Fighting Malaria with New Mosquito Nets

Two weeks ago, The Lancet published a promising study on the effectiveness of a new type of mosquito net. After a two-year trial period in Burkina Faso, the researchers found the new mosquito nets, treated with two insecticides, decreased cases of malaria by 12 percent. These findings promise strong potential for lowering the risk of malaria worldwide with the implementation of these new mosquito nets.

This research is a collaboration among several institutions including Durham University, Burkina Faso’s National Center for Malaria Research and Training, Liverpool’s School of Tropical Medicine and the Swiss Tropical and Public Health Institute.

Malaria Worldwide

According to The World Health Organization, almost 50 percent of the world’s population was at risk of contracting malaria in 2016. While risk areas exist around the world, sub-Saharan Africa suffers the most cases of malaria each year.

In 2016, sub-Saharan Africa had 90 percent of the world’s malaria cases and 91 percent of the world’s malaria-related deaths. Though malaria-related deaths have declined significantly, from 440,000 in 2010 to 285,000 in 2016, malaria is still a great threat to health worldwide. Traditional, chemically-treated mosquito nets have helped to reduce the cases of malaria, however, as mosquitoes grow more resistant, these traditional nets have become less effective, leaving users more vulnerable to malaria infection.

The World Health Organization estimated there were five million more cases of malaria in 2016 compared to the total number of malaria cases in 2015. The above-mentioned study’s mosquito nets address this problem, by targeting insecticide-resistant mosquitoes that are causing these problems.

New Mosquito Nets

The older mosquito nets generally have a pyrethroid insecticide treatment, intended to kill mosquitoes on contact. This treatment has become less effective with time since the mosquitoes have developed a resistance to the insecticide. The new nets, presented in the research, combat this issue, by using a different insecticide.

The new insecticide is effective because it combines traditional pyrethroid treatment with another agent, pyriproxyfen. Pyriproxyfen works as an insect growth regulator, shortening the lifespan of mosquitoes and thus their ability to transmit disease, as well as reproduce.

According to professor Steve Lindsay, who worked on the study, this combination of chemicals has three main benefits: it kills more mosquitos, reduces the number of mosquito bites and decreases the likelihood that mosquitoes will develop resistance to the chemical mixture.

Results in Burkina Faso

A two-year trial, conducted in Burkina Faso, demonstrated the effectiveness of these new mosquito nets, treated with pyrethroid and pyriproxyfen. Burkina Faso was ideal for the study, due to the high number of malaria cases. Located in sub-Saharan Africa, Burkina Faso has more than 10 million cases of malaria every year. Mosquitoes in Burkina Faso were also ideal test subjects since they exhibit high resistance to pyrethroid treatment. According to Professor Lindsay, 80 percent of mosquitoes in Burkina Faso are so resistant to pyrethroid, they are no longer killed by it.

Researchers conducted the study in 91 villages throughout rural areas of the country. By switching traditional mosquito nets with nets treated with the new chemical blend, researchers saw a 12 percent decrease in malaria cases. Furthermore, the overall exposure to mosquitoes dropped by over 50 percent during the test period.

With these results, the researchers concluded the trial mosquito nets offer increased protection against malaria as opposed to standard pyrethroid-treated nets. They also recommended that these new nets replace standard nets in areas with high malaria transmission rates and high instances of insecticide resistance among mosquitoes.

Future Potential

Although 12 percent reduction in malaria cases may seem marginal, on a global scale and in real numbers, this decrease in malaria infection would be monumental. As Professor Lindsay noted, if the nets were used across all of Burkina Faso during the two-year trial, researchers would expect 1.2 million fewer cases of malaria in the population overall.

Dr. Alfred B. Tiono, who headed the field study, has great hope for the impact these new mosquito nets could have globally. He believes, if used correctly, the nets could prevent millions of malaria cases worldwide. It is still unclear how costly large-scale manufacturing of the dual-chemical nets will be. However, Professor Lindsay remains hopeful the manufacturing costs will not exceed the costs of producing traditional nets. If only one life is saved by applying the new nets, no price is too high to pay.

– Morgan Harden
Photo: Google

Time for Celebration: Paraguay Successfully Eliminates Malaria

Paraguay has successfully eliminated malaria, making it the first country in the Americas to accomplish such a feat in nearly 50 years.

Victories Against Malaria

The country’s success has been attributed to its ability to detect malaria cases in a timely manner and discern whether or not the cases had been spread inter or intranationally. Between 1950 and 2011, Paraguay developed and implemented programs and policies meant to both control and eliminate the disease; the country registered its last case of P. Vivax Malaria, the most frequent cause of recurring malaria, in 2011.

After 2011, a five-year program focusing on case management, community engagement and public health education was launched in order to prevent transmission and prepare for official “elimination certification.”

Since the program’s completion in 2016, the Ministry of Health has launched a three-year initiative meant to further train Paraguay’s healthcare workers in regards to malaria. This prioritization will inevitably strengthen the country’s ability to promptly detect, diagnose and treat new malaria cases, as well as address the ongoing threat of “malaria importation.” The country has also prioritized controlling and minimizing mosquito populations within its borders.

New Directions and Prioritizations

The elimination of malaria provides economic leverage for Paraguay’s impoverished population. The significant financial burden of approximately $5 a day per malaria case, according to a study published by the U.S. National Library of Medicine, will no longer plague Paraguayan families. Such relief will help enable them to direct their money towards other essentials, such as food and education.

Poverty affects almost 40 percent of Paraguay’s rural population, as opposed to only 22 percent of its urban population. Peak malaria infection often coincides with harvesting season, severely impacting the amount of food rural families are able to produce.

Malaria cases are typically concentrated in said rural areas, where many lack the resources and public health education to adequately detect or treat the virus. The immediate situation of these rural communities is only impacted by instances of extreme flooding, which act as a breeding ground for mosquitos (potential carriers of the virus).

Points of Impact

Malaria primarily occurs in poor, tropical and sub-tropical regions of the world, most of which don’t have adequate access to primary care facilities – in many of the countries it’s present, malaria is the primary cause of death.

The virus is the result of a parasite carried by mosquitos. The most common symptoms of malaria include chills, fever and other flu-like symptoms. Left untreated, the disease can be fatal.

The groups most vulnerable to high levels of malaria transmission include young children and pregnant women. Malaria caused approximately 216 million clinical cases and over 440,000 deaths in 2016 alone.

Future Goals to Successfully Eliminate Malaria

The success of these programs provides a blueprint for other countries to successfully eliminate malaria themselves. Paraguay’s situation contrasts with those of other countries within the Americas, where the increase in malaria cases is greater than in any other region of the world. In fact, nine different countries reported malaria case increases of at least 20 percent between 2015 and 2016.

As a whole, however, Latin America witnessed over a 60 percent decrease in malaria cases between 2000 and 2015. As treatment and surveillance progress, many other countries will follow Paraguay in eliminating the virus. Argentina is expected to be certified later this year, and other malaria-free Latin American countries include Ecuador, El Salvador and Belize.

– Katie Anastas
Photo: Flickr

Fighting Malaria with Genetically Engineered Mosquitoes

This June, the Bill and Melinda Gates Foundation announced that it would be investing over $4 million in support of Oxitec — an Oxford-founded group that focuses on reducing insect-borne disease around the world. Specifically, the Gates Foundation and Oxitec are partnering to fight malaria with genetically engineered mosquitoes.

The Threat of Malaria

Mosquitoes kill more humans each year than any other creature — a total of 830,000 — and can carry a number of diseases including dengue fever and zika virus. The most deadly of these is malaria.

The World Health Organization (WHO) reports that there were 216 million cases of malaria in 2016, which resulted in nearly 450,000 deaths. Malaria hits the very young the hardest, and most fatalities are children under the age of 5; even the children who survive may develop intellectual disabilities.

Malaria occurs in nearly 100 nations. The world has made great progress fighting the disease, including eliminating it in much of Europe and North America, but progress has stalled. Support for fighting malaria has stagnated and the disease is starting to develop a resistance to the drugs which treat it.

A New Strategy

This is where Oxitec’s genetically modified mosquitoes come in. Oxitec introduces a self-limiting gene in male mosquitoes. When these lab mosquitoes mate with females in the wild, any male offspring are unharmed and continue carrying the gene. Female offspring, though, will die before they reach adulthood.

Only adult female mosquitoes can bite and spread diseases. The self-limiting gene effectively targets this portion of the mosquito population while also allowing new males to survive to carry and spread the gene after the original lab mosquitoes have died.

These genetically engineered mosquitoes would be one of several vector control methods (such as mosquito netting and repellant sprays) aiming to reduce the number of disease-carrying mosquitoes in affected areas.

The Oxitec mosquitoes have already proven effective in recent field tests in Brazil where they were released to combat the zika virus and dengue fever. Areas where modified mosquitoes were released showed an 82 percent reduction of larvae and a 91 percent reduction of dengue fever cases. This may have been a relatively small test, but the lab mosquitoes were incredibly effective and even outperformed tried and true traditional methods like insecticides.

Safety and Precision

Similar to many other genetically modified products, many have met the Oxitec mosquitoes with some suspicion. In 2016, residents of the Florida Keys voted against a planned field test in their communities, and environmentalist groups have also opposed Oxitec in the past.

Concerns with protecting the earth’s ecosystems are understandable and commendable. Still, genetically engineered mosquitoes have the potential to save hundreds of thousands of lives, protect children from the risk of lifelong disabilities and accomplish all of this with minimal and controllable impacts on the environment.

The modified mosquito strategy is not intended to cause the mass extinction of mosquito species. The self-limiting gene only lasts up to ten generations, which ideally will allow for long-term reduction in disease without leading to an unstoppable downward spiral in insect populations.

Long-Term Goals

The gene is also designed to only affect a single, specific species of insect at a time. This specificity allowed Oxitec field tests to target the Aedes aegypti mosquitoes that were instrumental in spreading zika and dengue fever in Brazil while leaving other insect populations unaffected.

Whatever the case, both the precision and effectiveness of the genetically engineered mosquitoes doubtless played a role in convincing the Gates Foundation to back Oxitec. Philip Welkhoff, the malaria program director at the Gates Foundation, has affirmed that new, innovative ways of fighting malaria are necessary to eradicate the deadly disease once and for all. The second generation of Oxitec’s mosquitoes are set to be field tested by 2020, and countless lives hope for a breakthrough.

– Josh Henreckson
Photo: Flickr

Top Effects of Poverty

Poverty stretches across the globe affecting almost half of the world’s population. Its effects reach deeper. Uniquely connected to different causes, the effects of poverty are revolving—one result leads to another source leads to another consequence. To fully understand the effects of poverty, the causes have to be rooted out to develop strategies to end hunger and starvation for good. Let’s discuss some of the top effects of poverty.

Poor Health

Globally, millions suffer from poverty-related health conditions as infectious diseases ravage the lives of an estimated 14 million people a year and are of the top effects of poverty. These diseases are contracted through sources like contaminated water, the absence of water and sanitation, and lack of access to proper healthcare. The list is broad and long. Here are the top diseases commonly linked to poverty.

• Malaria: Malaria is urbanely referred to as the poor man’s disease, as more than a million people living in poverty die from it each year. Caused by a parasite, malaria is contracted through mosquito bites. Most prevalent in sub-Saharan Africa, malaria affects the lives of many in 97 countries worldwide.
• Tuberculosis: Often referred to as TB, tuberculosis is a bacteria-borne disease. The bacterium, Mycobacterium tuberculosis, targets the lungs. It also affects the kidneys, brain, and spine. When discussing the effects of TB worldwide, it must be broken down by burden—high burden TB and low burden TB—all of which has to do with the number of cases that impact a country. High burden TB affects more than 22 countries, as low burden TB accounts for 10 cases per 100,000 people in a geographical location.
• HIV/AIDS: HIV stands for human immunodeficiency virus. This infection attacks the immune system and is contracted by contact with certain fluids in the body. If HIV is left untreated, certain infections and diseases can take over the body and cause a person to develop AIDS (Acquired Immune Deficiency syndrome). Thirty-six million people in the world have HIV/AIDS. In countries like Zambia and Zimbabwe, one in five adults live with HIV or AIDS.

Continuing the fight against poverty through economic expansion will help eliminate poverty-related illnesses and raise the value of health in poor communities.

Crime

There’s an old adage that says, “If a man don’t work, he don’t eat.” That’s not the case for a large number people living in poverty. Lack of economic opportunity leads to impoverishment which then leads to crime.

Global unemployment is at a high point. One hundred ninety-two million people around the world are jobless. In some parts of the world, mainly poor parts, unemployment standings will drive this number higher. In a study done on youth in the Caribbean, it was determined that joblessness fueled criminal activity in those aged 15 through 24.

Because of the struggles in the Caribbean job market, the murder rates are higher there than in any other region in the world. The crime rate affects 6.8 percent of the Caribbean population against the world average of 4.5 percent, calculating the global rate per 100,000 people.

People who live below the poverty line and don’t have access to sufficient economic opportunity, live by any dangerous means necessary.

Lack of Education

There is a direct correlation between low academic performance and poverty. Children who are exposed to extreme levels of poverty have difficulty with cognitive development, speech, and managing stress, which leads to adverse behavior.

In the country of Niger—the most illiterate nation in the world—only 15 percent of adults have the ability to read and write. Eritrea follows on the heels of Niger: with a population of 6 million, the average person only achieves four years of school.

In these poor locations, young adults and children have to leave school to work to help provide additional income for their families. Other children don’t have access to education due to decent schools being too far for them to travel to. On the other hand, schools nearby don’t have enough materials and resources to properly educate children. The conditions of the schools are just as poor as the children’s living conditions.

Where there’s poverty, there’s lack of education, joblessness, and poor health. The key to destroying the top effects of poverty is to attack the causes. More funding is needed for programs such as Child Fund International—a program that brings resources to children in poor communities. The International Economic Development Council supports economic developers by helping them create, retain, and expand jobs in their communities. And then there are the international efforts of the World Health Organization that fights to bring vaccinations and health-related resources to impoverished communities suffering from the infectious diseases of poverty. With these efforts along with other strategies, we can continue making strides to end the effects of poverty. 

– Naomi C. Kellogg 
Photo: Flickr

The Elimination 8: Ways of Shrinking Malaria in Africa

The Elimination 8 was created in 2007 by eight African countries with an initiative of abolishing malaria in Africa by 2030. By 2020, the E8 hopes to terminate malaria in the four low transmission countries of Botswana, Namibia, South Africa and Swaziland. By 2030, the E8 aims to terminate malaria in the four middle to high transmission countries of Angola, Mozambique, Zambia and Zimbabwe.

The E8 created a strategic plan to focus on strengthening efforts at cross-border and regional levels. The five core objectives of the plan are:

E8’s Five Core Objectives

1. Strengthen regional coordination in order to achieve elimination in each of the E8 member countries. While countries continue to pursue their own malaria elimination efforts, the E8 serves as a platform of communication and guidance between countries to advance regional-level efforts. The E8 coordinates a regional structure for all countries to follow in an attempt to stop malaria from spreading across borders. It also partners with the E8 scorecard, which actively monitors the malaria statistics and progress of the countries’ efforts on an annual basis.
2. Elevate and maintain the regional elimination agenda at the highest political levels within the E8 countries. The E8 relies on partnering with several organizations in order to continue shrinking malaria in Africa. The Ministers of Health and their partners act as additional leadership for malaria elimination. Through ALMA and SARN, the E8 has the ability to publish the E8 scorecard, which is crucial in holding countries accountable for their malaria efforts. Senior political officials help raise awareness for the E8 and can help to secure financial partners.
3. Promote knowledge management, quality control and policy harmonization to accelerate progress towards elimination. Africa experiences heavy population movement throughout its countries that contribute to the spread of malaria. The E8 created regional maps that outline statistics such as the risk of transmission across borders and human mobility patterns. The main goal is to uncover the “sources and sinks of malaria,” or the areas that export malaria to other countries and the areas that receive malaria from outside sources.
4. Facilitate the reduction of cross-border malaria transmission. The E8 countries are expected to follow a minimum set of standards in their efforts of shrinking malaria in Africa including the use of insecticides, insecticide resistance and management planning and case classification. The E8 provides guidance through managing information and relaying it across countries.
5. Secure resources to support the regional elimination plan, and ensure long term sustainable financing for the region’s elimination ambitions. In order for the initiative to succeed in shrinking malaria in Africa, the E8 requires substantial funding. The E8 has decided on a resource mobilization strategy that attempts to fund regional activities from long-term partners. Although this strategy does not fund individual country initiatives, the E8 provides intelligence to support each country.

The Back-and-Forth

The E8 countries experienced a 50 percent decrease in malaria cases over a five year period, from 14 million cases in 2007 to eight million cases in 2012. One particular country, Swaziland, experienced a drastic decline in malaria cases. In 2010-11, Swaziland reported 478 malaria cases during the transmission season with only three malaria-related deaths.

However, in the 2016-2017 malaria season, seven out of the eight countries reported an increase in malaria cases with outbreaks reported in Botswana and Namibia. Through the E8, health ministries held a meeting to determine the source of the alarming rates.

Two main factors were found in the cause of the increase. First, mosquitos were becoming resistant to insecticides and countries were not meeting their spraying targets; and second, insufficient use of surveillance systems caused late responses and a lack of epidemic identification.

Hope for the Future

In spite of the increase of malaria rates, the E8 is continuing to better their efforts to continue shrinking malaria in Africa. “I’m still optimistic and looking at 2025-2030,” says Richard Nchabi Kamwi, former Namibian Health Minister and now the E8 Ambassador for Malaria Elimination.

“Swaziland, for example, is far ahead– for the past five years it did not record a single malaria death. Botswana unfortunately during the last season experienced some local deaths, but I was impressed with the aggressive way in which they responded to the epidemic and how they persevered with their plan. Now it’s 2017, so maybe eradication by 2020 will not happen, but I am looking at 2025, with the final four countries following suit by 2030.”

The countries have modified their action plans for the next malaria season and have prepared epidemic response plans — hopeful omens for the future.

– Anne-Marie Maher

Photo: Flickr