LSHTM researchers carried out the initial trials of intermittent
preventive treatment in infants (IPTi), a strategy to improve malaria
control in very young children. LSHTM staff were active in setting up and
running a dedicated research consortium which developed and executed a
research agenda to provide data to inform policy. School staff presented
evidence to a series of WHO policy-making meetings which in 2009
recommended that IPTi should be included as part of routine malaria
control. This policy, which has been adopted in one country and discussed
by eight others, has the potential to benefit hundreds of millions of
A comprehensive body of research into the effectiveness, cost and
distribution of long-lasting insecticidal nets (LLINs) by LSHTM has made a
major contribution to the reduction of malaria-related mortality between
2008 and 2013, especially among children in Africa. The research formed
the basis of a radically altered strategic approach to combating malaria
by WHO and other agencies, and led to the roll-out of malaria campaigns
based around LLINs in several African countries. LSHTM research into the
technology of LLINs, which also contributed to these developments, is
described in a separate case study.
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.
Twenty years of comprehensive research into long-lasting insecticidal
nets (LLINs) by LSHTM
have contributed substantially to the prevention of around 1m deaths from
malaria between 2008
and 2013. The research made a direct impact on guidelines and strategies
issued by WHO as well
as driving new technologies for insecticide-treated nets (ITNs), with
benefits. Without the evolution of LLIN technology driven by LSHTM
research, the large-scale roll-out
of the new generation of nets (described in more detail in the other LSHTM
impact case study
on this body of research) would not have been possible.
Work by LSHTM researchers has led to a greater understanding of Plasmodium
species and contributed new methodologies for diagnosis. As a result,
patients with the uncommon
species P. knowlesi and many hundreds with P. ovale spp.
have been correctly diagnosed by
polymerase chain reaction (PCR), and the rapid detection of parasite DNA
is revolutionising clinical
trial design. The work has led to the successful commercialisation of a
malaria testing kit for use in developing countries. Through media outputs
and further research, the
work has taken awareness of the issues surrounding malaria diagnostics to
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.
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.
Research carried out by LSHTM made a fundamental contribution to the
creation of the Affordable
Medicines Facility — malaria (AMFm), a financing mechanism initiated to
improve access to
effective antimalarials through subsidies and price negotiations with drug
on LSHTM research showing the importance of the private sector in
medicines, the scheme was proposed by the US Institute of Medicine (IOM)
and piloted in Kenya
and Tanzania. After its 2009 launch, a subsequent evaluation by LSHTM and
others using LSHTM
methodological innovations led to AMFm's integration into ongoing funding
Miltefosine is the first oral drug to be developed for the treatment of
leishmaniasis, a worldwide
parasitic infection with up to 12m cases. Also developed as a cancer drug,
identified and tested for leishmaniasis therapy at LSHTM and has been
added to WHO's essential
medicines list as a result of subsequent clinical trials. It has been
widely used for the treatment of
visceral leishmaniasis (VL) in India, Nepal and Bangladesh, and for the
cutaneous form of the
disease in Latin America. Phase III and IV clinical trials of combination
miltefosine have been carried out in India.
Multidisciplinary research at LSHTM has increased understanding of how
antimalarial drug resistance emerges and spreads, resulting in impacts on
national, regional and international policy-makers and donors, and
especially benefiting malaria patients and communities in Southeast Asia.
The research influenced (1) WHO recommendations on using
sulphadoxine-pyrimethamine for intermittent preventive treatment in Africa
and (2) policy responses to the threat of artemisinin resistance including
the WHO `Global Plan for Artemisinin Resistance Containment' (2011) and
the Thai-Cambodia Artemisinin Resistance Containment programme
(2009-2011). These efforts were associated with decreased malaria cases,
and reduction in availability of artemisinin monotherapies in Cambodia.