Recent multi-centre trials showed that dihydroartemisinin-piperaquine (DP) was as efficacious and safe as artemether-lumefantrine (AL) for treatment of young children with uncomplicated P. falciparum malaria across diverse transmission settings in Africa. Longitudinal follow-up of patients in these trials supported previous findings that DP had a longer post-treatment prophylactic effect than AL, reducing the risk of reinfection and conferring additional health benefits to patients, particularly in areas with moderate to high malaria transmission. [Read more…]
Nearly 200 Million Africans at Risk for Malaria
New research shows that after 10 years of intensified campaigns against malaria 184-million people in Africa still live in moderate to high-risk areas. While the number is high, it’s down from nearly 220-million in 2000 when anti-malaria efforts began to increase.
The findings are based on thousands of community-based surveys in 44 African countries and territories. These are places where malaria has been endemic.
Dr. Abdisalan Noor, co-leader of the team that conducted the research, said, “What we are looking at, first of all, is to try and estimate the level of infection with malaria in African communities. This doesn’t necessarily mean the number of people who die of malaria, but the proportion of people who are likely to carry the most virulent type of the malaria parasite. That’s Plasmodium falciparum.”
Noor and co-leader Professor Robert Snow are with the Kenya Medical Research Institute-Wellcome Trust Research Program. The team also included researchers from Oxford University and the World Health Organization.
The study reflects the effects of the Roll Back Malaria campaign and other programs. The campaign brought together many multi-lateral, private and non-governmental organizations. The goal was to cut in half the number of deaths from malaria by 2010. It had a shaky start and was criticized in its early years for a lack of progress.
Dr. Noor said that the new study finds a mix of good and bad news about efforts to combat malaria.
“The positive news is there has been production in 40 of the 44 African countries for which we were able to estimate change. There has been some reduction in the proportion of people who are likely to be affected with the falciparum parasite. About 218-million people in 2010 lived in areas where transmission – malaria transmission – had dropped by at least one level of endemicity. So that’s good news.”
Endemicity is described as the measure of disease prevalence in a region.
“The other side of it.” said Noor, “is that despite all these gains almost 60 percent of African populations still live in areas where more than 10-percent of the population is likely to carry the malaria parasite. And out of these about 184-million people live in areas where more than 50-percent of the population are likely to carry malaria infections.”
Among the countries where disease transmission remained high or unchanged are DRC, Uganda, Malawi and South Sudan.
Despite the large number of people still likely to be infected, Noor says he does not want to detract from the gains made by the international community – namely, the reduction in risk for 34-million people from 2000 to 2010.
“We haven’t actually looked at the reasons why some places are more resilient to change than others. Epidemiologically, it’s got something to do with the higher the starting transmission, the longer it takes to bring down the disease,” he said.
Another reason, he said, may be weak health care systems in many countries. It can be difficult to get reliable estimates on how many people get sick or die from malaria. Noor says stronger health care systems would play a major role in reducing infection risk.
In the 10-year period studied, funding for malaria programs steadily increased from 100-million-dollars to two-billion dollars a year.
He said, “It’s no news that despite all this investment we need more. I think the estimate for the needs for malaria control in Africa is around five-billion dollars if we look at the last global malaria action plan.”
Noor said that there’s a lot to be proud of in the global community in terms of reducing malaria cases.
He added that despite a recent global recession — and competing priorities — resources for malaria campaigns should not only be sustained, but increased. That would help bring malaria to a point where, he said, it would be of “minimal public significance.”
Right now, though, the Roll Back Malaria campaign estimates a child dies every 60 seconds from the disease.
Source: VOA News
African Experts Discuss Need for Better Regulation of Medicine
In most African countries, pharmaceutical drugs are poorly regulated or not regulated at all, posing huge risks for those who depend on them to stay healthy. But for the first time, the topic has gotten the attention of African officials, who holding a scientific conference on the topic in South Africa.
Access to safe and effective medicine can be touch and go in Africa, where the market abounds with drugs that are fake or expired.
That can have disastrous consequences, says Margareth Ndomondo-Sigonda, a Tanzanian who oversees pharmaceutical issues for an African Union agency, the New Partnership for Africa’s Development, or NEPAD.
“The situation that you see in Africa is that most of the medicines circulating in our market, more than 30 percent, either does not meet the standards, meaning that it cannot treat the disease that it is intended to, or it is falsified, meaning that it is not a real medicine,” Ndomondo-Sigonda said. “Could be that it does not have the necessary active ingredients, and therefore it may not treat or it may even cause harm to the patient instead of actually treating the disease that is intended.”
She is one of hundreds of experts who gathered in Johannesburg this week for the first-ever scientific conference bringing together pharmacists, health workers, governments and civic organizations to discuss how to better regulate the drugs that make it to health facilities across Africa.
Ndomondo-Sigonda says that most African nations lack the capacity to effectively police medicines. Nations are considering tightening and refining their testing protocols and collaborating on testing, among other interventions.
Experts also noted the role that law enforcement authorities can play in cracking down on fake drugs. While this is sure to be a long and costly process, NEPAD’s head science advisor Aggrey Ambali says these measures may end up making drugs cheaper for consumers.
If countries cooperate to test drugs, he says, they can save money. And if local drug producers are made aware of the new guidelines, they can compete more effectively.
“Without actually having the actual numbers, but the pointers are there that if this were to succeed, I think there are opportunities of trying to find ways of cutting costs which can actually be reflected in the final price of the medicine,” said Ambali.
Ndomondo-Sigonda says consumers can protect themselves now by being selective about where they buy their drugs and sticking to trustworthy health facilities.
“The minute they go and buy medicines in the open markets, that is where the problem starts, because the products in the open markets, they are not assured because you do not know where they source them from and you have a huge potential for buying counterfeit medicines in such markets,” she said.
That fact was illustrated in 2011, when the World Health Organization reported that in Nigeria, the continent’s largest pharmaceutical market, nearly two-thirds of drugs used to fight malaria were fake.
via African Experts Discuss Need for Better Regulation of Medicine.
–Anita Powell
Source: VOA News
Tracking Black Market Malaria Drugs
“The theft and black market resale of anti-malaria medications is a serious problem in African countries like Angola and Tanzania, hindering the global aid effort to combat the disease. U.S. investigators are leading a probe into the widespread theft and black-market resale of malaria drugs donated to Africa by the U.S. government. Organized theft is plaguing the multibillion-dollar aid effort, according to people familiar with the investigation, raising questions about the supervision of donations in corruption-ridden nations,” according to the Wall Street Journal.
[Read more…]
Africa Faces $7 Billion Funding Gap to Fight Malaria
African countries face a $7-billion funding gap to control and eliminate malaria. To discuss this issue among others, African ministers of health came together at the African Union headquarters to commemorate World Malaria Day.
Every year 660,000 people die from malaria, and 90 percent of those deaths are in Africa. Eliminating malaria by 2015 is one of the United Nations’ Millennium Development Goals. But an estimated $26.9 billion is needed in the next three years to reach the goal.
African Union Commissioner for Social Affairs Mustapha Kaloko says funding is the main challenge, when it comes to fighting malaria.
“We Africans must create [an] innovative domestic national health financing model. We cannot and should not continue to rely on external funding for health. The experience of the last few years has shown that external funding are neither predictable nor assured,” he said.
A handout photograph taken on April 15, 2013 and released 16 by the African Union-United Nations Information Support Team shows a Somali woman holding her child at a clinic run by the Burundian contingent of the African Union Mission in Somalia.A handout photograph taken on April 15, 2013 and released 16 by the African Union-United Nations Information Support Team shows a Somali woman holding her child at a clinic run by the Burundian contingent of the African Union Mission in Somalia.
Malaria costs Africa $12 billion each year in lost productivity, alone. And, a recent study conducted by the Mckinsey global consultancy company notes that every dollar invested in malaria control in Africa, generates an estimated $40 dollar in gross domestic product. But, African countries receive about 75 percent of their budget for malaria control from abroad.
Fatoumata Nafo-Traore, executive director of the Roll Back Malaria Partnership, says African countries could become less dependent, if they would prioritize malaria control:
“Malaria should come among the priorities,” she said. “If that is the case then it would become easy really to find the resources within the government budget. Malaria control interventions are not very expensive. Rapid diagnosis tests costs 50 cents and the treatment for a child costs lest than a dollar. Also, bed nets will costs between $3 to $6. If you bring all these three together, it’s less than $10 to cover one person.”
In addition to becoming less dependent on aid to pay for malaria prevention, Petrina Haingura of the Namibian Ministry of Health advises African governments to make better use of the resources that are available. She says that resources are distributed in communities, without proper education:
“We need to make them aware of these problems of malaria. And, also, some communities are using this mosquito nets by using it to catch fish. But I think we need to emphasize why we are giving them these mosquito nets is to prevent malaria,” she said.
Malaria deaths have decreased to an average of about 33 percent on the African continent. But scientists expect that shortages in funding for control interventions could quickly turn around those results.
African ministers of health are in a four-day conference of the African Union where the call to fight malaria has been renewed.
Source: VOA News
Malaria Deaths in Africa
QUESTION
How many humans die of malaria in Africa?
ANSWER
According to the World Health Organization’s Roll Back Malaria programme (Roll Back Malaria – Key Facts), 665,000 people died from malaria globally in 2010, with 91% or 596,000 people dying in Africa alone. Eighty-six (86%) of deaths were in children under five years of age.
P. knowlesi versus P. falciparum: Treatment and Prevention
QUESTION
I would like to know about the P. knowlesi – treatment compared to P. falciparum? preventive medicine?
ANSWER
At this point in time, P. knowlesi is completely susceptible to chloroquine, and so can be treated successfully using this drug. P. falciparum, on the other hand, is known to have widespread resistance to chloroquine, and so the World Health Organization recommends that chloroquine should not be used to treat P. falciparum malaria. Instead, for non-complicated malaria, the WHO recommends treatment with artemisinin-based combination therapies (ACTs). These drugs can also be used against other forms of malaria, including P. knowlesi, particularly if the hospital also treats cases of P. falciparum regularly and so has supplies of ACTs on hand. One study even showed that treatment with ACTs (specifically artemether-lumefantrine) was more effective than chloroquine in treating P. knowlesi. Severe cases of either infection should be treated with intravenous artesunate or quinine.
Prevention for both is roughly similar – chemoprophylaxis should be taken by people travelling to an area where transmission of these types of malaria occurs. However, given P. knowlesi‘s susceptibility to chloroquine, this drug is effective as a prophylactic for this malaria species, whereas it is not appropriate for P. falciparum, given high levels of resistance. In terms of prevention of mosquito bites, this differs due to the types of mosquito vectors each of these species of malaria uses. P. knowlesi is only found in south-east Asia, where the mosquitoes that transmit it tend to be forest dwelling. As such, people who spend time in the forest in the evening and at night are most at risk of contracting P. knowlesi. Wearing long-sleeved clothing and insecticide while in the forest may help prevention in this case. P. falciparum is found throughout the world, and uses many different species of mosquito vector. In Africa, the mosquitoes which transmit P. falciparum tend to rest indoors and thus bite people at night while they are sleeping. Therefore, in these settings, it is especially beneficial to sleep under a long-lasting insecticide treated bednet. Indoor residual spraying, which coats the inside walls of a house with insecticide to kill indoor-resting mosquitoes, can also be beneficial.
Malaria in Africa
QUESTION
How many in Africa have been affected by Malaria?
ANSWER
In 2010, there were approximately 174 million cases of malaria in Africa. However, some people may present with more than one case of malaria per year (especially young children), so the number of people affected is likely considerably lower. However, 90% of deaths from malaria occur in Africa, and 60% in just six countries: Nigeria, DR Congo, Burkina Faso, Mozambique, Cote d’Ivoire and Mali. The good news is that malaria mortality has dropped by 33% in Africa since 2000, which is a very encouraging trend, though the aim of organizations such as Malaria No More is to fully eliminate deaths from malaria globally by 2015.
Malaria Vaccine
QUESTION
Is there a vaccine for malaria?
ANSWER
No, as of yet there is not a vaccine available for malaria. The most promising vaccine candidate, RTS,S, which has been developed by GlaxoSmithKline, is currently undergoing Phase III trials in Africa. The trial is not due to finish until 2014, so we will have to wait until then to know how effective it is. Preliminary results, published last year, suggested that it may prevent up to 50% of malaria cases in young children, though the long term protection level is not known. Other age groups will also have to be analyzed, as well as the effect of the vaccine on malaria mortality levels.
Vaccine for Malaria
QUESTION
Is there a vaccine to prevent malaria?
ANSWER
No, there is not currently a vaccine available to prevent malaria. The best current candidate, the RTS,S vaccine which was developed by GlaxoSmithKline, is currently undergoing Phase III clinical trials in Africa. Although preliminary results showed up to a 50% rate of protection against malaria in some age groups, the trials will not conclude until 2014 and so full results will not be known until after that date.