Exploring factors impacting the implementation of community-based malaria control, malaria burden, and surveillance in southern Malawi Insights from the community and health system perspective

Malaria remains a major cause of morbidity and mortality, with sub-Saharan Africa disproportionately bearing the highest burden. Vector control interventions have been at the forefront, significantly reducing malaria transmission. However, in recent years, global progress against malaria has stalled. Effective control and elimination of malaria in endemic regions necessitates concerted efforts from all stakeholders, including governments, scientists, NGOs, and communities. To facilitate implementation, the WHO developed the Global Technical Strategy for Malaria (GTS) 2016-2030. The GTS emphasises the significance of country ownership and leadership, with active community participation as a crucial factor for accelerating progress through a comprehensive, multisectoral approach. The GTS also emphasises the importance of improved surveillance, monitoring, and evaluation, alongside stratification based on malaria disease burden, to optimise the implementation of malaria interventions. This thesis employed a multidisciplinary research approach to achieve two main objectives in southern Malawi. First, it assessed the impact of community participation in implementing community-based malaria control strategies. Second, it investigated the burden and surveillance of malaria. This thesis demonstrated that utilising trained volunteers and involving local community stakeholders significantly enhanced the implementation of the community-led malaria prevention strategy, improving both fidelity and feasibility. This community-led approach further led to increased community awareness of house improvement (HI) and malaria, as well as enhanced acceptability of the strategy. The electronic data capture system was well-accepted by users and resulted in improvements in data completeness and consistency. Furthermore, the study found that community-based malaria control strategies effectively complemented the existing indoor strategy, as evidenced by the low incidences of malaria, ARIs, and diarrhoea.