Indoor malaria transmission reduction across sub-Saharan Africa has been attained through implementation of long-lasting insecticidal nets and indoor residual spray interventions with small-scale larval source management.
In a recent article about the spread of resistance to ACT in SE Asia, the authors recommend new drugs and better drug strategies:
'FEMS Microbiol Rev. 2016 Sep 8. pii: fuw037. [Epub ahead of print]
The clinical impact of artemisinin resistance in Southeast Asia and the potential for future spread.
Woodrow CJ1, White NJ2'.
Similarly, multiple resistance of Anopheline vectors is supposedly to be met with more careful selection of insecticides!
Using predictive models to assess the benefit of new technologies has great value, and is especially pertinent prior to conducting expensive, large scale, randomized controlled trials.
Malaria burdens have fallen dramatically this century, in large part because around a billion long-lasting insecticide-treated bed nets (LLINs) have been introduced into Africa (1, 2).
In spite of massive progress in the control of African malaria since the turn of the century, there is a clear and recognized need for additional tools beyond long-lasting insecticide-treated bed nets (LLINs) and indoor residual spraying (IRS) of insecticides, to progress towards elimination.
In this study, moderately (type A+) and severely (type A−) G6PD deficiency showed significant association with lower haemoglobin concentrations at baseline in African children with severe malaria without leading to severe malarial anaemia.
There is dangerous obstacle - we call it the Immunity Trap - in malaria prevention strategies which is most dangerous for countries which have relied on the ephemeral methods recommended by WHO and used by PMI, but which have not included permanent methods. In the 19 African countries in the US Presidential Malaria Initiative administered by the PMI for the last decade, of the 30 million who have lost their immunity, about half are also no longer protected by house spraying because of the high cost of new biocides.
A decade ago, I helped the US Presidential Malaria Initiative get its start in Angola. Since then the Malaria Initiative (the US PMI) has expanded under Tim Ziemer to 19 African countries, protecting 30 million people. Consequently, over the last decade these 30 million people have lost their immunity to malaria. Now that might seem obvious and maybe a good thing. But since they live in regions where malaria is endemic, it raises a serious issue about durability of the PMI strategy.
The Resistance Treadmill
Would you like to hear some Good News? Here are some nuggets, stimulated partly by recent comments from my colleagues Robert Bos, Tony Kiszewski and Pierre Bush.
Classic Problems we used to face