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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.
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.
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.
Innovative research into the spatial ecology of vector-borne disease at the University of Oxford led to the setting up of the Malaria Atlas Project (MAP), a programme which has provided sophisticated models of malaria distribution to inform planning and policy decisions of national governments and international agencies. MAP data underpinned the 2012 World Health Organization World Malaria Report and has influenced WHO's policy on malaria. Mapping has also been used in planning and resource allocation by other key players in the fight against malaria: the African Leaders Malaria Alliance, the Roll Back Malaria partnership, the Global Fund and the Global Health Group. More recent research to map the global distribution of dengue risk has been used in vaccine planning by the GAVI Alliance in conjunction with the Gates Foundation.
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.
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.
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.
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.
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 countries.
Earth Surface Processes and Environmental Change (ESPEC) Research Group researchers have developed the Liverpool Malaria Model (LMM). When integrated with various short range and long term climate models as part of wider research into a complex cross cutting `grand challenge', the LMM helps decision makers understand when an area is likely to become at risk from malaria in short and over longer time frames by indicating which areas are likely to become centres for epidemics. The impact of the research has been to advance policy makers' awareness and understanding of this complex issue, enhancing their capacity to manage associated risks.