Fighting malaria with tech solutions

In the middle of a muddy field next to a reservoir in Kasungu District, a team of scientists is hard at work. Boxes of equipment lie scattered around a patch of dry ground, where Lancaster University’s Michelle Stanton programmes an automated drone flight into a laptop perched on a metal box.

With a high-pitched whirr of rotor blades, the drone takes off and starts following the shoreline, taking photos as it goes. Once the drone is airborne, the team switches from high-tech to low-tech “bucket and spades” mode. Leaving the laptop, they collect ladles, rulers and plastic containers. Wearing rubber boots, they squelch through mud until they reach the water’s edge.

Choosing a spot amongst the lily pads, team members, including United Nations Children’s Fund (Unicef) innovation intern Patrick Kalonde measure the water depth with a ruler and carefully scoop 10 ladles of water into the containers. Using a mobile app, they record the GPS location of each sample. Back on dry ground, they wait for the water to settle and then use a pipette to count the number of mosquito larvae in each container.

The team from Liverpool School of Tropical Medicine and Lancaster University has been doing this for two weeks at five reservoirs in Kasungu. They are collecting data to identify mosquito breeding sites, so that the larvae can be managed and reduce the number of adult mosquitoes able to spread malaria.

“We stitch together the drone photos to create an aerial map of the reservoir,” Michelle explains. “The drone has a near-infrared camera, which can detect different types of vegetation. Our water samples tell us where the mosquito breeding sites are, and we can plot these on the map. Then, using image classification software, we can identify the common features of these sites and predict where other breeding sites are.”

Deadly disease

Malaria is one of the top three causes of death among children under the age of five. At Kasungu District Hospital, there is a long queue of mothers waiting outside the Under Five Clinic in the morning sunshine. Most of them have infants or small children strapped on their backs in a colourful chitenje wrap.

The mothers and children are registered at the clinic door. In a corner of the waiting room, health surveillance assistant (HSA) Zondiwe Nyirongo sits wearing white plastic gloves and an apron at a desk already littered with used malaria test kits.

“I’ve done 56 malaria tests this morning,” he says, referring to a written record. “Of these, 19 were positive. I do up to 300 tests every day, and around half of them are positive.”

One of the children to receive a malaria diagnosis is four-year-old Esther Gama from Kaning’a Village. After the test result, they receive three days’ worth of anti-malaria medication.

Her mother, Mary says: “Esther is my only child. She’s had malaria maybe six or seven times since she turned two years old and I’ve lost count.”

One of the reasons children like Esther keep getting malaria is a lack of mosquito nets.

“We don’t have any bed nets at home,” Mary says. “I received one when I was pregnant but I don’t have it now and we can’t afford to buy. Several children in our village have been admitted to hospital with serious cases and some of them died.”

Kasungu District medical officer Liz Msowoya says malaria is the number one cause of hospital admissions and deaths among under five children in the district.

“We’ve been seeing more cases this year,” she says. “This is partly due to the warmer, wetter weather, but also because public health initiatives have not been effective enough.

“We distribute mosquito nets but we know that not all families actually put their children under them. Some people misuse them for fishing or to protect crops. There is also a persistent rumour that they attract bedbugs, which is not true.”

She says that the fatalities are usually caused by people bringing their children to hospital too late.

“We lack resources such as blood supplies for transfusions,” she explains. “There is also a high HIV rate in this area so relatives cannot always donate blood. Sometimes the health workers donate their own blood because they don’t want the child to die. But other times there is nothing we can do.”

Innovative approach

The purpose of innovation is to find new ways to tackle entrenched problems. Chris Jones form Malawi Liverpool Wellcome Trust Centre who is co-leading the drone project with Michelle and says existing anti-malaria measures have led to a dramatic decrease in deaths over the last two decades, but new measures are needed.

“This is the first time the drones approach has been tried,” he says. “If we can prove the concept, this could become another malaria prevention measure to be used alongside bed nets and village health workers.”

The project made use of Unicef Malawi’s Humanitarian Drone Testing Corridor. Launched in 2017 with the government of Malawi, this allows universities, companies and individuals to conduct test flights within an 80km diameter area centred on Kasungu airfield. Tests must have a humanitarian or development application in the areas of transport, imagery or connectivity, and provide training opportunities for local Malawians.

Unicef conducted community sensitisation activities in the corridor to introduce local people to drones and what they are doing.

“Our contacts are in the health sector, not civil aviation,” explains Michelle. “It would have been very difficult for us to get permission to fly and conduct the community sensitisation ourselves. With the drone corridor, however, we could just come in and fly straight away.”

Kasungu District Hospital staffs are happy with interventions that can reduce malaria.

“If drone flights could identify the breeding sites, our environmental health officers could go out and eradicate the mosquitoes,” Msowoya says.n