Tackling malaria in remote mining communities in Guyana

Could you please provide a quick overview of the malaria situation in Guyana, namely with regards to the current malaria prevalence? How this has changed over the past 5 to 10 years?

Currently, Guyana represents about 3% of cases in the Americas. We have about 20 000 cases annually, primarily in the hinterland regions of the country, in 5 out of our 10 administrative regions. In these regions, we have a lot of gold and diamond mining and logging, and the population is very mobile.

Workers travel to remote areas to engage in mining, where there are few, or no, established health facilities, and therefore access to health services can be very limited. Coupled with high illiteracy rates among this population, this makes it more difficult to reach them with timely malaria prevention interventions, diagnosis and treatment.

Our malaria control programme aspires to a 75% reduction in malaria cases by 2025 relative to 2015 figures, and a 90% reduction by 2030. Given the interventions we are putting in place, we expect to achieve – or almost achieve – those objectives by the deadlines.

How do you tackle providing access to malaria services to mining communities, where the risk of malaria is higher?

We know that mining drives malaria transmission and that there is a correlation between gold prices and malaria cases in Guyana; it’s something we’ve documented through detailed studies we carried out and published in peer-reviewed journals. These studies have allowed us to understand the impacts of these populations’ remoteness as well as their barriers to accessing health services.

Using that knowledge, we’ve trained individuals in mining communities to use rapid tests to diagnose malaria cases, treat simple cases free of charge and report data using a simplified tool. We began in 2016 and have since scaled it up in several regions.

By detecting and treating cases early on, we can break transmission and reduce malaria numbers, helping us accelerate progress along the malaria elimination continuum. This approach helps ensure that remote populations have the same access to health services as those in settled communities.

How do you identify and train individuals in mining communities?

Within each camp setting, our teams work to identify and train 2 individuals who show leadership potential, have a more permanent presence in the camp and are interested in playing a role in malaria prevention and control. For example, this might mean we train a camp manager or a cook instead of a worker who might leave tomorrow morning. Other times, we’ll train village leaders or shop owners who interact with miners on a regular basis.

These individuals are trained on how to administer tests and treatments for uncomplicated cases, and they keep a daily-case register, manually recording demographic data and diagnosis. Our teams also visit the camps on a regular basis to collect data and provide additional support.

Training of miners to test and treat for malaria in remote settings. © Ministry of Health, Guyana

I understand that you’ve been implementing new behaviour change interventions among miners. Can you tell us a little more about those?

Working with the Johns Hopkins Center for Communication Programs and Breakthrough ACTION Guyana, we’ve been using a human-centered design approach to help improve health-seeking behaviour among miners. First, we carried out formative research to identify gaps in knowledge, attitudes and perceptions with regards to malaria control and prevention, interviewing miners, camp managers, community health workers and pharmacists, among others. Then, we used that understanding to develop different interventions (what we call prototypes). We piloted many of these, and we’re now scaling up the most impactful ones.

In 2020, we launched the “Little Mosquito, Big Problem” campaign that focuses on increasing knowledge about malaria transmission and symptoms, encouraging testing and providing subtle encouragements to complete treatment courses. Some of the materials, for example, show how the parasite’s presence reduces in the body as you take your treatment, to reinforce the message that the parasite does not die until treatment is finished. The campaign uses social media, radio skits, TV advertising and ads at cricket matches.

Has your team been implementing any new malaria surveillance efforts in the country?

In 2010, Guyana detected a unique malaria mutation called the C580Y mutation. Given concerns that this mutation might lead to resistance to artemisinin-based combination therapy (the first-line therapy in almost every country where malaria is endemic), we have been monitoring how it’s behaving in malaria parasites over time. We do this via sentinel site surveillance in collaboration with the Pan American Health Organization (PAHO), the Institut Pasteur and the Harvard T.H. Chan School of Public Health, which has helped sequence samples. For the time being, we have witnessed no in vivo resistance to artemisinin, but we are monitoring this closely given that the biggest threat to elimination would be the emergence of resistance.

What does your programme hope to achieve over the next 12 months?

As was the case almost everywhere in the world, the COVID-19 pandemic caught us by surprise and diverted personnel and resources from other health issues, including malaria. Now, our focus is on regaining momentum in the fight against malaria and getting back to work and to the speed we were moving at prior to the pandemic. It’s time to get back on track to achieving our targets.