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.
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.
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 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.
Since 1997 University of Liverpool (UoL) investigators have led global
research into malarial retinopathy, the fundus features associated with
severe malaria. The work has propelled this phenomenon from little-known
curiosity to an essential component in the diagnosis of cerebral malaria
(CM) and has altered understanding of how CM causes coma and kills. It has
changed medical practice of those diagnosing one of the commonest fatal
diseases in tropical countries. Malarial retinopathy is now considered an
essential clinical feature of CM aiding the appropriate management of coma
in infants. This change in practice has expanded from African research
settings to clinical practice required by WHO guidelines and disseminated
in major clinical textbooks from 2008.
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
Malaria is endemic in more than 100 countries but its rapid and accurate
diagnosis in locations remote from clinical laboratory facilities remains
challenging yet desperately needed. This case study describes how
scientific discoveries made in the field of digital data storage have been
developed and applied to deliver a rapid, reliable and low cost malaria
diagnosis sensor suitable for field application. Diagnostic devices have
been both laboratory-tested and clinically trialled on over 900 patients
under adverse field conditions in malaria endemic countries with very
promising results. The health impact includes not only
significantly reducing unnecessary treatments but potentially saving
millions of lives.
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.
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
Research by the University of Oxford's Shoklo Malaria Research Unit
(SMRU), Mae Sot (Thailand), has had a significant impact on the health
outcomes of pregnant women and infants in malaria affected areas, with
findings leading to major changes in World Health Organization
recommendations for the prevention and treatment of malaria in pregnancy.
Its studies have established the optimum treatment regimes (using
artemisinin-based drugs) and have shown that early detection and treatment
of malaria, including asymptomatic infection, during pregnancy prevents
maternal mortality, morbidity, and improves the outcome of pregnancy.