Malaria Control Debate

Sept. 9, 2014, 8:29 a.m.

What’s the best way to stop malaria? Is it to prevent the mosquito from transferring the parasite to people, or to treat the person who has the parasite in their blood? Logic suggests it’s more cost-effective to focus on the former, but in low-income countries even the cost of mosquito nets is a struggle when government budgets and aid won’t stretch to cover food and basic healthcare. The World Health Organisation’s (WHO) 2013 malaria report said that despite impressive gains against the disease, the expansion of interventions to keep mosquitoes away from human skin had slowed due to “a lack of funds to procure bed nets”.

Is the answer to fund more nets? Insecticide-treated nets (ITNs) are proven to reduce malaria deaths in children by one fifth and episodes of malaria by half, according to one Cochrane study. And long-lasting insecticide treated bed nets (LLINs) which last three years are funded by several large donors. But just supplying the nets is not enough. Messages on the importance of using them also need to be communicated, and there are issues around allergic reactions to the insecticide and ability to wash the nets.

Another prevention method is indoor residual spray (IRS), where homes are sprayed with insecticide to kill mosquitoes that land on the walls. This approach was reported to reduce malaria cases by 74% in one town in Ghana. But all of these tactics only apply to stopping mosquitoes from infecting people in the home, not when they are outdoors. Evidence that mosquitoes are developing a resistance to insecticide suggests it’s time to focus on other techniques.

On the treatment side, artemisinin-based combination therapies (ACTs) have been identified by WHO as the most effective treatment for malaria. The demand and the low yields from the sweet wormwood plant the drug comes from means the treatment is prohibitively expensive for many healthcare systems and is often hard to source in remote areas. The recent creation of a semi-synthetic artemisinin could bring down costs. As well as expense, another issue with ACTs is resistance to artemisinin,which has been documented in southeast Asia.

So, where should funders who want to contain malaria invest their money, on prevention or treatment? Is it time for new innovations in combating the disease to shine? Or to focus on better training and supplies for community healthcare workers to diagnose and treat the disease? Asmalaria endemicity (disease intensity) is declining, is it time for a new approach?

Join experts to debate these and other questions on Thursday 11 September, from 1-3pm BST.

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