19 ways to beat malaria

Celine Zegers de Beyl, monitoring and evaluation specialist,
Malaria Consortium, London, UK

Nets are still on top: Insecticide treated nets are still one of the most cost effective tools to prevent malaria with the potential to reduce up to 50% of cases, despite the growing threat of insecticide resistance.

Maintain awareness: In countries or areas in pre-elimination stage, such as Thailand or Cambodia, malaria is becoming uncommon. We have observed a decrease in the level of knowledge of the population, as well as healthcare professionals. This is a great concern if malaria is to be eliminated. Awareness needs to be maintained until the parasite is completely eliminated from the area.

Willis Akhwale, country director,
International Training and Educational Center for Health, Nairobi, Kenya, @AkhwaleWillis

Learn from history: Countries which eliminated malaria in the past used more than one strategy. Lucky for them at that time, the medicines were very effective and had no resistance. DDT was effective and environmental politics were non existent. Where we are today, it is unlikely that we have a silver bullet for malaria control.

Treatment is prevention: The more people have access to treatment with effective medicines the less the parasite prevalence. The issue therefore is access to healthcare services, hence health system strengthening is important.

Christopher Lourenco, adviser,
Clinton Health Access Initiative, Southampton, UK

Diagnosis and surveillance support prevention: Prevention methods, like long-lasting insecticide-treated nets (LLINs) and indoor residual spray are important. But by improving diagnosis and surveillance, the targeting of these prevention methods can be improved.

More drugs are needed: One major challenge is the use of mono-therapies available on the private market. I would urge for more international policy changes to crackdown on this. It could assist with the resistance issues. Resistance is a matter of time, and new treatment options would be a big help.

Matthew Todd, associate professor,
Open Source Malaria, Sydney, Australia,
@MatToddChem

Mass administration of drugs can work: If the medicines are safe, effective and inexpensive, mass administration can be very effective. My group came up with a drug that was amazingly effective in mass administration programmes for schistosomiasis. Every disease is different, but we have to look at that example and think, can’t we apply that in other areas?

We need more open source research: We need projects that target unexplored biology of the parasite, and how it behaves. And we need to share our research much more than we are currently doing by, for example, not patenting our discoveries.

Andrew Tatem, reader, University of Southampton, Southampton, UK, @AndyTatem

Don’t be complacent: We have made great progress in reducing malaria burden across the world over the past 15 years. But we have seen many examples throughout history where success in malaria control has meant funding is transferred to other health priorities, resulting in a resurgence to previous levels. We must think of malaria control as a long-term investment and not something that we can stop once numbers decline.

Know your enemy: When funding is limited, we should make best use of resources through understanding the local epidemiology of an area, both spatially and temporally to tailor interventions. There are at least two examples I know where malaria control programmes followed the general advice of mass net distribution, only to find out they had predominantly outdoor and daytime biting mosquitoes, meaning expensive reorganisation and wasted time and effort.

Haris Chandra Singh, Odisha region director,
Lepra Society, Bhubaneswar, India

Living conditions can prohibit net use: LLINs are ideal, but in some contexts such as tribal areas and slum locations use of mosquito nets is not convenient.

Kill the larvae: From our experience, killing larvae is most economical. This is possible with more awareness followed by community involvement.

Lawrence Barat, senior malaria adviser,
President’s Malaria Initiative, Washington DC, USA

Understand local context: Larviciding has not been shown to be effective in rural areas of Africa where every water-filled cattle hoof print (billions of them) is a potential breeding site for Anopheles gambiae (the predominant malaria vector in the region). The World Health Organisation indicates larviciding is only a strategy to be used in areas where such breeding sites are fixed, findable and few.

Beware of fake medicines: Poor quality and counterfeit drugs are a major threat to malaria control, particularly in those countries where most people seek treatment at private sector outlets.

Invest in diagnostics: At the programme level, particularly in Africa, changing clinicians’ practices is one of our greatest challenges. For 50 years, clinicians were taught to assume every fever was malaria. Aside from wasting drugs and missing the true cause of fever, this approach also promotes drug resistance. The advantage of rapid diagnostic tests (RDTs) is that a person can be trained to perform the test in a few hours and they can do it under a tree in a remote village.

Jorgen Stassijns, malaria and dengue adviser,
Médecins Sans Frontières (MSF), Brussels, Belgium

The hot spots need attention: As MSF, we’re working on malaria in a number of sub-Saharan countries such as the Democratic Republic of Congo, South Sudan, Niger and Central African Republic. Despite the fact that a package of effective, relatively cheap tools exist for prevention, diagnosis and treatment, these are not available for lots of people in areas where we work.

Take drug resistance seriously: The emerging resistance to artemisinin in south-east Asia and the possible spread of this to the rest of the continent and Africa, should be considered as a public health emergency and a threat to malaria control.

Christian Nsanzabana, scientific coordinator,
WorldWide Antimalarial Resistance Network, Oxford, UK

Include locals when designing education campaigns: Often a top-down approach is used in prevention campaigns without involving locals. You need to get the population understanding the strategies. You can’t get nice LLIN coverage if you don’t understand local culture. For example when I was working in Ivory Coast on a distribution campaign, changing the color of the net from white to blue increased use in some villages.

We need domestic funding: Sustainability is another problem, because funding - especially for African countries - mainly comes from international donors. We need to engage more national governments to increase domestic funding. This is crucial if we want to move to malaria elimination and eradication.

Read the full Q&A here.

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