Malaria Nearly Eliminated in Sri Lanka Despite Decades of Conflict

August 29, 2012 by Malaria.com

UCSF, Sri Lankan Researchers Credit Adaptability of Malaria Control Program

Despite nearly three decades of conflict, Sri Lanka has succeeded in reducing malaria cases by 99.9% since 1999 and is on track to eliminate the disease entirely by 2014.

According to a paper published today in the online, open-access journal PLOS ONE, researchers from Sri Lanka’s Anti-Malaria Campaign and the UCSF Global Health Group examined national malaria data and interviewed staff of the country’s malaria program to determine the factors behind Sri Lanka’s success in controlling malaria, despite a 26-year civil war that ended in 2009.

Typically, countries with conflict experience a weakening of their malaria control programs and an increased risk of outbreaks and epidemics, the researchers said.

Chief among its keys to success was the program’s ability to be flexible and adapt to changing conditions, the study found. For instance, to protect hard-to-reach, displaced populations, public health workers deployed mobile clinics equipped with malaria diagnostics and antimalarial drugs, whenever it was safe to do so. Likewise, when it was impossible to routinely spray insecticides in homes in conflict zones, the malaria program distributed long-lasting insecticide-treated nets, engaging non-governmental partner organizations familiar with the areas to help with distribution.

The program was able to sustain key prevention and surveillance activities in conflict areas through support from partner organizations and support from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Otherwise, researchers found that the keys to Sri Lanka’s success were the same as those deployed in non-conflict areas: rigorously and consistently providing interventions to prevent malaria among high-risk populations; proper and prompt diagnosis and treatment of all confirmed malaria cases; and maintenance of an effective surveillance system to quickly detect and respond to spikes in cases. Still, challenges remain.

“Sustaining the gains of elimination efforts and preventing resurgence is even more challenging today, especially in tropical settings such as Sri Lanka,” said Rabindra Abeyasinghe, MD, the paper’s first author, who led the research at the Sri Lankan Anti-Malaria Campaign. “In this era, sustaining the interest of partners and local decision makers, and ensuring continued funding, are becoming increasingly difficult. To avoid the tragic mistakes of the past, we must resolve to continue to devote the necessary resources and energy to the fight against malaria in Sri Lanka.”

Sri Lanka has an extensive history of battling malaria, and nearly eliminated it once before. In 1963, during the era of global eradication efforts, the country achieved a low of only 17 cases, down from 92,000 cases in 1953. With funding declines and reduced spraying and surveillance, the country saw a massive resurgence to 1.5 million cases in 1967-1968.

Since 1970, Sri Lanka has worked to bring malaria back under control, with compelling success, the authors said. In 2011, the country recorded just 124 locally acquired cases – about six cases per million people. This reduction is particularly noteworthy, the researchers noted, given that much of the progress was made during the civil war.

“It is very exciting to document Sri Lanka’s current progress toward malaria elimination, to add another chapter to our country’s ongoing fight against the disease,” said Gawrie Galappaththy, MD, a study coauthor at the Anti-Malaria Campaign at Sri Lanka’s Ministry of Health. However, she said, achieving zero malaria will require continued investments and hard work.

“There is no silver bullet for malaria elimination,” Galappaththy said. “Instead, it’s a daily commitment to finding the cases, treating the patients and preventing transmission.”

Today, even with the country’s great progress, Sri Lanka continues to face hurdles in its goal of driving malaria transmission to zero. Total malaria cases have dramatically dropped, but the proportion of Plasmodium vivax malaria infections – the more difficult to diagnose and treat form of malaria most common in Sri Lanka – is on the rise.

Another challenge is the shift in the population group at highest risk for malaria. In most of the world, children and pregnant women are most at risk; however following the success of Sri Lanka’s control program in protecting and treating these populations, the researchers found that the group most at risk today in Sri Lanka is adult men, particularly those exposed to malaria-carrying mosquitoes through their work, such as gem mining, military service and farming. Sri Lanka is developing new strategies to target these groups.

“Sri Lanka is showing the world how to eliminate malaria,” said Sir Richard Feachem, KBE, FREng, DSc(Med), PhD, director of the Global Health Group and senior author of the paper. “The country has made extraordinary progress, reducing malaria by 99.9 percent in the past decade. And all this achieved during a particularly nasty civil war. With continued commitment from the country’s Government and supporters, we are confident that Sri Lanka will finish the fight and become a malaria-free country.”

The paper can be found here: “Malaria control and elimination in Sri Lanka: documenting progress and success factors in a conflict setting,” The research was funded by the Bill & Melinda Gates Foundation. The authors did not report any disclosures.

The Global Health Group is part of UCSF Global Health Sciences and is dedicated to translating new approaches into large-scale action to improve the lives of millions of people. The group’s Malaria Elimination Initiative provides research and advocacy support to countries moving towards an evidence-based path to malaria elimination.

Source: UCSF

Organizations Against Malaria

May 15, 2012 by Malaria Q&A

QUESTION

What is a good organization that helps stop malaria?

ANSWER

There are many organizations that work very hard to control malaria. The most well known are those that design policies and implement projects to control malaria on the ground, in places where the disease is most deadly. These include multilateral international organizations such as UNICEF and the World Health Organization (as well as its regional counterparts, such as the Pan-American Health Organization, PAHO), country-led aid organizations such as DIfD in the UK and USAID in the US (the President’s Malaria Initiative, PMI, is largely implemented via USAID) as well as non-governmental organizations which seek to improve the lives of people in developing countries, such as Save the Children, Malaria No More and many other such groups.

Some of these groups have also joined forces to create multi-faceted organizations and programmes dedicated to controlling malaria, such as the Roll Back Malaria consortium and the Global Fund to fight AIDS, TB and Malaria, which provides millions of dollars of funding to projects throughout the world.

Secondly, there is also an aspect to malaria control which is not so easily seen on the ground, and that is the vast numbers of researchers who are dedicated to finding new drugs to treat malaria, new methods for control and new insecticides to prevent transmission from mosquitoes, among many other examples. These researchers are found in universities and research institutes all over the world, including many in sub-Saharan Africa, India and other places where the burden of malaria is very high.

On our website, you can find some personal accounts of scientists, working for the global pharmaceutical company AstraZeneca, who are doing drug discovery research in Bangalore, India. There are also blog posts from scientists at Princeton looking at transmission of malaria between monkeys and humans in south-east Asia, and information about cutting edge research at the Global Health Group at the University of California, San Francisco, whose members conduct work on a variety of aspects of malaria biology and control initiatives.

Researches Say Hydroxychloroquine Can Help Treat Cancer

March 14, 2012 by Malaria.com

Researchers say a drug commonly used to treat malaria and rheumatoid arthritis has also proved effective in treating some aggressive cancers. When scientists administered hydroxychloroquine, an anti-malarial drug, together with known cancer drugs, they found it stopped the growth of cancerous tumors in two-thirds of the patients.

Scientists know that human cancer cells grow by getting energy from adjacent tumors, where cells have begun to self-destruct.

The spread of cancer is accelerated by the death of these cells.

“This process called autophagy, which literally means to self-eat, is present in all cells,” said Dr. Ravi Amaravadi. “But what we are finding in our research is that cancer cells have a very high level of autophagy even before any treatment, and so they are poised to take on the damage from existing cancer therapies and simply break down the damaged parts to fuel further growth.”

Dr. Ravi Amaravadi spoke to us via Skype. He is a cancer specialist at the University of Pennsylvania School of Medicine. His group treated patients by combining conventional cancer medications with the anti-malarial drug, hydroxychloroquine. The compound is known to inhibit autophagy and researchers hoped it could stop cancer cells from growing.

In clinical trials, scientists found that hydroxychloroquine paired poorly with some cancer drugs. But it worked well with others, such as Temsirolimus, in helping to halt tumor growth – a so-called “stable disease” rate – in patients with melanoma, an aggressive skin cancer.

“And when Temsirolimus [a cancer drug] was tested in melanoma, it had zero percent stable disease rate,” said Amaravadi. “And when we combined with hydroxychloroquine malaria drug, the stable disease rate went up to 76 percent so that’s a very big difference.”

Researchers used a high dose of hydroxychloroquine to block autophagy, much higher than what’s normally used to treat rheumatoid arthritis or malaria. The dosage has not yet proved harmful.

Dr. Davide Ruggero at the University of California, San Francisco, is also studying the growth of cancer cells. He says the results of the research with hydroxychloriquine are promising.

“This is a great discovery because we know that the compounds are not toxic – have already been used,” said Ruggero.

But Dr. Amaravadi warns that oncologists should not use the anti-malaria drug outside of clinical settings. He says hydroxychloroquine has severe side effects when combined with some cancer drugs. So the knowledge of which compounds work well together is critical.

Source: VOA News