By Dr. Derick Pasternak
We continue to focus on four categories of malaria-related information: Prevention, Diagnosis, Treatment, and Campaigns. I’ve collected relevant publications from the scientific and mainstream press this past month. Sometimes an article will not fit neatly into one of these four; it may be necessary to add a category or two in the future. Abstracts of all articles cited are available; see below for those articles that are also in Malaria Partners International’s on-line Library in their entirety.
Prevention:
- The WHO/UNICEF published guidance to community health workers on how to proceed in view of the COVID-19 pandemic. The complete text is available. Relevant guidance for malaria workers is as follows:
- Access to and use of one of the core vector control tools should be maintained (ITNs or indoor residual spraying), including through adapted campaigns that are delivered using best practices to protect health workers and communities from COVID-19 (57, 58). Adaptations might include suspending some data and accountability procedures that increase person-to-person contact and the potential risk for COVID-19 transmission (for example, not requiring a signature for ITNs received by a household).
- Campaigns for seasonal malaria chemoprevention should continue.
- Countries where malaria has been eliminated and those working to prevent re-establishment should maintain intensive malaria surveillance activities in addition to core vector control activities, using best practices to protect health workers and communities.
- In exceptional circumstances, such as when there is a significant breakdown or inability of the health system to deliver services, mass administration of antimalarial treatment could be used to rapidly reduce mortality and morbidity.
- Countries should not scale back efforts to detect and treat malaria, including at the community level, such as through iCCM or community integrated management of childhood illness, which is discussed above.
- An exciting article in Nature Communications informed us that a parasitic microbe that infects Anopheles arabiensis prevents the proliferation of falciparum in that mosquito, so it will not transmit the disease. So far, this is a finding in Kenya only; the microbe has not been tested in other species of A. gambiense complex. The study was also reported in the lay press (BBC News) and is highlighted elsewhere in the Newsletter. The article is available in its entirety.
- Moderate or high intensity pyrethroid resistance was detected nationwide in the Democratic Republic of Congo, as published in Malaria Journal in April 2020. This is a serious threat to sustained malaria control with pyrethroid LLINs. Next generation nets (PBO nets or bi-treated nets) should be considered for mass distribution, according to the article.
- The scientific periodical Nature published an article that described Tanzanian children who were relatively resistant to infection by falciparum. These children possess an antibody to a particular parasite antigen. Vaccinating non-human primates with this particular antigen partially protected them against the parasite. These facts hold promise for another direction in vaccine development.
- Major prevention implications are raised by the May article in Malaria Journal on shifting transmission risk of malaria in Africa as a result of climate change. The article is available.
Diagnosis:
Current understanding of malaria transmission dynamics and parasite movement mainly relies on the analyses of epidemiologic data, e.g. case counts and self-reported travel history data. A September 2019 article in Malaria Journal describes ‘next-generation gene-sequencing” (NGS). Potential roles of NGS in better understanding of transmission patterns, accurately tracking parasite movement and addressing the challenges of imported malaria in low transmission settings of sub-Saharan Africa are discussed.
Treatment:
A study published in Malaria Journal in May demonstrates for the first time that there is synergy of complement, pre-existing immunity, and drug treatment with artemisinin in younger patients with symptomatic malaria in Western Kenya, a high-transmission area.
Campaigns:
The Lancet published on line a lengthy article from the Global Burden of Disease Health Financing Collaborator Network, analyzing health sector spending in middle- and low-income countries between 2000 and 2017. Malaria is one of the four specific targets of spending analysis, as seen in detailed graphs in the article. The article states that low- and middle income countries that eliminated malaria altogether during this period include Argentina, Armenia, Azerbaijan, Costa Rica, Georgia, Iraq, Kyrgyzstan, Morocco, Paraguay, Sri Lanka, Syria, Tajikistan, Turkey, and Uzbekistan. Relevant extracts from the article are available as well as the entire 32-page article.