Victor Alegana: Estimating disease burden in Africa
Health statistics help us quantify the burden of disease in a population, and the impact of interventions. In sub-Saharan Africa, only half of febrile malaria cases are treated in the formal health sector; what is happening in the private sector or informally is not well understood. With improved diagnostics and treatments, testing and treating has become better, but tracking involves more routine systems to improve surveillance.
My name is Victor Alegana, I am an early career researcher at the KEMRI Wellcome Trust Research Programme in Nairobi, and most of my research focuses on infectious diseases in sub-Saharan Africa.
I effectively do research around malaria and childhood illnesses. I also look at other things such as interventions in health, how they impact populations. I have lately diversified into not just malaria but the whole burden of infectious diseases in Africa.
As my research focuses on burden estimation, particularly on malaria, I believe that health statistics are quite important for several reasons. They are vital for us to understand the burden of diseases in a population. We need to know how many cases, the disease burden in any single part of the country, for example the countries in sub-Saharan Africa, so that we can intervene appropriately. Secondly, if we are intervening in a population, we need to know what the impact of these interventions is, and health statistics help us understand the impact of those interventions, whether we are reducing disease burden or we are just not doing much. My area of research is impactful on tropical illnesses, because I am able to monitor some of the statistics I come up with, and what the health status of the population is.
Recently, I have been looking at febrile malaria cases in Africa. One of the things I wanted to understand is of all the febrile case burden, or the fever cases that we see in populations in sub-Saharan Africa, how many of these are actually treated in various sectors. My findings highlighted a few important things: out of the case burden we see on fevers, only half are treated in the public formal sectors that we know, the other half are being treated in the private sector, some are treated informally. We don’t have much control on what happens in formal treatment, and we don’t understand what happens to those treated privately, nor the effective case management that goes on in those sectors.
My research findings highlighted that we are only able to publicly handle 50%, so should we improve our public health systems? Should we incorporate private systems in decisions we make about our own health? Should we understand more about those cases that are treated outside of the public sector? What effective case management projects can we use for those who are treated informally, or at community level? These are the key questions that have raised my inquisition, to try and understand what is going on with these other sectors, outside the public sector.
I think that with the change in disease burden in sub-Saharan Africa, one of the things that has become clearer in the last 3 years is the need for improved surveillance. In 2012 the WHO enacted the T3 initiative, where you test, treat and then track the particular case you are looking at. This is the whole framework of surveillance, It has developed in the sense that we are starting to appreciate the use of routine sectors, or public sectors. We are trying to better understand what is happening in routine cases that actually come to the health facilities, how do we treat them? We are trying to improve treatment practices, because we do have effective medicine that have improved over the last 5-10 years. In malaria for example, since mid-2006 the use of ACTs has improved the treatment of malaria.
In terms of testing, we have improved diagnostics. We now have RDTs, rapid tests that can be used in informal settings, at the community level, to test if someone has a disease or not before you treat them. If a case is not malaria, it will help the clinician to find out what other disease could the child be harbouring, and effectively handle that case. We’ve improved issues on how we handle cases. Research has improved in this area over the last 5 years, which is one of the most effective things that we have done when it comes to disease burden.
My line of research at the moment focuses on improving disease burden estimation. If you look at the last 10 years or so, malaria mapping has improved tremendously. We’ve collected more community surveys, we’ve understood what levels of prevalence of disease at the community level are. But we haven’t appreciated the use of routine data more, and how it can be used effectively to quantify the burden in a population.
My line of research has focused on this area of using routine data, because with this change in burden we are trying to strengthen surveillance, approaches like the T3 initiative contribute to how we estimate our health statistics. This is the reason why we need to invest more in routine systems, we need to invest more in the science of how we use routine systems to estimate disease burden. It doesn’t cost as much where we already have the health facilities for example, we know people come to these health facilities. My research has focused on understanding how people use these systems, and we need to invest more to improve how we estimate disease burden within these routine systems. They are the best barometers of diseases in a population, for not just malaria, but many other infectious burdens in sub-Saharan Africa.
Translational Medicine includes themes such as diagnoses, treatment and management of these cases. For malaria, we are now using this T3 initiative which is testing, treating and then tracking. Over the past few years, we have tremendously improved the “fast Ts” which is to test and to treat, but not much has been done around tracking, and tracking of infections involves surveillance in the community following up cases when disease burden is now lower, or when cases are rare. This feeds in perfectly within translational medicine, around case management, surveillance activities and so on. There is a relationship between what I do, and what happens with translational medicine themes, and the two fit in together.
This interview was recorded in May 2019