New insights into the international burden of malaria

Malaria research scientists from around the globe have published new insights into the international burden of malaria and what can be done about it.

The new data are presented in a supplement to the American Journal of Tropical Medicine and Hygiene titled “The Intolerable Burden of Malaria II: What’s New What’s Needed”, released on September 9, 2004.

“The global burden of malaria is staggering and intolerable”, says National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony S. Fauci, M.D. “The articles in this important publication help to quantify this burden and describe what is being done — and what is needed — to reduce the human suffering and economic toll caused by malaria.”

“This supplement comes at a critical time when agencies around the world are working harder than ever to find new solutions to the seemingly intractable problem of malaria,” said Dr. Sharon Hrynkow, Acting Director of the Fogarty International Center (FIC), which led the development of the supplement on behalf of its partners. “Multilateral efforts, including the Global Fund for AIDS, TB and malaria, as well as national efforts will benefit from the information gathered in this supplement,” she added.

In the groundbreaking publication, available to researchers worldwide at no cost, it is reported that artemisinin-based combination therapy can significantly delay the development of malaria parasite resistance and are more effective than anti-malarial agents currently in use. New information on insecticide-impregnated bed nets designed to protect children, pregnant women, and newborns from the disease is also reported. “This combination therapy is just one of several approaches in clinical development that is designed to prevent or reduce the onset of malaria and promote earlier recovery,” notes Dr. Kenneth Olden, director of the National Institute of Environmental Health Sciences (NIEHS). As many as 35 candidate vaccines are in clinical development, of which 16 are designed to prevent or reduce the onset of parasitemia, reduce febrile malaria attacks, and promote earlier recovery. Transmission-blocking vaccines, also called “altruistic vaccines”, prevent infectious sexual stage (sporozoite) development in the salivary glands of Anopheles mosquitoes and block the transmission of malaria by infected mosquitoes, thereby protecting larger communities.

Every year, malaria kills close to two million persons and is associated with close to five billion episodes of clinical illness throughout the world. Over 50 percent of the world’s population is exposed to the disease — an increase of close to 10 percent over the past decade. Those living in the most economically deprived areas receive the worst care and suffer catastrophic economic consequences from their illness. Almost three percent of disability-adjusted life years (DALYs) are due to malaria mortality globally, 10 percent in Africa.

Only the second of its kind, the new supplement contains data contributed by malaria researchers from around the world, including many in malaria-endemic areas.

“The most successful malaria control programs over the past 100 years, in the Americas and Europe, and now in Africa and Asia, have been linked to strong research activities. New antimalarial drugs, insecticides, bed nets, and other methods to control malaria have come from field research in the swamps and other mosquito breeding areas, and the laboratories, clinics and hospitals of the United States, Caribbean, and southern Europe,” says Fogarty’s Dr. Joel Breman, one of the editors for the supplement. Now, a growing number of scientists from Africa, the area suffering the greatest toll from malaria, are more actively involved in combating this scourge compared to a few years ago. Their contributions to understanding the socio-cultural dimensions of the burden of malaria are vital to the development of effective interventions and improving understanding of how to deploy and facilitate access to those interventions.

Input for the supplement was derived from the Multilateral Initiative on Malaria (MIM) Pan African Conference, held in Arusha, Tanzania and hosted by the MIM, an alliance of organizations and individuals working together to maximize the impact of scientific research on malaria in Africa. The supplement was supported by the Fogarty International Center, the National Institute of Allergy and Infectious Diseases, the National Library of Medicine and the National Institute of Environmental Health Sciences of the National Institutes of Health and other partners.

The new supplement, featuring 37 papers, was edited by Dr. Joel Breman, FIC, Dr. Martin Alilio, Academy for Educational Development (formerly of the Fogarty International Center), and Dr. Anne Mills, London School of Hygiene and Tropical Medicine. Featured papers in the malaria supplement discuss the latest findings on relationships between malaria and other morbidities, including HIV in pregnant women; malnutrition; and neurological, cognitive, and developmental sequelae. The authors explore new antimalaria treatment methods, examine methods for calculating the global burden of disease and malaria, and assess the impact of mosquito transmission on morbidity and mortality. Approaches for determining the economic toll caused by malaria are examined; and the role of urban malaria, epidemics and social and economic burdens in impeding the development of cost effective, newer malaria control methods are analyzed. Featured papers also discuss the research agenda and other focused activities that help to define malaria’s toll on the world’s population. Full text of the journal supplement can be accessed by visiting http://www.ajtmh.org/content/vol71/2_suppl/index.shtml.

http://www.nih.gov/