What does the future hold for the fight against malaria in Africa?
A recent press release from Wellcome Trust Sanger Institute raised a lot of concern. Based on a scientific paper published in Nature, 13 June 2012, it appears that a single infected person could harbour many genetically different Plasmodium falciparum parasites. The team from Oxford University found that these parasite populations easily swap DNA to create new forms.
This evidently raises the question how far PCR (polymer chain reaction genotyping) can distinguish between recrudescence (or treatment failure) and re-infection by new bites from anopheles mosquitoes.
WINTER DIALOGUES OF AFRICAN MALARIA COALITION
MIT 26-27 JANUARY 2013
Despite the cold weather, malaria was definitely in the air in Cambridge during the last week in January. Shortly after the African Malaria Coalition held our Winter Dialogues at MIT, Harvard held a Malaria Forum just up the river. There were important differences in the two meetings, but the subject was clearly the same; how to strengthen the fight against malaria.
African Malaria Coalition and the Harvard Malaria Forum
Pregnant woman arrives at the Maternity. She is worried because she had to leave her kids at home and the River Jurua is about to flood the area, so coming to the Maternity (which involves getting a boat lift from a neighbour and then walking 1.5 km)is a great deal. She is 31 weeks into her pregnancy. Two weeks ago she had a malaria episode, Pf, and was given Quinine and Clindamycin. Now she has diarrhea, lower abdominal pain, 9 g/dL of hemoglobin, 29% hematocrit.
Jim Webb's forthcoming book on the history of the fight against malaria in Africa is a plea for all of us..... (for me that includes WHO and USPMI folks)..... to learn from history, especially the history of these clever mosquitoes who quickly learn to overcome any synthetic biocide produced by the chemical industry. He cites the experience in Turkey, Pakistan and Sudan where the malaria programs went through 8 major classes of biocides after DDT lost its effect..........
Many malaria vector control specialists also work on dengue mosquitoes. After all, both diseases overlap in geographic distribution and are endemic throughout the tropics.
I have been a member of Rotary International for the past three years. During that time I have met several people working on malaria that are also Rotarians. Rotary International is heavily engaged in the polio eradication campaign (through its international campaign 'End polio now' and has been instrumental in getting polio vaccination underway in the 1980s when the disease was still rampant.
The video below is an interview with Dr. Jo Lines posted online two weeks ago. Dr. Lines is currently with the London School of Hygiene and Tropical Medicine again after several years of serving the World Health Organization in Geneva. He has been one of the frontline people in the science surrounding insecticide-treated bednets, and later in advocacy and uptake of this simple technology that has saved an estimated 1 million lives over the past decade. A remarkable achievement no doubt. Have a look...
Resistance to drugs and biocides happens when we try to control malaria. It is a historical pattern we have seen repeatedly. And we know that ACT is about the only way to treat malaria now in Africa, especially since resistance to chloroquine has been widespread for years.
And we are also seeing that the use of permethrin for spraying houses - the same biocide used to treat bednets - is beginning to cause resistance in mosquitoes in Africa too.
Age: 24 Gestational age:: 37 wks Malaria history:
Six days ago, on January 11, Aaron Swartz committed suicide. As a malariologist you may not know who he was (I also had not heard of him to be honest), and that's why I pay tribute to him here. Aaron's extraordinary life, during which he mobilised millions of people around the world to fight for freedom on the web and free access to information, amongst many other accomplishments, ended too soon (read about him here). Why he committed suicide remains unknown, but he was charged with a 35 years sentence to prison and a 1 million dollar fine, for downloading several million scientific articles from the JSTOR database. Articles for which he had in mind to make them publicly available to the world. Because he believed that scientific information needs to be available to those that can make good use of it and should not be locked behind paywalls. At MalariaWorld we believe the same. But was it worth dying for this cause?
Pop-quiz: You're not an MD, you are conducting research in a malaria endemic setting and you are not part of the local health system. You overhear a doctor prescribing the wrong malaria drug treatment to a pregnant woman. What do you do?
In malaria endemic areas, researchers and basic health workers need to and often do find ways to join forces and complement each others work. Nevertheless, the prevalent idea among a few who are higher up in the health services is that researchers, like myself, are only there for the "kill". Some of the complaints are that we have a limited time-span in the area, we take joy in seeing a patient who provides us with some parasites and we ultimately take without giving in return. I think that these are usually the things we hear most (and mostly through the grapevine...).
"We have been fortunate to see a marked decrease (98%) in malaria case load in the Macha area over the past 10 years. While it is impossible to name one particular project or program that made this happen, we believe that the involvement of people at the community level has made a significant impact.
Well, for one thing, we know how to build durable electric power supplies.
When 17 hydroelectric dams were built on the Tennessee River in the southern USA after the Second World War, malaria disappeared from the region within a few years, and never returned. This was before DDT and chloroquine. Why? Because the availability of adequate water and affordable electricity resulted in increased income for the people, better housing with screens, and electric fans that made sleeping indoors comfortable in the hot, humid malaria season.
Just continue spending on ritual LLINs and IRS, or invest limited budget in more effective ways?
Epidemiological nugget three;
The basic concept of this document stems from Patrick Ogwang, Makerere University, Uganda. Additional inputs on limonene and nerolidol from Pierre Lutgen, Belherb.
At MalariaWorld we aim to serve you - it's the very reason we exist.
But every year in December, during the festive season, we ask you for a small favour in return. A small gift in return for a full year of weekly newsletters that we drop in your mailbox, and a website full of information on malaria that you all receive for free.
This year we are not asking anything for MalariaWorld itself. Instead we have another cause for which we ask your support...
Malaria World has become a broad and wonderful forum for exchanging information on malaria, with about 7,000 members, coming into 2013. And lately there have been many items relevant to the big fight against malaria in Africa. These items have come from all over the world; the latest exciting one being the contribution by the people from Southern Africa who are showing us the way.
But there are important groups who are noticeable for their absence.
There is too little appreciation in current vector-borne disease paradigms for the intervention characteristics that are appropriate for stop-gap emergencies vs. those that are vital for the end-game: elimination. Regardless of whether you think elimination of any vector-borne disease is possible, it will not be accomplished without this.
Epidemiological Nugget Number Two........Many malaria programs are slowly converting to better diagnostic methods for reporting the prevalence of malaria. However the numbers have to be carefully analyzed, because of the artifacts caused by changes in False Positivity of the better diagnostic tests. The most common diagnostic method used in Africa - and reported through WHO - is called Clinical Diagnosis. This method, relying on the clinical judgement of the health care worker, has a False Positivity Rate of about 80%.
I am from Ethiopia, have got BSC in medical Laboratory technology and MSc in tropical infectious disease. I am working as ass. researcher in malaria and other vector born research team, Infectious and non infectious department in Ethiopian Health and Nutrition Research Institute (EHNRI). I am very happy to share experience. Hope I will get more knowledge from you.
Abeba Gebretsadik Reda
Malaria and other vector born research team
Infectious and non infectious disease department
Ethiopian Health and Nutrition Research Institute
Epidemiological Nugget Number One: Bednets are avoided by adults, especially during the hot and humid malaria season.......However infants cannot escape their mothers protective care, thus infants usually sleep under bednets, even though no one else in the family does.........Now - what happens when groups like PMI report their success in terms of reduced Infant Mortality, or prevalence of malaria among infants?..........It is no surprise that Infant Mortality drops because the infants are sleeping under bednets.
In the human body the parasite injected into the bloodstream by the mosquito undergoes the transformation from the asexual plasmodium into the sexual gametocytes which the mosquito is going to pick-up during its blood meal. The killing effect of artemisinin on gametocytes is known since twenty years and was first mentioned in in vitro trials at the John Hopkins University. These results were confirmed in 1993 by research teams in China and India and mentioned in the document WHO/MAL/98.1086.
Last week showed unambiguously that unless the world pulls up its sleeves, the hard-won gains of the last decade may go up in smoke. 'The world' in the previous sentence is you, us, all of us engaged as professionals in the field of malaria. MalariaWorld has put out warning signals over the last three years, about the problems with drug resistance, about artemisinin resistance in SE Asia and the risk of it escaping to other parts of the world, about impregnated bednets being shipped to parts of Africa where full-blown resistance against pyrethroids occurs, about counterfeit drugs undermining curative treatment and increasing the risk of resistance popping up, about the difficulties of vivax elimination, about the problems with zoonotic malaria, about...the list is endless I'm afraid...
Water, Engineers and Malaria..............
We are all sure in - our hearts - that suppression of malaria in Africa will improve the rate of economic development. Recently this hope was formalized in an African Futures Brief by Moyer and Emde at the Pardee Center of the University of Denver in their Brief #5 published in November. Their projections indicated that driving the malaria prevalence down to zero in Africa by 2025 would by 2050 result in an increase in income of $30 per year per person, compared to the current average for Africa in 2010 of only $1.25.
This contribution was posted as a comment by Dr. Bill Jobin, Director of Blue Nile Associates in response to the meeting report of the WHO Malaria Policy Advisory Committee that was held in September 2012.
It is ironic that a WHO policy meeting in September will ignore the terrible truth outlined by the WHO Director General Margaret Chan in December - that the malaria program is going to crash..... With due respect to Rob Newman and Margaret Chan in Geneva, I would like to suggest 6 steps to save their Global Malaria Program. My suggestions are simple applications of rational approaches to a problem, the same things we would do with any other problem in life. It does not take a Rocket Scientist to figure this out. Simply put, I suggest that they Narrow their Focus, Expand their Base, add 2 more Components to their Strategy, establish a valid Monitoring and Evaluation system, and set Realistic Goals against which they can Measure their Progress ......