The formula for malaria control in developing countries often seems simple: limit exposure through bed nets, control mosquito vector populations, and provide treatment for infected cases. Yet, implementing solution “A” to address problem “B” can be infinitely complex. How does one decide who gets what? Is the intervention cost-effective? What do the people want? Should this be a priority, considering the litany of grievances affecting the lives of our most vulnerable populations? Without grasping the magnitude of the problem, we are left to rely on speculation and blind policy. The importance of high quality data and surveillance cannot be understated, with research being the driving force behind valued policies. In this regard, malaria surveillance in Haiti represents a major obstacle for targeted control and management.
To address these gaps in data, The University of Florida’s Department of Environmental and Global Health (EGH) is collaborating with the Haitian Ministry of Public Health and Population, along with partner organizations, Fish Ministries Haiti, Family Health Ministries, and Community Coalition for Haiti (CCH), to best determine the needs of the people about malaria control. Doctoral candidate Michael von Fricken, working with EGH Research Assistant Professor Dr. Bernard Okech, is conducting malaria surveillance in the Ouest and Sud-Est departments of Haiti to provide policymakers with valuable information on malaria previous exposure rates, the prevalence of protective genetic factors, and transmission dynamics by region. Currently, the malaria research team is enrolling participants from clinics and schools in Port-au-Prince, Gressier, Leogane, and Jacmel, with each site representing a variety of environmental and demographic characteristics.
The entire study falls within 25 square miles, capturing the epicenter of the 2010 earthquake and roughly 30 percent of Haiti’s 10 million residents. Preliminary data suggests major regional differences in protective genetic factors and risk of malaria infection, despite the proximity of each site location. However, this distance is filled with vast mountain ranges, rolling valleys, and coastal plains. Haiti’s unique topography represents the biggest barrier to accurate surveillance. Policies must be tailored by geographic variation instead of departmental lines, due to the influence that altitude,
Michael recently travelled to the coastal city of Jacmel to screen for malaria and only found 4 cases after screening 80 febrile patients. He observed that with each finding he is left with 20 new questions. What is the cause of fever in the remaining patients? Are these findings similar to what we are seeing elsewhere? What are the malaria transmission rates in the general population? When speaking to the parents of a participating school Michael said, “I hope there is no malaria in your community; I honestly want to find zero cases.” Ultimately, research is a means to public health, not an end; the best intervention is the one that doesn’t need to be implemented.vegetation, rainfall, and temperature can have on disease incidence.
The next step is to begin screening in Christianville, Gressier, with the help of partners at Fish Ministries, to better determine differences by region. The documented absence of a disease can be just as important as its presence. If malaria is not a significant cause of fever in Haiti, efforts must be directed towards investigating other possible sources.