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The MARA/ARMA collaboration was initiated to provide an Atlas of malaria for Africa, containing relevant information for rational and targeted implementation of malaria control.
The MARA/ARMA initiative is
non-institutional and runs in the spirit of an open collaboration. A group of
dedicated African scientists, based at institutions across the continent, work
co-operatively towards achieving the overall objectives.
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Sub-Saharan Africa carries the highest per capita burden of disease in the world of which malaria is the single most important cause. Of global deaths attributed to malaria 90% now occur in sub-Saharan Africa. Recent advances in public health are offering new opportunities to make significant reductions in the burden of disease. However, many factors, especially endemicity, affect the choice of control methods. This requires us to rethink how we define endemicity, and how we may map malaria risk in order to better support planning and programming of malaria control.
Detailed mapping of malaria risk and endemicity has never been done in Africa. Accurate estimates of the burden of malaria at regional or district level remain largely unknown. In the absence of such data it is impossible to rationalize allocation of limited resources for malaria control.
To date over 10 000 data points have been collected (see Figure on right), from published and unpublished sources, through literature searches and country visits. The intellectual and monetary value of the collated data base alone is hard to appreciate. It represents decades of malaria research in Africa, much of which was on the verge of being lost and forgotten, and certainly not being used.
MARA/ARMA has provided the first continental maps of malaria distribution and the first evidence-base burden of disease estimates. There is currently hardly any major document on malaria in Africa that does not make use of MARA maps and the BOD figures produced by MARA/ARMA are now universally used.
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| Several malaria risk maps have been produced, both theoretical based on climate (left) and statistical based on the data (right). Estimates of populations at risk are provided on this web site. Over 2000 poster-sized maps have already been disseminated to all endemic African countries, financed by RBM. | ||
First regional empirical malaria risk map
The Eco-System and Health Analysis Workshop (ESHAW) in West Africa has produced the first sub-continental malaria transmission risk map in 1999. The workshop produced malaria disease endemicity estimates (as we were working with parasite ratios) as well as the first regional estimates of population at risk for various endemicity levels within a countries, thus indicating that only 10% to 15% of populations are exposed to highly endemic malaria (PR>=70%).Spatial statistics and modelling
MARA/ARMA is at the cutting edge of, and has made significant steps forward in, the geographical modelling of malaria using eco-physiological / climate / GIS (geographical information systems), as well as spatial statistical approaches. Highly original spatial statistical methods are being developed currently to strengthen the analysis of the MARA/ARMA data.The scientific aspect of the project is exemplified by no less than 13 scientific publications, largely in prestigious medical and scientific journals. Five doctoral degrees have already emerged directly out of MARA/ARMA.
Dissemination of Products
MARA/ARMA products have been disseminated in a range of formats:
2. Technical report in English and French
3. Posters of malaria models
Around 3000 poster sized maps of malaria models and population distribution were produced and sent to malaria control programmes / departments of health / research institutions in all endemic African countries.
A CD-ROM based Low-end Information Tool providing easy access to MARA/ARMA products.
1. Functional network of scientists / institutions set up for MARA activities
with computers, GIS and MSOffice software
The different coloured countries denote five functional MARA/ARMA regions:
Anglophone West
Francophone West
Central
Eastern
Southern Africa
2. Additional national centres provided with training and software
3. Network of skilled GIS people established through training and support
4. Fully functional regional GIS centres
5. Training
a) GIS and databases: 33 people
b) Climate change methods: 23 people
c) In-house: 20+ people
d) End-user workshop: 45
people 
6. Higher degrees: 8 people 
MARA/ARMA maps and data allow:
1. Appropriate selection of malaria control tools (different control tools are
appropriate in different endemic settings);
2. Evidence-based planning (a base-line estimate of people at risk or infected
is needed to plan interventions and assessment studies);
3. Spatial targeting (eg. where are the high-priority areas);
4. Rational budgeting (eg. how many cases of malaria can be expected per
administrative area).
5. Adequate timing (eg. when in the year do bed-nets need to be
insecticide-treated);
6. Empirical assessment of control interventions (eg. how many people need to be
surveyed to demonstrate a certain reduction in malaria).
1. MARA/ARMA centres have become a data resource
in Africa
2. MARA/ARMA has made significant advances in the geographical modelling of
malaria
a) Eco-physiological / climate / GIS approaches
b) Spatial statistical approaches
3. MARA/AMRA has contributed greatly towards developing spatial thinking in
malaria and health.
4. MARA/ARMA has allowed the first accurate assessment of burden of malaria in
Africa.
5. There is a call for MARA/ARMA maps by different organizations and
researchers.
6. Plans exist to emulate MARA/ARMA in other areas, eg Mapping malaria in Papua
New Guinea.
7. MARA/ARMA was selected as one of 700 projects of the World Exposition
EXPO2000, which focussed on projects in which people are working on
practical solutions for the challenges of the future.
1. 1996: First workshop, development of protocol (funded by TDR: $ 10
000)
2. 1997-1998: Phase 1 (core funding from IDRC: CA$ 250 000 over 2 years)
a) Original team linked up (PI’s and data
coordinators)
b) Development of proforma, relational data base &
stand-alone data entry system
c) Training of data coordinators in GIS and data
collection methods
d) Acquisition of digital databases, computers and
software
e) Started data collection (<3000 data points),
developed numerical malaria models
f) Technical report published and distributed in
English and French
3. 1997-present: Direct support to Kenyan node, burden of disease
research (funding by Wellcome Trust UK about US$ 50 000 per year)
4. 1997-present: Data collection in European tropical research institutes
(funded by Swiss Tropical Institute)
5. 1999-2001: Phase 2 (core funding from MIM/TDR US$ 324 000 over 3
years)
a) Further data collection (10 000+ data points),
double-entry validation
b) Data analysis, spatial modelling of empirical data
c) Further GIS and database training courses, in-house
training, 5 higher degrees
d) Expansion of network, regional GIS capacity
development, regional GIS centres
e) Increased interaction with malaria control bodies,
information dissemination
6. 1999: Production and dissemination of >1600 poster maps (funded by
RBM US$ 64 500)
7. 1999: Eco-System and Health Data Analysis Workshop (funded by IDRC US$
25 000)
8. 2000: further development of various aspects (additional funding from
RBM US$ 180 000 over 1 year)
a) Highlands & desert malaria data collection
b) Malaria information systems
c) Development of regional centres
d) Spatial analysis and modelling.
9. A conservative estimate of in kind contributions by hosting African
institutions runs to about $450 000 per annum, the bulk of which was contributed
by the coordinating centre in Durban.
During the first two years of its existence the MARA/ARMA initiative has essentially been funded by the International Development Research Centre of Canada (IDRC). The South African Medical Research Council (SAMRC), the Wellcome Trust, UK, The Swiss Tropical Institute and the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) also contributed significantly. Recently MARA/ARMA has been awarded funding from the Multilateral Initiative on Malaria (MIM) of the UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases (TDR). Production of poster maps for all endemic African countries is funded by the Roll Back Malaria (RBM) Initiative.
We acknowledge the institutions which will host the regional centres and who, together with the co-ordinating centre SAMRC, will contribute towards saff salaries, equipment etc. The SAMRC is acknowledged for the upgrading of the GIS lab facilities to accommodate MARA/ARMA staff and visitors.
