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Artigo Original
Introduction:
Malaria elimination had remarkable progress in recent
years, but still far from the 2020 milestone of 40% re-
duction in incidence and mortality, according toWHO
[1].Therefore it is necessary to think differently towards
a paradigm change.
The lastWorld Malaria Report [1] reveals about 200 mil-
lion new cases, worldwide in 2015, with an estimation of
430 thousand of life lost, mainly in the southern region
of theWorld (90% in sub-Saharan-african countries).The
global mortality rate has been decreasing but slowly, now
at 29% on average, while 31% forWHOAfrican Region
[1]. The most successful malaria measures, such as the
ones that increases diagnostic testing for children (reach-
ing about 77%) and the administration of three doses,
or more, of intermittent preventive treatment (IPTp) in
pregnant women (31% in 2015, inAfrican countries), or
even the doubling of the use of insecticide-treated mos-
quito nets (ITNs), still lack in population coverage.These
interventions have significantly contributed to malaria
mortality reduction, especially among the more vulner-
able population, the under 5 years-old children.This gave
5 years-old children a global life expectancy gain of 5%
(12,3% forWHOAfrican Region), from 2000 to 2015,
with economic impact of about US$ 2040 billion (US$
1810 billion in sub-SaharanAfrica) [2].
Countries are still at different stages regarding malaria
elimination. Between 2010 and 2015, the global malaria
incidence rate decreased 21%, going faster in theWHO
European Region (100%) and theWHO South-East Asia
Region (54%) than in theWHOAfrican Region (21%),
together with theWHO Eastern Mediterranean Region
(11%).
What are the factors behind this? Besides the deep asym-
metries in healthcare access and socio-economic condi-
tions (i.e. health determinants), among others, the par-
allel control programs and of epidemics-report systems
gave rise to lack of global valuable information, an im-
portant barrier to efficiently tackle the problem and im-
plement any quick intervention [2]. Remote areas face
additional difficulties in both detection and treatment
demanding innovative approaches [1].
To accomplish the sustainable development goal of end-
ing the epidemics by 2030, measures should target the
disease elimination at local and remote areas, and invest
on preventive and control programs [2].The dissemina-
tion factor could be more efficiently addressed, focus-
ing on the elimination at the source, the reservoirs, with
continued measures to prevent the re-establishment of
transmission from mosquitoes to final hosts. Research
and Development (R&D) allows the development of in-
novative prevention and control solutions to interrupt
transmission and accelerate the elimination process.
As the world advances toward malaria elimination, the
elimination management paradigm has to change to ad-
dress early case detection in more local and remote areas.
Remote areas face additional difficulties in both detec-
tion and treatment demanding innovative approaches.
The integration of health data for observatory and inter-
vention purposes, using innovative web-based technolo-
gies is of major importance to achieve such goals. It allows
the availability of evidence-based information, real-time.
For example,WHO has been promoting a platform, the
"District Health Information System" (DHIS2), that al-
ready centralizes health and diseases-specific data from
more than 50 countries, including several ones on ma-
laria programs [2]. However, most of the countries lack
supporting organization to tackle the helath information
integration’s implementation. For instance, Namibia's
case, which has about 67 different data sources and only
3 are integrated (including the DHIS2 system), mean-
ing that this is still an ongoing process [3]. The lack of
interoperability standards and integrative policy, the lack
of qualified human resources or low levels of internet
connectivity, among others, are main barriers to be over-
come.
Malaria elimination needs evidence-based decision-mak-
ing with real-time access to malaria cases data.Years of
endeavor towards malaria elimination have created sev-
eral databases. Unfortunately these database often lack
interoperability making the use and the crossing of data
difficult.The access to real-time alerts can promote de-
cision-makers leadership and quick action in launching
early interventions particularly in less-resources settings.
The early detection in local and remote areas, and infor-
mation integration for a faster response, are key.
Therefore, we aim at testing a collaborative process of
design and implementation strategy, combining simple
elements of gamification, Geographical Information Sys-
tem (GIS) andArtificial Intelligence (AI) to enable early-
detection and risk of malaria epidemics alerts, and to di-
rect interventions around detected cases. Our case will
focus in a region of Angola.
Methods
A smart, comprehensive, sustainable and integrated in-
formation system is required to support this challenge.
This study aims at improving malaria epidemics manage-
ment through the use of artificial intelligence and other
technologies power.
The collaborative design and implementation strategy
combines simple elements of Gamification,Geographical
Information System (GIS) andArtificial Intelligence (AI).
This solution enables epidemics situations early-detection