If we limit ourselves to the conventional approaches to fighting malaria - drugs, bednets and biocides - the future looks bleak. It looks like an endless war. The war started about 1950 when DDT and chloroquine looked like perfect weapons. But since then the development of resistance has shown us how ephemeral they were. The mosquitoes began to eat DDT for breakfast, and the malaria parasites learned to swim in chloroquine. Historians are showing us that malaria has incredible tenacity in Africa. We long for a solution to this horrible problem - an Exit Strategy.
Wherever malaria has been eliminated, success was likely to have been based on the interplay of a series of mechanisms. In the United States it may have coincided with the advent of residual insecticides, but there were a variety of factors associated with the success. These were seasonal changes, environmental factors, political decisions that affected where people could live, the advent of improved treatments and increase in wealth and improvement of living standards. The same can be said of Italy and much of Europe in the early part of the 20th Century.
It all begins in 1952 with the work of the Liverpool School of Tropical Medicine (BG Maegraith et al, British Medical Journal, 1952, 1382-3). They found that in rats inoculated with Plasmodium berghei and living on a diet of milk there was a strong suppression of the growth of the parasites. This was valid for retail whole cow’s milk, reconstituted dried milk from different origins and human milk. Most rats on normal laboratory diet died in a few days.
I appreciate the publication of my first paper on economic benefits from suppressing malaria in Africa, printed in the MWJ of 2014 v5 n4 and cited on the MWJ webpage. I demonstrated that the return on investment in malaria suppression was about 6.5 to 1, a really good investment, don't you think?
The mode of action of quinine and chloroquine is almost exclusively based on the inhibition of the crystallization of heme into hemozoin, killing plasmodium in its own digestive rejects. In several papers M Akkawi from the Al Quds University in Palestine has shown that extracts of several medicinal plants : Salvia officinalis, Artemisia sieberi, Artemisia afra, Artemisia annua, Inula viscosa had similar effects, in some cases equivalent or better than chloroquine for the inhibition of beta-hematin (see literature references below).
Mass Drug Administration (MDA) is a tantalizing tool that can support elimination efforts and help dramatically knock down malaria prevalence. Why isn’t it more widely used?
by George Jagoe
In the April 2014 issue the magazine Rotary Contact from Belgium-Luxembourg duly recognized he efforts and results achieved by Rotarians from Ieper and Luxembourg in the promotion of Artemisia annua tea against malaria. Geert Flamang has launched plantations in Katanga and Pierre Lutgen has run clinical trials in several African countries which demonstrate an efficiency of >95%. These trials have allowed to show that the antimalarial potency can be increased by using the dried leaves in lieu of aqueous extracts, as powder in capsules or mixed with food.
I feel that we should start a conversation about coordination. I attended Malaria Day here in Baltimore last week, and one still hears people speaking as if all we have to do is send more nets to Africa! Africa is swimming in nets, in fact there are NO plans that one hears of to REPLACE (key word) expended of torn nets in anything but an ad hoc manner. Yet Anopheles funestus (resistant to pyrethoids) is appearing all over Eastern and Southern Africa.
It is World Malaria Day today (Friday 25 April), and to help raise awareness there are two new Special Collections available from The Cochrane Library - one for malaria diagnosis and treatment, and one for prevention and control.
A new open access Cochrane Review was released earlier this month by John Odaga et al. that may be of interest to Malaria World members:
Rapid diagnostic tests versus clinical diagnosis for managing people with fever in malaria endemic settings
Almost a century after Dr. Israel Kligler initiated a malaria elimination campaign in Mandate Palestine, the undersigned met in Jerusalem to honour his exemplary approach that consisted of an integrated attack on malaria that ultimately led to its disappearance.
In many ways, the disease burden of malaria in Africa today resembles that of Palestine when Kligler first arrived. His success – a toolbox that included larval mosquito control, swamp drainage, quinine prophylaxis and treatment, community education - played a major role in making the Holy Land habitable and productive.
Learning from Success
Over the past 60 years, conferences on malaria have increased from maybe one per decade to multiple conferences annually. The 1950 Kampala Malaria Conference set the parameters for the 1955 Global Malaria Eradication Programme, followed 40 years later, 1992 and 1996, with the meetings in Dakar and Amsterdam that galvanised WHO and international support to eradicate malaria. Roll Back Malaria, the Global Fund, the Gates Foundation and other major international donors took us to the 21st century goal of malaria elimination.
Rubin Hall, Forchheimer Student Center, Ein-Kerem Campus, Jerusalem
8:30-9:00 Coffee/Tea (reception area adjoining Rubin Hall)
9:00-9:30 CONFERENCE OPENING - GREETINGS:
- Prof. Yehuda Neumark. Director, Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem
- Dr. Sanford F. Kuvin. Founder & Chairman of the International Board, Sanford F. Kuvin Center for the Study of Infectious and Tropical Diseases, Hebrew University of Jerusalem
- Prof. David Lichtstein. Dean, Faculty of Medicine, Hebrew University of Jerusalem
- Dr. Rob Dixon. Deputy Head of Mission, British Embassy in Israel
- Dr. Gabriel E. Alexander. Jewish National Fund/Keren Keyemeth LeIsrael
Integrated Community Case Management (iCCM) is a strategy that enables those living beyond the reach of health facilities to access lifesaving treatments. It should be a national priority and an integral part of national health sector plans, a recent symposium in Ghana has concluded.
New operational research projects in malaria elimination will start this April, after being selected for funding through MESA. The MESA operational research portfolio includes: proof-of-concept of novel vector control and diagnostic tools, use of mapping technologies for surveillance and tailored response, and mobile phone applications for hard to reach populations. Urban, rural and forest settings are addressed. The projects are summarised here.
Four years ago, after working for six years as a hospital and pre-hospital emergency doctor in Spain, I accepted a position as a remote site doctor in Sierra Leone. Until then malaria was an obscure, almost phantasmagorical, condition to me.
Recently, we at the Cochrane Infectious Diseases Group (CIDG) have published several systematic reviews of malaria interventions which may be of interest to Malaria World members. Each of the reviews are open access and are listed below:
• Mass drug administration for malaria
• Larvivorous fish for preventing malaria transmission
PSI is seeking an experienced, dynamic Deputy Director of its Malaria and Child Survival Department (MCSD) to oversee PSI’s rapidly expanding portfolio of MCS programs. PSI is one of the largest global health organizations and its malaria and child survival programs account for about half of its business.
Sir Ronald Ross discovered the seeds of malaria on the gut walls of a mosquito. What was the species? Was it An. stephensi or An. rossi? Has the riddle been already solved? Please share your thoughts.