Research in West Africa by LSHTM and partners has shown that monthly
treatment with effective antimalarial drugs during the rainy season
provides children with a very high degree of personal protection against
malaria, can be delivered on a large scale by community health workers at
moderate cost, and with no serious side-effects. Based on this research,
WHO now recommends that children living in Sahel areas where malaria is a
major problem should receive such `seasonal malaria chemoprevention' (SMC)
with sulfadoxine-pyrimethamine plus amodiaquine. Ten countries have
incorporated SMC into their strategic plans for malaria control.
In spite of recent reductions in transmission, malaria continues to kill
over half a million people annually. To assist in fighting the global
burden of malaria, Kenya-based Oxford research team, the Malaria Public
Health Department (MPHD) has spent the past decade analysing malaria risk,
interventions, and control methods, to better define and target malaria.
This research has been used to inform local governments, the World Health
Organization (WHO), and international funding organisations about malaria
risk, interventions and control methods to better define and target
The University of Oxford's Professor Nick White and his colleagues
successfully demonstrated the effectiveness of artemisinin (an ancient
Chinese remedy) in the treatment of malaria. They also pioneered
artemisinin-combination therapy (ACT), the most effective and fast-acting
malaria treatment in the world. Responsible for saving hundreds of
thousands of lives every year, ACT was recommended by the World Health
Organization (WHO) in 2006 as the primary method of malarial treatment
globally. Malaria kills more than half a million and affects over 225
million people every year.
Malaria in Africa, traditionally diagnosed from fever symptoms, has been
and other causes of fever missed. This research demonstrated the magnitude
undertook trials of rapid diagnostic tests, identified alternative
bacterial diagnoses, completed
economic appraisals and studied prescriber behaviour. The research
underpinned a major change
in policy by WHO (2010), substantial investments by the Global Fund to
fight HIV, TB and Malaria
(GFATM), and changed clinical practice, to direct antimalarials to malaria
patients only. In one
country alone, 516,576 courses of inappropriate artemisinin-based
combination therapy (ACT)
were averted, worth in excess of $1m.
Malaria kills around 650,000 children a year but can be prevented by
killing the mosquito vectors. As mosquitoes become resistant to
insecticides the prevention measures can become ineffective. Research at
the Liverpool School of Tropical Medicine (LSTM) led by Professor
Hemingway FRS has been instrumental in the development of current World
Health Organisation (WHO) guidelines to manage resistance, and has led to
improved resistance diagnostics and novel monitoring software to integrate
entomological and human health outcomes. LSTM's research led to the
creation of the Innovative Vector Control Consortium (IVCC) which was
established as an independent Product Development Partnership (PDP) in
2008. New, longer lasting formulations of insecticides developed by IVCC
are now in operational use, and several novel public health insecticides
are under development.
Malaria in pregnancy causes the deaths of 200,000 newborns and 10,000
mothers annually. The Liverpool School of Tropical Medicine is the
coordinating centre of the global Malaria in Pregnancy Consortium.
LSTM-led research from 2007 has contributed to the World Health
Organisation's (WHO) estimates of the global burden of malaria in
pregnancy, showing that 125M pregnancies are at risk, more than double
previous estimates. The Consortium has also contributed to a better
understanding of the low uptake of existing interventions by pregnant
women, and identification of the best prevention strategies. Consequently,
WHO updated its policy recommendations in 2007on
intermittent-preventive-treatment for prevention of malaria in pregnancy,
adopted in 37 sub-Saharan countries, and in 2012, already adopted in 9
Researchers at the Mahidol-Oxford Research Unit (MORU) in Thailand
performed the first comparative trials to unambiguously show artemisinin
resistance in Plasmodium falciparum parasites in western Cambodia,
as well as its emergence on the Thailand-Myanmar border. These studies
emphasised the importance of urgent containment, leading to rapid
responses from the World Health Organization (WHO) and international
governments for the tracking and containment of drug-resistant malaria.
Innovative research into the spatial ecology of vector-borne disease at the University of Oxford led
to the setting up of the Malaria Atlas Project (MAP), a programme which has provided
sophisticated models of malaria distribution to inform planning and policy decisions of national
governments and international agencies. MAP data underpinned the 2012 World Health
Organization World Malaria Report and has influenced WHO's policy on malaria. Mapping has also
been used in planning and resource allocation by other key players in the fight against malaria: the
African Leaders Malaria Alliance, the Roll Back Malaria partnership, the Global Fund and the
Global Health Group. More recent research to map the global distribution of dengue risk has been
used in vaccine planning by the GAVI Alliance in conjunction with the Gates Foundation.
Impact on health and welfare: The malaria screening assay allows
early re-admittance of malaria-risk donors to blood donation programmes
whilst maintaining protection against transfusion-transmitted malaria.
Increasing the availability of safe blood for donation through use of the
malaria assay saves lives.
Impact on commerce: The malaria EIA is the front-line assay in at
least ten countries today. Almost 2.5 million tests have been sold in the
REF impact census period through a number of distributors, including
Bio-Rad worldwide, [text removed for publication].
Beneficiaries: Individuals requiring blood transfusions, national
blood transfusion services and hospitals; commercial companies marketing
the malaria EIA.
Significance and Reach: Over 700,000 assays are now performed per
year in the UK, France, Belgium, Portugal, Spain, Italy, Netherlands, New
Zealand and Australia. In the UK alone, more than 345,000 blood donations
from malaria-risk donors have been cleared for clinical use.
Attribution: All research was led by Dr Jana McBride, Dr David
Cavanagh, and Eleanor Riley, at the University of Edinburgh (UoE), except
output  which was an international consortium to which UoE contributed
recombinant malaria antigens and technical expertise.
The World Health Organization (WHO) estimate 3.3 billion people are at risk of malaria, with 219
million cases and over half a million deaths annually. The Liverpool School of Tropical Medicine
(LSTM) has applied new methods of research synthesis to malaria, and the results of this work
have directly influenced important global decisions on malaria policies, including the adoption of
new antimalarial drugs. In this case study, we report on the influence of the LSTM on malaria
control over the last 15 years by preparing rigorous, up-to-date, timely systematic reviews on
malaria. This work has also contributed to substantive improvements in the methodological rigor
and transparency of the WHO malaria policy group in evidence-based policy formulation and