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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.
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 non-infectious to 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 [6] 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 lives.
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 malaria.
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.