Information and stories about malaria.

Need to Prevent Malaria in Pregnancy

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The presence of the malaria epidemic in the developing world has decreased significantly. However, for specific populations, malaria is still a life-threatening disease. There is a strong demand and need to prevent and treat malaria in pregnancy.

Malaria poses a threat to pregnant women and contributes to both maternal and infant mortality. In addition, malaria during pregnancy can result in maternal anemia and low birth weight of children. Stillbirths, miscarriages and preterm births are associated with malaria in pregnant women.

Given these facts, malaria poses a risk to communities and families, particularly when pregnant women contract the disease.

In Sub-Saharan Africa, malaria in pregnancy is associated with Plasmodium falciparum infection, but can also result from Plasmodium vivax.

Current strategies to address malaria in pregnancy include intermittent preventive treatment with sulfadoxine-pyrimethamine, use of insecticide-treated nets and treatment if malaria is contracted.

Pregnant women in the developing world have had difficulty receiving necessary health care due to inefficiencies within health care systems and lack of awareness about specialized treatment.

Local staff may not have the training or resources to offer pregnant women. In addition, preventive sulfadoxine-pyrimethamine and insecticide-treated nets are not widely available. There is a lack of skill and the ability to scale up the resources that are available.

Moving forward, malaria treatment for pregnant women would likely be more successful if policies and programs could work with other maternal and reproductive health programs.

Clara Menéndez, a medical researcher at ISGlobal, and her colleagues emphasize that a multidisciplinary approach will be required to fully address malaria and how it impacts the lives of pregnant women and their families.

– Iliana Lang

Sources: The American Journal of Tropical Medicine and Hygiene, The Lancet Global Health The London School of Hygiene and Tropical Medicine
Photo: 100X Development Foundation

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President’s Malaria Initiative: Progress and Future

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In 2005, George Bush launched the President’s Malaria Initiative (PMI) to work towards eradicating malaria across 15 high-risk African countries.

By acting quickly and efficiently, PMI has helped to reduce malaria mortality by 50 percent since 2005. Over 6 million people are alive today – without the influence of PMI, they would have died from malaria.

Since its creation, PMI has expanded and has helped hundreds of millions of people by core preventative strategies: providing people in high-risk zones with durable and insecticide-treated mosquito nets, antimalarial treatment options, fast-acting diagnostics, indoor anti-mosquito spray and prevention options for pregnant women.

Malaria is a disease carried by mosquitoes, which bite and infect people, leaving them ill with fevers, chills and symptoms associated with the flu. If the disease is not treated, people are at risk of death. In 2013, 198 million cases of malaria were reported, and of those, half a million people died. Many of these deaths were children under the age of 5.

The World Health Organization estimates that 106 countries and 3.4 billion people are at risk of malaria infection.

Mali is an example of where PMI has contributed to improving the quality of life of citizens through malaria treatment. The entire population of Mali is at risk of contracting malaria with 90 percent of citizens living in the central and southern regions where the disease is endemic.

People in transit, perhaps fleeing their homes due to displacement, are even more at risk because of their weaker immune systems. Malaria is the primary cause of death in Mali, especially for children under the age of five.

Despite malaria’s omnipresence in Mali, the devastation caused by malaria has diminished since PMI’s inception in 2005. The mortality rate of children under the age of 5 has decreased by 50 percent in 2013.

PMI’s success is not limited to Mali – the Initiative has made incredible progress across Africa. It has distributed over 31 million mosquito nets, sprayed over 5 million households with insecticides (impacting 18 million people), given over 13 million antimalarial medications for pregnant women and trained over 27,000 health workers.

According to the Bill and Melinda Gates Foundation on their website, Impatient Optimists, “Malaria is clever, resilient and capable of evading our most dependable interventions. If we aim for a malaria-free world, the global response must constantly evolve and adapt to challenges that don’t even exist yet.” The strategies that have worked in the past may not work in the future. Eradicating malaria fully will be a constantly transforming process.

In partnership with the President’s Malaria Initiative and other organizations, the Gates Foundation is committed to eradicating malaria in the future. On Impatient Optimists, the Foundation highlighted its goals broadly: “We need to expand access to prevention, diagnosis and treatment, which PMI has proven capable of doing on a massive scale. We also need to build stronger health systems and introduce new tools and strategies, an increasingly important part of PMI’s work in recent years.”

The reduction of malaria in the world so far illustrates the potential for completely eradicating malaria in the future — a goal that will save millions of lives.

– Aaron Andree

Sources: CDC, Impatient Optimists, PMI
Photo: Impatient Optimists

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The Silver Standard for Eradicating Malaria

eradicating_malariaEvery minute, a child dies from malaria. 90 percent of the deaths from malaria occur in the poorest African countries. Malaria is a preventable, treatable disease, yet more than half of the world’s population continues to be at risk.

Malaria has long been established as a poverty-related disease. Poverty is both a cause and effect of this potentially lethal disease: poorer people can often not afford preventive measures, and the contraction of disease leads to further economic loss. Consequentially, a substantial investment of time and resources into finding a solution is necessary to interrupt this vicious cycle.

The most successful method to combat the problem has been vector control- that is, to eradicate the mosquito transfer agent. Traditionally, the efforts have been to implement better preventative measures, primarily through insecticides, which are both expensive as well as environmentally harmful.

A more modern approach to the problem is to employ biotechnology to eliminate the mosquito vector more economically and effectively. This encompasses targeting the mosquito at a subcellular level by using a cytotoxic agent- that is a chemical that disrupts the mosquito’s cellular machinery.

Of these methods, the use of silver nanoparticles is becoming increasingly popular as nanotechnology advances. Silver nanoparticles are miniscule, nanoscale pieces of silver, which is highly toxic at cellular levels. This toxicity is being explored in its usages as antimicrobial and pesticidal agent.

Silver nanoparticles are traditionally synthesized using laboratory-grade reagents, which tend to be expensive and not readily available. Many researchers are now looking to phytosynthesis as an answer. The process of phyto-synthesis manipulates the ability of plants to carry out reactions to use in chemical synthesis. For instance, the phytosynthesis reaction of plants can be alternatively used to reduce silver ions to silver atoms.

Recent endeavors to utilize the phytosynthesis capabilities of plants have centered on the use of plant waste products to maximize productivity and minimize cost. In a recent study, researchers used the husk of coconut plant- abundant in the tropical regions plagued by malaria. They used the husk of coconut, which is a waste product from the fruit, to synthesize silver nanoparticles from silver nitrate. The synthesis eliminated the use of a synthetic reagent, and achieved successful results.

The nanoparticles produced were then used by the researchers to treat larval Culex quinquefasciatus, a species of mosquitos found in sub-tropical regions which is similar to the malaria mosquito in its transmission mechanism. The nanoparticles were observed to have significant larvicidal effect on the mosquito.

The study indicates the great potential of phytosynthetic methods to produce cheap and effective insecticides. By using plants indigenous to the tropical areas where malaria is most prevalent, the insecticidal measures of prevention can be made more accessible to the people. The use of waste products of coconut in the process is considerably cost-effective and eco-friendly.

Although the implementation of these innovative techniques may be some way in the future, ingenuity in research offers promising new horizons for a better, healthier world. To borrow Einstein’s words, it is time our technology caught up with our humanity.

– Atifah Safi

Sources: WHO 1, WHO 2, Science Direct
Photo: Flickr

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India on the Verge of Eliminating Malaria

India on the Verge of Eliminating Malaria
The population of India is over 1.2 billion. It is only second behind China in terms of population, but has some of the poorest living conditions of any country of the world. Open sewages are the perfect breeding ground for malaria carrying mosquitos throughout the country.

The center for disease control reports that malaria is located in all areas throughout the country including major metropolitan cities such as Mumbai and Delhi. According to the World Health Organization, 95 percent of the Indian population live in malaria endemic areas, and 75 percent of all cases of Malaria in South East Asia are reported in India.

Yet, despite the odds, India has been pushing to end malaria, and may be very close to realizing that goal.

According to WHO, India had over 883,00 cases of malaria in 2013. The number was 2 million in the previous years, thus halving the numbers that were recorded throughout the early 2000s. And that trend is continuing.

The Indian National Vector Borne Disease Control Programme (NVBDCP) has been leading the charge and have been utilizing efficient and successful tactics to combat the spread of malaria. The first and foremost is early case detection and prompt treatment.

Dr. A C Dhariwal, the Director of the NVBDCP, said how, “Through rapid diagnostic tests, artemisinin-based combination therapy, long lasting insecticidal nets and indoor residual spraying, we’ve been able to bring down the rates of malaria and reduce the number of deaths.”

The program also has four phases to end malaria: control, pre-elimination, elimination and prevention of reintroduction. Both treatment strategy and the phase strategy are results of the NVBDCP implementing all the tools the World Health Organization recommended to India to fight malaria.

The country is currently on phase two of pre-elimination and is targeting rural villages and communities where the population is at least 1000 citizens. In order to complete this phase, India has to achieve an annual parasite incident (AP) of less than 1 per 1000 in all districts within all states. Currently India is at 74 percent and steadily climbing.

Many of the people who are carrying out the effort are women. The Indian Ministry of Health and Family Welfare has deployed more than 900,000 female volunteers throughout the country. These women are chosen from their local communities and are trained in administrating early detection and treatment protocols.

If all goes well, India plans to reach the elimination phase by 2017 and completely eradicate malaria by 2030. This would be right on track with world goals of reducing malaria by 90 percent the same year globally. Experts say that to reach the target, all countries must contribute a total of $100 billion to organizations fighting malaria. Key contributors include WHO, the United States, the United Kingdom and The Bill and Melinda Gates Foundation.

The United States should allocate more aid towards aiding India fight Malaria. India is an ally and a strong economic partner to the U.S. A healthy India means more opportunities for U.S. goods to reach the world’s largest middle class population. That sounds like a healthy investment.

– Adnan Khalid

Sources: Center for Disease Control, National Vector Borne Disease Control Programme, United Nations, WHO 1, WHO 2
Photo: Columbia University Medical Center

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Experimental Anti-Malaria Drug Offers New Hopes

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An international group of medical scientists and vaccination experts have announced the discovery of a new class of antimalarial compounds capable of killing malaria parasites in an alternative method than currently observed in other medications. The team of researchers has expressed hopes that the discovery of the compounds will someday lead to a single dose cure or preventative vaccine for malaria that would cost as little as $1.00 US.

Dr. Ian Gilbert and his team of colleagues of the University of Dundee in the UK, in collaboration of the Medicines for Malaria Venture, discovered that the compound now named DDD107498 is capable of killing Plasmodium Falciparum, the species of the Malaria parasite considered most deadly, through targeting a molecule considered essential for protein synthesis.

In an interview regarding the discovery of the new compound, Dr. Gilbert eagerly reported, “This is an exciting new compound. It works against multiple life-cycle stages and has the potential to be an important medicine in the battle against malaria.”

With over 198 million cases of malaria worldwide recorded in 2013 and nearly 600,000 lives lost, mostly children who lived within sub-Saharan Africa, the race to discover a “miracle” malaria medication is tireless. Many scientists are exciting about the discovery of a compound that can fight Plasmodium Falciparum, as this form of malaria is especially dangerous due to its innate ability to develop resistances to various anti-Malaria drugs. The new anti-Malaria drug will be stronger against the parasite.

Through the analysis of over 4,700 compounds, the scientists learned that DDD107498 held the capabilities to fight malaria. Dr. Akhil Vaidya, a malaria research scientist at the Drexel University College of Medicine, reported that, “’The drug DDD107498 appears to have excellent pharmacological properties that would make it possible to devise a single dose cure for malaria, as well as to prevent malaria. It is also important that the drug works against various stages of the parasite, thereby making it possible to be used as a transmission blocking drug.”

The team of scientists hopes to determine an effective partner drug for DDD107498, as this compound is considered a relatively slow-paced killer of the Malaria parasite. Dr. Vaidya believes that combining the compound with a fast-killing drug would be the most suitable solution.

The pharmaceutical company Merck Serono has now adopted the development of the compound, which is currently undergoing critical stages of safety testing. Dr. Gilbert hopes that the first human clinical trials will begin within a year, and the drug will be available for consumer medical treatments within five to six years.

Dr. Michael Chew of the Wellcome Trust, a funder of the research being conducted, has claimed, “The need for new antimalarial drugs is more urgent than ever before, with emerging strains of the parasite now showing resistance against the best available drugs. The discovery of this new antimalarial agent, which has shown remarkable potency against multiple stages of the malaria lifecycle, is an exciting prospect in the hunt for viable new treatments.”

– James Thornton

Sources: Humanosphere, Royal Society of Chemistry
Photo: The Scotsman

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Causes of Child Mortality in Developing Countries

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According to the World Health Organization, 9.2 million children under the age of 5 die every year, many from preventable conditions that could be treated with simple healthcare interventions. The majority of these deaths occur in Sub-Saharan Africa and South Asia, where the child mortality rate is 175 per 1000 (compared to 6 per 1000 in industrialized countries).

Many of the diseases that kill children younger than 5-years-old are caused by lack of access to healthcare facilities, improper hygiene and sanitation, unclean water and not enough food, and low levels of education and information. The top three causes of child mortality are:

1. Pneumonia
About 15 percent of child mortality deaths are caused by pneumonia. In 2013, pneumonia killed an estimated 935,000 children under the age of 5. Pneumonia occurs when the air sacs in the lungs, the alveoli, are filled with pus and fluid. This makes breathing difficult, and does not allow the infected person to intake enough oxygen. Those who are malnourished have weaker immune systems and are therefore at a higher risk of dying from pneumonia. Pneumonia is also more likely to affect those who have pre-existing illnesses such as HIV, who live in an area where levels of indoor air pollution are high because of cooking with biomass fuels like wood or dung, who live in crowded homes, or those who have parents who smoke. While pneumonia can be treated with antibiotics, only one third of the children infected with pneumonia get the antibiotics necessary to cure them.

2. Diarrhoeal Disease
Each year, diarrhea kills 760,000 children under the age of 5. It is caused by unclean drinking water, contaminated food or person-to-person contact and poor hygiene. Malnourished children are more susceptible to diarrhea, and children in developing countries are likely to contract at least three cases of diarrhea each year. Since diarrhea leads to malnourishment, those who are already weakened by the disease are likely to contract it again. Diarrhea then leads to severe dehydration, which leads to death. It can be treated with rehydration zinc supplements. A good method of preventing diarrhea is decreasing levels of malnutrition, therefore making children less likely to be infected with the disease.

3. Malaria
In Africa, a child dies every minute from malaria, a disease caused by parasites. These parasites are transmitted to people from mosquito bites. The symptoms are first expressed as fever, chills and vomiting, and can then progress to severe illness and death if not treated within 24 hours. Malaria is preventable through the use of mosquito nets and levels of deaths caused by malaria are decreasing. Malaria related mortality cases in Africa have fallen 54 percent since 2000.

Child mortality is also high in countries that have a high Maternal Mortality Rate (MMR). More than a third of child mortality deaths occur in the first month of life and are related to pre-term birth, birth asphyxia (suffocation), and infections. In order to reduce Child Mortality, Maternal Mortality rates also have to decrease. This can happen with increased access to healthcare facilities and increased prenatal visits.

Child mortality rates are decreasing, but there is still work to be done. Vaccinations, adequate nutrition and increasing education will all help to decrease the levels of child mortality.

– Ashrita Rau

Sources: WHO 1, WHO 2, WHO 3, WHO 4
Photo: Flickr

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Substandard Medications Threaten the Eradication of Malaria 

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Health professionals attempting to treat patients with malaria are currently facing another complex obstacle in the developing world: the distribution of substandard, falsified and degraded antimalarial medications.

Drugs classified as substandard are medicines that have insufficient amounts of the necessary active ingredient. In order to effectively kill the bacteria and other harmful organisms thriving inside a malaria patient, the full, prescribed dose of the drug needs to be ingested.

When anything less than the full dose is ingested, these organisms not only continue to survive, but also develop a resistance to the drug entirely. This renders current anti-malaria drugs completely ineffective.

“Poor quality antimalarial drugs are very likely to jeopardize the unprecedented progress and investments in control and elimination of malaria made in the past decade,” according to Fogarty scientist, Gaurvika M.L. Nayyar.

Since the early 2000s, the World Health Organization has recommended artemisinin as the first line of treatment for malaria patients, since “artemisinin and its derivatives are powerful medicines known for their ability to swiftly reduce the number of Plasmodium parasites in the blood of patients with malaria.”

Artemisinin is combined with other supplementary drugs in Artemisinin Combination Therapy treatments in order to effectively assist those diagnosed with malaria. However, these substandard drugs are causing an increase in bacterial resistance to artemisinin treatments, rendering the first line of malaria defense utterly useless.

According to a study done by National Public Radio in 2012, “a third of all anti-malarial drugs taken off the shelf in nonrandom surveys in Africa and Asia were absolutely fake. In about 4,000 samples, there was not a drop of active ingredient there.”

The distribution of these partially active medications has recently been classified as a “global pandemic” affecting the poorest parts of the world, specifically West Africa and Southeast Asia, where drug regulatory systems are weak.

The Centers for Disease Control and Prevention said, “Counterfeiting occurs throughout the world, but it is most common in countries where there are few or no rules about making drugs. An estimated 10 percent to 30 percent of medicines sold in developing countries are counterfeit. In the industrialized world (countries such as the United States, Australia, Japan, Canada, New Zealand, and those in the European Union), estimates suggest that less than one percent of medicines sold are counterfeit.”

On April 20, The American Journal of Tropical Medicine and Hygiene released a special issue, titled “The Global Pandemic of Falsified Medicines: Laboratory and Field Innovations and Policy Perspectives,” which contained a series of 17 papers. Each is written by a different author from a different university or institution, yet all cover the implications surrounding the distribution of substandard medicines throughout the developing world.

According to one of the studies, over 122,350 child deaths were caused by insufficient or partially-active anti-malaria drugs in 2013 alone. This figure represents one-fifth of all deaths caused by malaria.

“These findings are a wake-up call demanding a series of interventions to better define and eliminate both criminal production and poor manufacturing of antimalarial drugs,” Nayyar said.

– Hanna Darroll

Sources: NPR, FIC, ASTMH, WHO
Photo: TheraBreath

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5 Things You Didn’t Know About Malaria

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Malaria is a disease caused by Plasmodium parasites, which are carried by Anopheles mosquitos. The mosquitos thrive in high temperatures, making malaria more common in tropical and subtropical regions. According to the Center for Disease Control, common symptoms include fever and flu-like illness, along with other issues, depending on the strain. The disease can also cause anemia and jaundice. Without treatment, malaria can lead to more severe issues and can be fatal. The following are some lesser known facts about the disease.

1. The United States was not considered free of malaria until 1951.

While many picture malaria being concentrated in more tropical areas, malaria was once prevalent across the globe. Malaria has been eliminated from several mild-weathered developed countries. In order to be considered officially free of a disease, a country needs to have no new cases of the disease for three years. The United States did not completely eliminate malaria until 1951, according to the Gates Foundation.

2. There are five species of Plasmodium parasites that cause malaria in humans.

P. falciparum, the deadliest of the species, can be found in tropical and subtropical areas around the world and is especially predominant in sub-Saharan Africa.

Another species, P. vivax, is the most prevalent of the five species and is found mostly throughout Asia, Latin America and some parts of Africa. Meanwhile, P. ovale is found predominantly in West Africa. P. vivax and P. ovale are both dormant for several months or years before they activate within an infected human being.

While these three species have a two-day replication cycle, P. malariae has a three-day cycle. Without treatment, this species can create a chronic infection that can last throughout one’s lifetime.

Finally, P. knowlesi is a species found in Southeast Asia that was recently shown to be a cause of zoonotic malaria. This species has a one-day replication cycle.

3. Malaria can either be categorized as uncomplicated or severe.

Uncomplicated malaria attacks tend to last between 6-10 hours and generally involve a cold stage, a hot stage and a sweating stage. Meanwhile, severe malaria is much more likely to be fatal. It involves infections of organs or the blood and can lead to abnormal neurological behavior, kidney failure, severe anemia, seizures or other effects.

4. The treatment used in the 17th Century is still used widely today.

In the early 17th century, indigenous tribes in Peru taught Jesuit missionaries about the cinchona tree’s medicinal bark and its effectiveness in treating fevers. The medicine from the bark is known as quinine, which has been seen as one of the most effective drugs in treating malaria. It is still one of the major antimalarial drugs used to treat the disease today.

5. There is a positive correlation between malaria and poverty.

While it is argued that both conditions feed into one another, it is clear that poor countries, who are most severely affected, have the least access to effective treatment and services for malaria. Malaria does not only affect both the physical and economic health of individuals, but it also affects the health of nations who need to deal with malaria systematically. According to the World Health Organization, Africa spends roughly $12 million annually addressing problems related to malaria, and economic growth in malarious African nations is therefore slowed by up to 1.3 percent annually.

– Arin Kerstein

Sources: CDC, Earth Institute, Gates Foundation, World Health Organization 1, World Health Organization 2
Photo: Centers for Disease Control and Prevention

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Photonic Fence Zapping Malaria, One Mosquito at a Time

Photonic_fence
A laser defense system from the scientists at Intellectual Ventures may prove to be an effective weapon against malaria-spreading mosquitoes.

The device is known as a “photonic fence” and works by monitoring a virtual field for disturbances caused by insects. Once an intruder is properly identified as a mosquito, it is targeted with a deadly laser. Within a fraction of a second, the device shears off the bug’s wing, leaving it dead or incapacitated.

Bees, butterflies and humans need not worry, however; the software powering the photonic fence is precise. It can determine not only the type of insect but also its gender and species. This accuracy is needed because only mosquitoes of the genus Anopheles carry malaria and only females bite people. The software analyzes insect size, wing movement pattern, airspeed and other characteristics to discern friend from foe.

Naturally, the idea is not without its skeptics. One concern is that rural areas often have unreliable power grids. The scientists at Intellectual Ventures hope to solve this problem with the use of solar cells. The laser itself doesn’t require much energy, as it targets the wings of a mosquito rather than its tough exoskeleton.

Intellectual Ventures sees the device as supplementing, rather than replacing current measures of control. These include habitat destruction, nets for homes and beds, as well as pesticides. Nonlethal uses of the photonic fence are also possible, such as monitoring mosquitoes or agricultural pests so that they can be treated with more traditional methods.

The company is currently field testing the device in a partnership with Lighting Science Group. Models are not yet for sale and the so-called mosquito laser will need to be produced cheaply in order to be effective.

The device couldn’t come at a better time. Over three billion people—more than half the world’s population—are at risk of malaria worldwide. An estimated 584,000 people died of malaria in 2013, out of 198 million cases. Although the disease is present in the Middle East, Asia and Latin America, most deaths due to malaria occur in Sub-Saharan Africa. Young children are particularly vulnerable to the disease; it is estimated a child dies of malaria every minute.

Its widespread economic effects worsen malaria’s human devastation. Several studies have demonstrated a relationship between malaria and poverty, and many of the world’s poorest countries have high rates of the disease. Refugees and transient people are at heightened risk of malarial infection, as they may not have developed any immunity.

– Kevin Mclaughlin

Sources: Intellectual Ventures, NCBI, WHO
Photo: Intellectual Ventures Lab

Malaria on its Way Out; Good News to Come

malaria
Malaria is spread through mosquitoes that carry the disease. In the United States, the swamps and marshes that housed malaria-carrying mosquitoes were destroyed to eradicate the disease, a trick that worked well. However, this is not a tactic that will work worldwide, especially in hot and humid places where the majority of the landscape is marshland.

In places like these, a promising solution has been created: long-lasting, insecticide-treated nets (LLINs). An insecticide-treated net is a bed net that has been treated with safe, residual insecticide to kill and repel the infected mosquitoes while also physically blocking them out. LLINs are designed to remain effective for multiple years without needing to retreat.

Malaria kills about 660,000 people a year, most being children. LLINs are cost-effective in production and distribution and are considered to be one of the most cost-effective ways to save lives. The process of distribution is simple and thorough: survey the people to determine the need for the nets, deliver the LLINs, and then promote their use.

In the 2012 World Malaria Report that looked at 17 sub-Saharan African countries determined that 68-84 percent of people that owned the nets were using them, an increase since 2010. Along with this increase came fewer malaria-related deaths; however, the exact figures collected were fairly unreliable.

However, with a long-term solution at hand, scientists can focus on eradicating the disease entirely. In the Southern U.S. and Europe, where malaria has been eradicated, a big factor in defeating the disease was a change in human behavior, a shift in land use, and in housing. Scientists believe that more research is needed to understand the factors affecting transmission before the disease will be fully eradicated.

There is a long way to go before malaria is gone for good, but the long-lasting, insecticide-treated nets have proven to be successful in the lives of individuals. They are cost-effective and well-used. Eradication of malaria is within the foreseeable future.

– Hannah Resnick

Sources: Give Well, TDR
Photo: Fast Coexist