By Ebrahim Adamjee
- Pregnancy reduces maternal immunity to malaria and other illnesses.
- Despite efforts, malaria remains a significant health challenge in Sub-Saharan Africa.
- Regular monitoring of antimalarial drug efficacy is needed to inform treatment policies in malaria-endemic countries.
For decades now, malaria has been a major public health threat, particularly in tropical and subtropical regions of the world.
According to the World Health Organization (WHO), there were an estimated 247 million cases of malaria worldwide in 2021, with the vast majority (95%) occurring in the Sub-Saharan African (SSA) region.
In the same year, there were an estimated 619,000 malaria deaths globally, with children under the age of 5 accounting for approximately 75% of all malaria deaths.
Despite proper awareness and public education that has been done in these countries, there continues to be many cases and avoidable deaths associated with this infectious disease.
Pregnancy reduces maternal immunity to malaria and other illnesses, making women more susceptible to infection and at greater risk of illness and severe anaemia, and consequently may result in the death of both the mother and the unborn child.
Further, maternal malaria also interferes with the growth of the fetus, increasing the risk of premature delivery and low birth weight – a leading cause of child death in SSA.
In 2020, the COVID-19 pandemic disrupted malaria prevention and control efforts. There were concerns that the gains made in reducing malaria cases and deaths could be reversed.
However, there has been notable progress in terms of the elimination of malaria over the last couple of decades. The most recent World Malaria Report indicated that 27 countries had less than 100 cases of malaria in 2020, up from 6 countries in 2000.
For more developed economies, significant improvements in their health systems and surveillance have helped minimize the impact of malaria, and most of them have achieved elimination.
Since 2015, 11 countries have been certified by the WHO Director-General as malaria-free, including the Maldives (2015), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018), Uzbekistan (2018), Argentina (2019), Algeria (2019), El Salvador (2021), China (2021), Azerbaijan (2023) and Tajikistan (2023).
Despite progress made in the past two decades, malaria remains a significant health challenge in SSA.
Nevertheless, there have been innovations in malaria treatment that have improved the effectiveness of drugs and reduced side effects.
Artemisinin-based combination therapies (ACTs) are the current recommended treatment for uncomplicated malaria, and they are highly effective in killing the Plasmodium parasite.
ACTs contain artemisinin, a fast-acting drug that rapidly reduces the number of parasites in the blood, with a longer-acting partner drug to eliminate any remaining parasites.
But, according to the WHO, in recent few years, partial artemisinin resistance has emerged as a threat to global malaria control efforts. Recent reports confirmed partial artemisinin resistance in Africa in Eritrea, Rwanda, and Uganda.
A robust strategy has been developed in partnership with National Malaria Programs to educate patients and the healthcare community on the importance of taking the full dose of treatment.
Further, next-generation non-artemisinin-based treatments are in development that kill the malaria parasite through different mechanisms.
Several malaria vaccines are in development, with some showing promising results in clinical trials. The RTS, S/AS01 vaccine has been shown to provide partial protection against malaria in young children in clinical trials, and the rollout has begun.
These innovations in malaria treatment are providing light at the end of the tunnel as they hold great promise for reducing the burden of malaria and improving the health outcomes of those infected and affected by the disease.
As the world marked World Malaria Day, attention was drawn to the impact of this parasitic disease, especially in Sub-Saharan Africa. Despite the efforts and advocacy, there is more work to be done.
Antimalarials, including pediatric antimalarials, have saved countless lives, yet infants under five kilograms are still neglected. Malaria vaccines are recommended for children above five months and there are no optimized treatments for babies under five kilograms.
Currently, babies are treated with tablets meant for children weighing more than five kilograms adjusted to weight. Yet, weight adjustment alone could lead to overdose and potential toxicity as small babies metabolize drugs differently.
It is against this backdrop that Novartis is working with Medicines for Malaria Venture (MMV) to develop a formulation optimized for infants under five kilograms, so they receive the right amount of treatment.
Closing the gap for these small infants is essential to malaria elimination and no child should die of malaria.
Looking to the future to see significant change, there is a need to mobilize the global malaria community to act now and fast. For this to be attained, relevant policies and regulatory guidelines from the health and government sectors must be adhered to promptly and effectively.
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Further, in keeping with the strategy to manage partial artemisinin resistance in Africa, regular monitoring of antimalarial drug efficacy is needed to inform treatment policies in malaria-endemic countries and to ensure early detection of, and response to drug resistance.
The writer is the Medical Affairs Head, Specialty Medicines & Programs, Novartis Sub-Saharan Africa.
