World Malaria Day 2014 – How Best to Invest in Malaria Prevention and Control

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Each year, April 25 provides an opportunity to reflect on the current status of the fight against malaria. We are in the middle year of the World Malaria Day theme of “Invest in the Future. Defeat Malaria,” which is set to last until 2015.

Funding for malaria control and prevention, as with all international public health endeavors, has always been perceived as a critical issue, but there is a refreshing diversity to the ways in which it is being discussed this World Malaria Day.  The U.S. Centers for Disease Control and Prevention (CDC), who spear-headed the successful eradication of malaria in the U.S. back in the 1950s, specifically mention their efforts to maximize effectiveness, and their strategies for using and evaluating new tools such that they can get the most impact per precious dollar spent.  The WHO has highlighted the importance of sustained political commitment, as a crucial factor related to ensuring continued financial support for malaria initiatives. The Global Fund to Fight AIDS, TB, and Malaria recently announced a new funding model, designed to enable “strategic investment for maximum impact.” [Read more…]

Organizations Against Malaria

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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.

Duo-Cotecxin and Fansidar as Treatment

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QUESTION

My husband weighs and has malaria. He was told by the pharmacist to take 2 tablets stat, then 1 daily for five days followed by 3 Fansidar tablets. We live in Papua New Guinea. I see on the Duo-Cotecxin web site the dose is three tabs daily. Which is correct?

ANSWER

Fansidar is a very different drug to Duo-Cotecxin—it is made of a combination of sulfadoxine and pyrimethamine, whereas Duo-Cotecxin is an artemisisin-based combination therapy (ACT), consisting of dihydroartemisinin together with piperaquine. As such, the dosages and time courses of therapy are likely to be different. However, Fansidar is not usually recommended as treatment anymore—it appears to have low efficacy against Plasmodium vivax and in the 1980s and 1990s, the World Health Organisation and Center for Disease Control (CDC in the US) only recommended it for use against chloroquine-resistant P. falciparum.

However, nowadays, both organisations recommend ACTs (like Duo-Cotexcin) to treat all uncomplicated P. falciparum infection as well. Therefore, unless your husband has been diagnosed with P. ovale or P. malariae malaria (both of which are sometimes found in PNG), Fansidar probably should not have been the first-line treatment given to him. Keep a close watch over his recovery, and if there is any sign of reccurrence of the symptoms, go back to the doctor for another malaria test.

Where is malaria found?

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QUESTION

Where is malaria found?

ANSWER

Malaria is found throughout the world’s tropical and sub-tropical areas, and mainly in Central and South America, Africa, Asia and the Indo-Pacific region. It is most common in tropical regions, where transmission occurs year-round; in sub-tropical and temperate areas, transmission may only occur during seasons that have appropriate climatic conditions. This includes sufficiently high temperature and water availability for the growth and development of the mosquito, which transmits the disease. Currently, the greatest burden of the disease is felt in sub-Saharan Africa, where over 90% of deaths due to malaria occur. The map below shows the estimated risk for malaria across the world, courtesy of the World Health Organisation.

Global_Malaria_2010_WHO

Map of the global distribution of malaria, courtesy of WHO (www.who.org)

Malaria in Sub-Saharan Africa

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QUESTION:

I live in the USA and I would like to start a business to fight mosquitoes and malaria: Can you advise me how and where to start?

ANSWER:

I take it from the subject heading of the question that you would like to focus on sub-Saharan Africa—a crucial thing to note at this stage is that malaria is serious disease that affects millions of people throughout Africa (as well as across the rest of the world’s tropical and sub-tropical regions) and as such, I would encourage you to think about ways in which you can help people fight the burden of this illness.

You also should understand that many of the people who are at greatest risk from contracting malaria also happen to live in extreme poverty; an inability to pay for diagnosis or treatment is one of the great problems affecting the sustainability of malaria control initiatives in developing countries. As such, if you plan to start a business aimed at fighting mosquitoes and malaria, you need to think carefully about the model for such an initiative; for example, do you intend to make a profit? Many organisations already work in sub-Saharan Africa as non-profit organisations (NPOs), which use fund-raising or the sale of bednets in order to provide free services elsewhere, and these types of organisations are generally better respected in terms of their motivation to eliminate the burden of malaria in impoverished communities. So, if this sounds like the type of work you would be interested in setting up, I would look at the various other organisations that are already working on the ground in sub-Saharan Africa (Malaria No More, the Malaria Consortium, and non-governmental organisation such as the World Health Organisation and UNICEF, to name a few) and see if you can find a niche where you think you can make a difference to people’s health. To gain experience, you might also consider seeing if any of these organisations accept volunteers or have job positions open, to see what working to fight malaria is really like in practice.