…Must work at
community level to control disease
Recently, the
International Center for Journalists (ICFJ) and Malaria No More programme selected some journalists to participate in “Covering the Fight to
Eradicate Malaria: A Fellowship for U.S. and International Journalists, ” in
Thailand and Cambodia. Among the nine
journalists who were selected, eight of them that participated to tour the two countries returned enthused with the
on-going multi-level malaria research and development to ensure innovation and
fight drug-resistance parasite. The journey took them to key research centres,
clinics in both countries and as far asThai-Myanmar border to visit the Shoklo
Malaria Research Unit (SMRU) clinic. CHIOMA UMEHA, (HEALTH EDITOR, NEWSWATCH
TIMES), who represented African journalists in the premier fellowship, reports
that African countries, especially Nigeria is behind the global race to
eradicate malaria in view of on-going research in the two countries.
Many know that Thailand is a
dominant exporter of rice in the world. However, only few may be privy to the
Malaria Control Programme going on there. Also, not many are aware that the
country is at the centre of global efforts to prevent the loss of the best
anti-malaria drug currently available which is Artemisinin-based Combination
Therapy (ACT).
Similarly, many may not know about the effort of the Asian country in
containing artemisinin resistance along the Thai-Cambodia and Thai-Myanmar
borders.
But, eight journalists who were
sponsored by the International Center for
Journalists(ICFJ) and Malaria No More programme
to participate in “Covering the Fight to Eradicate Malaria: A Fellowship
for U.S. and International Journalists,” in Cambodia and Thailand were
privileged to obtain first-hand experience
of the malaria research activities in these areas. The Journalists, who just
returned from their visits to the two countries, said they discovered what
could pass on as a ‘model’ in malaria research and development, to provide
innovation and combat drug resistance.
From connecting with top researchers, government officials and small business leaders to studying cross-border migration and disease control issues, the six-day fellowship in Thailand and Cambodia showed a broader context of the barriers to malaria eradication and the threat of drug-resistant malaria.
From connecting with top researchers, government officials and small business leaders to studying cross-border migration and disease control issues, the six-day fellowship in Thailand and Cambodia showed a broader context of the barriers to malaria eradication and the threat of drug-resistant malaria.
The programme included visits to
clinics, meeting doctors, patients and staff at the Shoklo Malaria Research
Unit (SMRU); Armed Forces Research Institute of Medical Sciences (AFRIMS)
clinic location in Mae Sot town; office of the Bureau of Vector-Borne Disease
(BVBD) and AFRIMS Library, Bangkok, Thailand.
Others were visits to Phonm Penh,
Cambodia to first Public Private Mix (PPM) provider; Memot Plantation, Memot
District, TbongKhmom; PPM providers PonheaKrek and Soung Districts, TbongKhmom
province, Cambodia among others.
What they saw confirmed that there
are many missing gaps which account for the challenge in malaria control,
especially in Africa countries such as Nigeria that is endemic of the disease.
Malaria is a preventable and curable
disease, yet in 2013, the World Health Organization (WHO) estimated that the
disease killed more than 580,000 people.
Nearly half the world’s population
is at risk of malaria. Most deaths occur among children under the age of five
living in sub-Saharan Africa.
Lack of access to quality
artemisinin-based combination therapy (ACT) to treat malaria is increasing
around the world, but its misuse, together with the use of cheaper, ineffective
drugs can lead to dangerous drug resistance. Spread of resistance could
jeopardize the efficacy of ACT, which is the best treatment currently
available.
Also, misdiagnosis of fever can lead
to misuse of ACT, which contributes to increasing drug resistance, as well as
avoidable deaths from pneumonia and diarrheal disease. Fever case management is
thus becoming increasingly important.
Artemisinin is one of the most
effective drugs against malaria; its use in combination with other therapies
has led to a revolution in malaria control globally.
Giving his presentation titled:
“Introduction & Overview in Fighting the World’s Oldest Disease,” Professor
Arjen Dondorp, Head of Malaria & Director of Mahidol-Oxford Tropical
Medicine Research Unit (MORU) identified
five human Plasmodium (P) species are:
P. falciparum, P. vivax, P. malariae, P. ovale and P. knowlesi.
At Shoklo Malaria Research Unit
(SMRU), MORU Units, journalists were exposed to wide range of new malaria research projects
geared to ensuring: Elimination of artemisinin resistant P. falciparum and
elimination of P. vivax and studies on malaria vectors and the hypnozoites of
P. vivax.
The Wellcome Trust – Mahidol
University – Oxford Tropical Medicine Research Programme, also known as the
Wellcome Trust Thailand Major Overseas Programme (MOP), was founded in 1979 as
a collaboration between Mahidol University’s Faculty of Tropical Medicine, the
Nuffield Department of Medicine in Oxford, and the Wellcome Trust.
Following sustained support from the
Wellcome Trust, the programme has grown considerably in reach and capability,
with the creation of the Shoklo Malaria Research Unit (SMRU) on the
Thai-Myanmar border in 1986.
Commenting on the extent of research
advancement at SMRU, Dondorp said: “We have conducted over 50 clinical trials
involving over 15,000 patients making SMRU the world largest single centre by
the number of patients recruited; pioneered the development of artemisinin
combination therapies (ACTs) and studied the next generation of antimalarials.
Gilles Demas, Director of the
Malaria Elimination Programme, guided the eight journalists, including,
ICFJ/Malaria No More staff, the Programme Manager, Lyndsey Wajert, Global
Communications Manager, Dena Gudaitis and Jeff Doyle in two groups round the
SMRU laboratory.
During the tour, Demas, Director of
the Malaria Elimination Programme, detailed how the laboratory which now
possess a fully functioning insectary hosts two anopheles colonies transmitting
P. vivax and P.falciparum. P. vivax sporozoites are produced for in-vitro
studies of liver stages.
Demas further explained that the
laboratory is presently collaborating with entomologists to identify the main
vectors on the Thai-Myanmar border as part of the malaria elimination studies.
According to him, the malaria
in-vitro laboratory has successfully adapted the culture systems to the flow
cytometry, the microscopy laboratory and the study of new diagnostic tools.
Similarly, the Director of the
Malaria Elimination Programme added: “The microbiology laboratory provides a
range of tests for diagnostic, surveillance and research purposes”.
The various tests, he said include:
Microscopy, culture, antibiotic susceptibility testing, and immunological based
assays and molecular assays.
Specifically, Gilles said that the
lab carries out influenza surveillance (funded by the Centre for Disease and
Control (CDC), Dengue diagnostics and antenatal urine screening.
“More recently, molecular
diagnostics for tuberculosis diagnosis has been implemented that also enables
rapid detection of rifampicin resistance,” he added.
Briefing journalists, Prof Francois
Nosten, Director of the SMRU, said that the unit has performed many treatment
trials and pharmacokinetics studies of antimalarials in pregnancies which were
published in literature.
Nosten who also said that the unit
has studied large numbers of isolates of P. falciparum and P. vivaxinvitro.,
described in details the epidemiology of malaria in this area.
He gave a quick historical
background of drug development which began with Chloroquine in the late 50s. He
said Fansidar was developed to replace Chloriquine before the introduction of
Mefloquinein 1985. Following rising cases of malaria and failure in treatment
with available drugs, Artesunate (INN), part of the Artemisinin group of drugs
was developed and its use began in 1991.
The SMRU Director noted that there was an
official declaration of Artemisinin-based combination therapy (ACTs) use across
the world in 2006, adding that this led to a global shortfall of malaria, for
example in Greater Mekong Sub region (GMS) Thailand, where few cases were
recorded.
Lamenting, he said malaria parasite
is becoming increasingly resistant to ACTs and stressed: “Our concern is that
the story is repeating itself; eight years, nothing has been done. While this
is going on in Cambodia, it is knocking on the door of India; it will progress
to Africa and it will result in millions of death.”
Still bemoaning, Nosten said: “We
have failed to communicate this global emergency to the world; we failed to
raise the concern. If we show people dying of ‘Ebola,’ people are scared; with
malaria, this is not so, people are not in the clinic, those parasites are
hiding.”
Raising alarm over a re-emergence,
SMRU Director said: “We are in a race against the parasite. Those parasites are
evolving and make themselves resistant, one day, they will re-emerge. If that
happens, that will be catastrophic.”
Reacting to the lessons which
Nigeria can derive from the research efforts in the two Asian countries, he
regretted that Africa is behind in the race against malaria parasites. He
also recommended for a study of next generation drugs, while urging Nigeria to
start working at the community level to achieve malaria control, insisting that
nothing is going to come out of the Ministry of Health.
He maintained:
“We have to start working with Civil Society Organisations (CSOs) and warned;
“Don’t wait for government.” According to him, 90 per cent international
assistance evaporates following over-dependence on government to champion
malaria control cause, especially in African countries like Nigeria.
To forestall what
he declared as a public health emergency, Director of the SMRU, stressed: “We
must eliminate (falciparum) malaria quickly before it becomes untreatable. This
implies also attacking the asymptomatic parasite reservoir. We urgently need new antimalarial drugs; till
then, we will have to be creative with what we have: Targeting ACT drugs
(TACT).
This story was published in Newswatch Times on November 26, 2015.
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