guiding decision-making around malaria control and elimination. The project, which started in 2021 and received support from the Bill & Melinda Gates Foundation via Fundação Manhiça, focused its efforts in Mozambique, which is among the 10 countries with the highest burden of malaria worldwide, and reported an estimated 9.23 million cases in 2023.
Now that the project has come to a close, the team involved at Malaria Consortium is reflecting on its successes and trials.
"The GenMoz project has highlighted the transformative role of surveillance data in combating malaria," says Neide Canana, Senior Research Coordinator for Malaria Consortium Mozambique. "By providing health workers with the tools and training needed to gather and utilise genomic data, the initiative has strengthened malaria surveillance and empowered local teams to make informed decisions in reducing the disease's burden. Through its collaborative approach, GenMoz has fostered a culture of genomic data use within the health system, enhancing public health impact and driving progress toward malaria control in Mozambique."
Key outcomes and lessons learnt
Between 2022 and 2023, the project trained 139 health workers -- ranging from supervisors to health facility staff -- in how to collect samples, manage data and analyse information to track malaria more effectively.
In total, 64 health facilities in 13 districts across Mozambique participated in the MMS system. Over 11,000 patients consented to provide dried blood spot samples, contributing to a significant dataset for molecular sequencing. Frequent supervision visits helped improve the quality of data collection and strengthened the skills of health workers.
The team also found that continuous supervision of the monitoring efforts meant that health workers could handle complex genomic data collection with confidence, which led to more accurate results. Integrating these efforts into routine operations will enable Mozambique to sustain and build upon the progress made by GenMoz.
While the project made remarkable strides, challenges also presented themselves. Delays to the start of the project impacted its full potential: 72 of the planned 91 monthly supervision visits (79 percent) were completed in 2022, although this could have been much higher. Further challenges included a lack of power coverage in certain areas affecting the refrigeration of samples; and high absence and turnover of technicians interrupted project activities, impacting on sample collection targets.
A brighter future
Building on Malaria Consortium's broader surveillance strengthening efforts across the country, our continued emphasis on ongoing supervision and regular training -- for more accurate reporting, collection and use of high-quality data -- is helping to strengthen national efforts to translate data into action. To derive the greatest value from these insights, sustained investment in health systems is needed to overcome resourcing constraints that may stand in the way of more effective implementation.
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The GenMoz project is more than just an innovative malaria surveillance programme -- it's a beacon of hope for Mozambique's fight against this deadly disease, setting a precedent for future public health strategies in the country and in similar settings, globally. By combining cutting-edge science with local expertise, the project has set the stage for smarter malaria control strategies that can save lives and bring us closer to a malaria-free future.
Read more about the GenMoz project: Implementing a quality-assured genomic data and sample collection system in Mozambique
