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.
Integrated Vector Management (IVM) was developed by the World Health
Organisation to control vector borne diseases using combinations of
interventions. Professor Steve Lindsay and his team have contributed to
the development and assessment of many of the tools used for vector
control, including insecticide-treated bed nets (ITNs), larval source
management and house screening for malaria control. This research has
influenced international policy on the control of malaria and other
important diseases. It is estimated that 294 million ITNs have been
purchased for malaria control, and have helped save 1.1 million lives over
the past decade.
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.
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 substantial programme of research carried out by LSHTM has provided
evidence for a major
shift of strategy and progress in global efforts to eliminate malaria. As
a result, WHO now
recommends a policy designed to ensure medically-treated individuals are
mosquitoes. In addition, drug development partnerships such as the
Medicines for Malaria Venture
now include transmission interruption in the target product profiles for
new medicines. Several
countries have made strategic decisions for the prevention of malaria
transmission on the basis of
the research, and the senior investigators act as advisers to
international anti-malaria initiatives.
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
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.
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
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.
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.