Log in
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 lives.
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 downstream commercial 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 malaria parasite 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 low-cost, easy-to-use 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 an international audience.
Malaria in Africa, traditionally diagnosed from fever symptoms, has been massively overdiagnosed, and other causes of fever missed. This research demonstrated the magnitude of overdiagnosis, 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 [6] 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 manufacturers. Drawing on LSHTM research showing the importance of the private sector in supplying antimalarial 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 streams.
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, miltefosine was 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 therapies including 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.