Malakit : self-diagnose and self-treat malaria among illegal gold miners
All the solutionsPresentation
- Leading structure: Antilles-Guyana Centre of Clinical Investigation of the Cayenne Hospital Centre
- Partners : scientific: Antilles-Guyana Centre of Clinical Investigation INSERM 1424 (National Institute of Health and Medical Research); Pasteur Institute of Guyana; FIOCRUZ of Brazil (Fundação Oswaldo Cruz) – institutional: Ministries of Health of Brazil, Suriname and France; Regional Health Agency of Guyana; the World Health Organization /the Pan American Health Organization; the Global Fund Against Malaria – field actors: DPAC; SWOS
- Duration of the project: April 2018 – 2020
- Funders of the project : European Union (FEDER); Regional Health Authority of Guyana; Cayenne Hospital Centre; Brazilian Ministry of Heath; the Global Fund; Pan American Health Organization
Context:
In French Guiana, Malaria is still present (less than 300 cases in 2018) and the Maroni river, which is the natural frontier between Suriname and French Guiana, is at the heart of the sanitary and economic stakes the territory has to face. Illegal gold miners are today massively infected. They form a mobile population mainly coming from the poorest States of Brazil. They could contribute to the reintroduction of the malaria in some areas where the infection is today under control. A study led by the Regional Health Authority shows that the areas of high malaria transmission are located in the Upper Maroni, in Saint-Georges region, amont a population composed of creoles, amerindians and brazilians, and in the deep Amazonian forest, where there are illegal gold prospectors, gendarmes and forest rangers.
The remoteness of the mining camp – which are difficult to reach and dispersed – and the illegal administrative situation of these people lead to frequent self-medication. They remain out of the range of the health monitoring system. A study showed that 52% of gold miners self-medicated during their last malaria crisis, using under-the-counter drugs.
Strategy and objectives
Malakit is a kit for self-diagnosis and self-treatment of Plasmodium infections dedicated to the persons working at illegal gold mining sites.
Malakit is a small, waterproof and easy to transport pouch, which contains three rapid diagnostic tests and medications, in case of the result is positive. Illustrated instructions in Portuguese are printed directly on the plastic holders.
Malakit distribution is implemented at “rest sites”: these places are transit points at border crossings consisting of wooden shacks on stilts set up as shops, hotels, and bars where miners can purchase logistical equipment, rest, and sell gold. These sites are located in Suriname and Brazil along the two borders represented by the Maroni and Oiapoque rivers respectively. Kits are distributed by mediators of non-profit organizations: SWOS, in Suriname and DPAC Fronteira in Brazil.
It is an innovative and pragmatic public health project which meets 3 main objectives:
- to increase the appropriate use and complete malaria treatment after a positive malaria diagnosis with a rapid test
- to reduce the malaria prevalence among illegal gold miners
- to improve their knowledge about malaria and its prevention.
The project’s innovative characteristics
Mediation
This project targets a population constituted with a majority of Brazilians, so the mediators are also almost all Brazilians, and speak Portuguese. They have a good level of knowledge of the illegal gold mining, which helps to establish a climate of trust in the communication with the miners. The distribution is done in both Surinam and Brazil, so mediators were hired by the local NGO concerned.
The mediators thus train the miners to carry out a diagnostic test of malaria by themselves, repeat the importance of taking the antimalarial treatments correctly and so on.
Technologic
Data will be collected from health mediators at the time of kit distribution and during subsequent visits, and from illegal gold miners themselves, through a smartphone application which can be used without connection. The malakit app is a source of general information for participant and also a guide for users when they feel sick and are about to use the kit. It contains videos, information for pregnant women…
These data are used to monitor the project.
Results and perspectives
The project was launched in April 2018, with a 24 months pilot study. After more than a year of distribution in Suriname and ten months in Brazil, more than 3,000 people received a kit, and 500 came for a return visit.
The first result is the very good acceptance of the project by the population with a high rate of participation and their ability to perform correctly the malaria test by their own.
Complete results will be available at the beginning of 2020.
How can this project duplicated on other rivers?
Malakit can be adapted for other regions confronting with similar problems (an inaccessible population, an extensive geographical territory, and a public health issue).
If the results are positive, this project could serve as an example in other regions of the world confronted with similar problems. However, beyond malaria, this small sachet represents a conceptual innovation: that of giving autonomy to people so they can perform an objective diagnosis of a disease and administer an adapted treatment to themselves, thus allowing them to take care of their own health.
Maylis Douine, epidemiologist and doctor, Clinical Investigation department of the Cayenne Hospital
Solution follow-up
Two years later
How the project will be carried out
The initial project encountered several obstacles: the difficulty of access to the target populations, the language barrier between the partners, the difficulty of travel within the territory and with the partners (due to visa problems, few air links, and few roads), making cooperation between the three countries involved more difficult. The total cost of the project has been reassessed during the course of the project.
These difficulties led to the implementation of an external qualitative study conducted by the University of Montreal and financed by the AFD.
The project in its initial form ended in March 2020 as scheduled but a follow-up is underway.
Results
The evaluation included 1098 people and the analysis of the main indicators assessed behavioral changes and the impact on malaria. The results were presented to all scientific, associative and institutional partners and to the medical community.
The study shows that the distribution of 4,700 kits to 3,733 people has led to a clear decrease in the use of black market malaria drugs, thus limiting the risk of emergence of resistant parasites. The prevalence of malaria among gold miners traveling along the Maroni River decreased from 22% to 5%, thus limiting the risk of parasite transmission.
Distribution
Reflections are underway on the continuation of the project and its dissemination by the CHU of Cayenne. In Suriname, the project is being extended by the National Malaria Control Program.
Translated with www.DeepL.com/Translator (free version)
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Photo credit: Ronan Lietar-IMAZONE/ Carbu