Ongoing challenges in the management of malaria

Gilbert Kokwaro

doi:10.1186/1475-2875-8-s1-s2

Abstract

This article gives an overview of some of the ongoing challenges that are faced in the prevention, diagnosis and treatment of malaria.Malaria causes approximately 881,000 deaths every year, with nine out of ten deaths occurring in sub-Saharan Africa. In addition to the human burden of malaria, the economic burden is vast. It is thought to cost African countries more than US$12 billion every year in direct losses.However, great progress in malaria control has been made in some highly endemic countries. Vector control is assuming a new importance with the significant reductions in malaria burden achieved using combined malaria control interventions in countries such as Zanzibar, Zambia and Rwanda. The proportion of patients treated for malaria who have a confirmed diagnosis is low in Africa compared with other regions of the world, with the result that anti-malarials could be used to treat patients without malaria, especially in areas where progress has been made in reducing the malaria burden and malaria epidemiology is changing. Inappropriate administration of anti-malarials could contribute to the spread of resistance and incurs unnecessary costs.Parasite resistance to almost all commonly used anti-malarials has been observed in the most lethal parasite species, Plasmodium falciparum. This has presented a major barrier to successful disease management in malaria-endemic areas.ACT (artemisinin-based combination therapy) has made a significant contribution to malaria control and to reducing disease transmission through reducing gametocyte carriage. Administering ACT to infants and small children can be difficult and time consuming. Specially formulating anti-malarials for this vulnerable population is vital to ease administration and help ensure that an accurate dose is received.Education of healthworkers and communities about malaria prevention, diagnosis and treatment is a vital component of effective case management, especially as diagnostic policies change.Preventing resistance emerging to both ACT and insecticides used in vector control remains an ongoing challenge in an era of changing malaria epidemiology.

Highlights

Malaria is one of the world’s most deadly diseases
The most serious forms of the disease are caused by the parasite Plasmodium falciparum; malaria caused by Plasmodium vivax, Plasmodium ovale and Plasmodium malariae results in milder disease in humans that is not generally fatal
Up to 40% of African health budgets are spent on malaria each year [5], and on average, a malariastricken family loses a quarter of its income through loss of earnings and the cost of treating and preventing the disease [2]

Summary

Background

Malaria is one of the world’s most deadly diseases. Even though it is highly preventable and treatable, it causes approximately 881,000 deaths every year [1], with nine out of ten deaths occurring in sub-Saharan Africa, and 85% of malaria-related deaths in children under five years of age. The development and spread of parasite resistance to certain anti-malarial agents has presented a major barrier to successful disease management in malaria-endemic areas, and has probably contributed to the resurgence of infection and the increase in malaria-related deaths in recent years [9]. The relatively high rate of treatment failure reported with the ACT dihydroartemisinin–piperaquine against P. falciparum may be attributed to cross-resistance between chloroquine and piperaquine [18] This may reduce the usefulness of new therapies prior to large-scale deployment if they are derivatives of currently used drugs to which resistance has already been established. Artemisinin derivatives can reduce parasite load by a factor of approximately 10,000 per asexual cycle [19], compared with a reduction of 100-fold to 1,000-fold per cycle with most other anti-malarial drugs [9] They have gametocidal properties, which could have an important effect on the incidence of malaria. Participants can share expertise on how to forecast demand for AL, as well as discussing ordering and distribution systems, and routes for financing and procurement

Conclusion

Findings

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