News story about trial relating to SMS messages enhancing malaria care
Tamzin Furtado on 8 Aug 2011
Researchers at the KEMRI centre in Kenya have been researching ways of improving care for children with Malaria, using SMS messaging as an intervention for care workers: the research and findings are reported here.
Malaria Journal - interesting methods papers
Tamzin Furtado on 23 Aug 2011
Journal for Malaria Researchers, but with articles which are adaptable to other areas of research, for example some interesting methods papers on how to design, set up a lab, do stats and assessment in a Vaccine trial.
Malaria Vectored Vaccine Consortium
The Editorial Team on 29 Feb 2012
The Malaria Vectored Vaccines Consortium (MVVC) is a partnership of four African and four European institutions. It has two related objectives:
To develop a malaria vaccine for use by populations where malaria is endemic
Malaria in Pregnancy Consortium Safety Tools and Resourcesby Global Pharmacovigilance
Research in pregnant and breastfeeding women is a complex area, with both the wellbeing of the mother and child paramount. Careful monitoring of any intervention to treat, or prevent, illness is required to ensure the benefits outweigh any harms. Read this article to find out more and download some of the safety tools developed by experts from the Malaria in Pregnancy Consortium.
Watch the Malaria Consortium's excellent video summary of the amazing progress that has been made to address malaria, and also highlighing the key challenges that remain.
Malaria remains a major global health threat. In the last fifteen years there has been remarkable progress in reducing cases and deaths due to malaria.
What did we know before this research?The border between Thailand and Cambodia is the world’s epicenter of cases of multi-drug resistant Plasmodium falciparum , the most dangerous malaria species. Recently, cases of resistance to artemisinin have been documented in the region and triggered efforst to contain further spread.
What we did we know before this research?In Africa it’s common practice to overdiagnose malaria, which means that very often patients are given ACT drugs simply because they present fever. Not only this leads to the waste of expensive drugs, but it also means that patients don’t receive treatment for their actual illness.
How the use of rapid diagnostic tests influences clinicians’ decision to prescribe ACTsby ACTConsortium
Evidence shows that in many African regions, including Ghana, malaria is massively over-diagnosed. This means that patients who are not diagnosed with malaria by tests that identify malaria parasites in the blood are still considered to have the disease and therefore receive anti-malarial treatment.
The World Health Organization recommends artemisinin-based combination therapy (ACT) as the first-line treatment for malaria. This consists of combining two drugs: artemisinin (which derives from the artemisia plant) and a partner drug (one of existing antimalarials). If taken alone rather than combined, they are considered monotherapies and are less effective.
Scientific title: Interactions between the antimalarial combination artemether/lumefantrine and antiretroviral therapy including nevirapine or lopinavir/ritonavir in HIV-infected adults What did we know before this research?Several African countries are heavily affected by both HIV/AIDS and malaria. The World Health Organization and ministries of health in most endemic countries recommend the use of artemisinin-based combination therapy (ACT) for malaria and antiretroviral combination treatments (ART) for HIV/AIDS, and such treatments have become increasingly available.
Scientific title: Determining sub-national intervention coverage and malaria impact estimates in young children and older age groups using a continuous Malaria Indicator Survey in Chikhwawa district, Malawi What did we know before this research?In areas where malaria transmission rates are moderate to high, the progress of malaria control is mainly evaluated using national household surveys such as Malaria Indicator Surveys (MIS), Demographic Health Surveys (DHS) or UNICEF Multiple Indicator Cluster Surveys (MICS). These are then complemented by data from Health Management Information Systems (HMIS).
Scientific title: Qualitative study on antimalarial drug use in the context of perceptions of ACTs and intra-household decision making in the Chikhwawa district of Malawi What did we know before this research?There are very effective antimalarial drugs available , but it is a challenge to ensure that they reach those that need them and that they are used appropriately.
What did we know before this research?International efforts to increase the use of artemisinin-based combination therapy (ACT) over the past decade have been based on the argument that this will lead to fewer malaria deaths. It has also been assumed that these drugs are safe even if used repeatedly. While there is no evidence to suggest concern, this has not been demonstrated directly in children under five years of age living in those areas.
In many malaria-endemic countries HIV/AIDS continues to spread, therefore an increasing number of patients need treatment for both infections at the same time. The WHO and ministries of health in many endemic countries recommend the use of artemisinin-based combination therapy (ACT) for malaria and antiretroviral combination treatments (ART) for HIV/AIDS. Such treatments have become increasingly available and research is being conducted into the clinical implications of taking ACT and ART concomitantly.
In many malaria-endemic countries HIV/AIDS continues to spread, therefore an increasing number of patients need treatment for both infections at the same time. The World Health Organization and ministries of health in many endemic countries recommend the use of artemisinin-based combination therapy (ACT) for malaria and antiretroviral combination treatments (ART) for HIV/AIDS. Such treatments have become increasingly available.
It is common practice in Africa to overdiagnose malaria, meaning that very often patients are given ACT drugs simply because they present fever. Given the high price of this type of medication, this approach becomes unsustainable. At the same time, it means that patients don’t receive treatment for their actual illness.
What did we know before this research?In sub-Saharan Africa it is common to overdiagnose and overtreat malaria, which means that patients who are not formally diagnosed with malaria are still considered to have the disease and therefore receive anti-malarial treatment. This leads to the waste of expensive drugs and increases the risk of developing drug resistance.
Scientific title: Infectious disease aetiologies of uncomplicated febrile illness in children <5 years of age in rural Zanzibar. As a result, Zanzibar has turned into a low transmission area with a decline of P. falciparum malaria among children with fever from approximately 30% to 1%, as well as a significant reduction of the crude child mortality.
Scientific title: Effectiveness of Malaria Rapid Diagnostic Tests in fever patients attending primary health care facilities in Zanzibar. Over the past decade, Zanzibar has adopted artemisinin-based combination therapy (ACT), long lasting insecticide treated nets and indoor residual spraying
Strategies for expanding access to quality malaria diagnosis in south-central Asia where malaria incidence is lowby ACTConsortium
Scientific title: An examination of ACT strategy in south-central Asia on P. falciparum malaria in a context where P. vivax is the major species. With the exception of Sub-Saharan Africa, most areas that are endemic for malaria have a combination of two species: Plasmodium falciparum and P. vivax. P. vivax is often the dominant species, accounting for a greater proportion of malaria cases.
Costs and effects of strategies to improve malaria diagnosis and treatment in Nigeriaby ACTConsortium
Scientific title: A cost-effectiveness analysis of provider and community interventions to improve the treatment of uncomplicated malaria in Nigeria. Private-sector providers are a major source of malaria treatment in Nigeria, and many patients in Enugu state seek treatment at pharmacies and drug stores as well as public health centres.
Training manuals from REACT study in Cameroon. REACT Cameroon designed six training modules to support the introduction of malaria rapid diagnostic tests (RDTs). The manuals were used to train health workers at government and mission hospitals and health centres. The six modules are presented in two manuals
Cost-effectiveness of interventions to support the introduction of malaria rapid diagnostic tests in Cameroonby ACTConsortium
Scientific title: A cost-effectiveness analysis of provider interventions to improve health worker practice in providing treatment for uncomplicated malaria in Cameroon. Testing patients before prescribing medication is important, and should ensure patients receive the most appropriate treatment. This is important because unnecessary and inappropriate treatment has costs –incurred by patients, but also governments and donors working to control malaria.
IMPACT 2: Evaluating policies in Tanzania to improve malaria diagnosis and treatmentby ACTConsortium
Scientific title: IMPACT 2: Monitoring Interventions to Improve ACT Access and Targeting. It is generally agreed that artemisinin-based combination therapies (ACT) are the best treatment for malaria, but it is less clear how it should be deployed by national programmes.
Evaluation of the referral system implemented in registered drug shops, and impact on the public health systems in Uganda. Most malaria deaths occur within 48 hours after the first symptoms appear. In rural areas, where access to health centres is poor, home-based management of malaria can reduce mortality caused by the disease by up to 50%. This approach provides training to members of the community who are then able to give effective treatment near the patients’ home.
Introducing rapid diagnostic tests in drug shops to improve the targeting of malaria treatmentby ACTConsortium
Introducing rapid diagnostic tests (RDTs) into the public and private health sectors in Uganda: a randomised trial to evaluate impact on antimalarial drug use. This study examines whether it is feasible and cost-effective to introduce RDTs into drug shops in Uganda in order to promote a rational and correct use of ACT drugs when managing cases of malaria.
Use of rapid diagnostic tests to improve malaria treatment in the community in Ugandaby ACTConsortium
This study evaluates whether the use of rapid diagnostic tests by community medicine distributors – with the aim to improve diagnosis and treatment of malaria in the community – is feasible, well accepted and cost-effective. This cluster randomized trial compares two approaches.
The PROCESS project is a complementary evaluation study that runs alongside the PRIME trial, which aimed to improve health centre management, fever case management and patient centred services at Ugandan health centres.
The PRIME trial: Improving health centres to reduce childhood malaria in Ugandaby ACTConsortium, Sarah Staedke
In Uganda and elsewhere, poor health services may limit appropriate management of fever cases and delivery of good quality care. Ultimately, this could contribute to the lack of progress on malaria control. In the formative research that preceded our intervention, we identified barriers and aspirations for quality health care. We used these results, together with evidence from studies elsewhere and the inputs of local stakeholders, to identify the most feasible interventions with the greatest potential for impact on health outcomes.
The TACT training manuals and patient leaflet were designed to support the use of malaria rapid diagnostic tests (RDTs). Here we provide Trainer/Trainee manuals in English and French, and visual patient information sheets in English, French and Swahili.
The Artemisinin-based Combination Therapy (ACT) Consortium Drug Quality programme collected and analysed the quality of over 10,000 artemisinin-based drugs from six malaria endemic countries. Report available in English, Spanish and French.
In this video of a seminar delivered at the University of Oxford in June 2014, Professor Nicholas White talks about the challenge of antimalarial resistance.
Infectious diseases and Microbiology videosby Nuffield Department of Medicine
Join the Gametocyte Study Groupby WWARN
The WWARN Gametocyte Carriage Study Group is assessing the risk factors associated with gametocyte carriage and clearance. Find out how you can join.
Our understanding of the extent and nature of resistance in P. vivax parasites is limited. WWARN’s new literature review summarises the global extent of reduced P. vivax susceptibility to the frontline antimalarial chloroquine.
Mobile Phone Based Clinical Microscopy for Global Health Applicationsby David N. Breslauer, Robi N. Maamari, Neil A. Switz, Wilbur A. Lam, Daniel A. Fletcher
Coming soon! A paper series on clinical trial design for tropical diseases. Read more here and get involved!