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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.
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.
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.
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 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.
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.
The World Health Organization (WHO) estimate 3.3 billion people are at risk of malaria, with 219 million cases and over half a million deaths annually. The Liverpool School of Tropical Medicine (LSTM) has applied new methods of research synthesis to malaria, and the results of this work have directly influenced important global decisions on malaria policies, including the adoption of new antimalarial drugs. In this case study, we report on the influence of the LSTM on malaria control over the last 15 years by preparing rigorous, up-to-date, timely systematic reviews on malaria. This work has also contributed to substantive improvements in the methodological rigor and transparency of the WHO malaria policy group in evidence-based policy formulation and guideline development.
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.
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.
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.