World Malaria Day 2017, observed on Tuesday, April 25, seeks to raise awareness and highlight the need to close the gap in access to malaria prevention tools. While the burden of disease continues to decline, efforts to improve access to interventions that prevent, diagnose and treat malaria are needed to reach the Sustainable Development Goals of malaria elimination by 2030, especially in sub-Saharan Africa where malaria is most prevalent.
To highlight this need, we are featuring a recent publication authored by James Carlucci, M.D., and M.P.H. (Global Health) candidate. His thesis, Prevalence and Risk Factors for Malaria among Children in Zambézia Province, Mozambique was published in Malaria Journal last month. This paper highlights the need for interventions focused on caregivers, who may have the most difficulty seeking malaria diagnosis, care, and treatment for their children. The paper was co-authored by VIGH staff and faculty.
Dr. Carlucci will receive his Master in Public Health degree in May and will complete his pediatric infectious disease clinical fellowship in July. This summer, he will join Vanderbilt University Medical Center (VUMC) as an Instructor in the Department of Pediatrics and the Division of Pediatric Infectious Diseases. In addition to completing his residency at VUMC, Dr. Carlucci received his medical degree from Vanderbilt University School of Medicine.
We asked Dr. Carlucci to reflect on his research and experience with us.
Why did you choose Malaria for the topic of your thesis?
Until recently, I’ve mostly been focused on pediatric HIV and tuberculosis (TB). My interest and passion for HIV and TB work has grown out of opportunities and experiences I’ve had working in southern Africa, where HIV and TB were among the most important problems facing children and their families. For example, between residency and fellowship training, I spent a year living and working in Lesotho, where almost a quarter of population is infected with HIV, and where TB incidence is among the highest in the world. Because of the high elevation in Lesotho, there weren’t many mosquitoes, and malaria wasn’t really an issue. The only time I really thought about malaria was when I would take prophylaxis prior to traveling to endemic areas in other parts of Africa.
When I returned to Vanderbilt for my fellowship in Pediatric Infectious Diseases, I started to learn more about the work that the Institute for Global Health (VIGH) was and continues to do in Mozambique. I also learned that the situation in Mozambique is quite different than in Lesotho. Certainly, HIV and TB are major issues in Mozambique, but malaria is by far the bigger problem for children in Mozambique. In fact, malaria claims the lives of more young children in Mozambique than HIV and TB combined. So, when one of my mentors, Dr. Troy Moon, presented me with the chance to work with him on a project investigating the malaria situation among children in an especially underserved area of Mozambique, I jumped at the opportunity.
What was a notable outcome of your research?
Not surprisingly, the prevalence of malaria among children in Zambézia Province, Mozambique is quite high and varies between geographically distinct districts within the province. However, we were surprised to learn that children were more likely to be diagnosed with malaria if they lived in households with higher incomes, fewer children in the home, and more highly educated female caregivers. At first it seemed counterintuitive that having more resources would be associated with malaria, but when we accounted for access to health services, we realized that children with fewer resources were probably not accessing care and therefore not being diagnosed with malaria. These findings highlight the importance of empowering women with the education and resources they need to ensure optimal health outcomes for their children, and suggest that health initiatives should target the poorest and least educated caregivers.
Describe your experience in Mozambique.
I first visited Mozambique as a tourist, several years ago. It’s a beautiful country with a long Indian Ocean coastline, amazing beaches, world-class scuba diving, and great cuisine. The Mozambicans I’ve met have been universally kind and welcoming, and the Portuguese influence and language are unique in the region. But sadly, the story of Mozambique also includes the legacy of post-colonial conflict, dramatic disparities, poverty, and poor health outcomes. My more recent visits to Mozambique, to build research collaborations and to help with efforts to better capacitate their health system, have been both challenging and inspiring. Engaging with Mozambican and international partners to better understand and work toward solving complex problems, in a culturally sensitive way, and in a language, that I’m still trying to learn has been a real struggle. But at the same time, it’s been a huge privilege to be a part of a team so enriched by personal experiences and local expertise and with the common goal of improving the lives of people in need. I’m glad that I’ll be able to continue working in Mozambique as I transition into a faculty position in Vanderbilt’s Division of Pediatric Infectious Diseases and Institute for Global Health, and I’m hopeful that my research will contribute to creating a better future for the children of Mozambique.
For the latest information on malaria, download this year’s campaign brochure, “Malaria prevention works: let's close the gap,” produced by the World Health Organization.