insecticide-treated bed nets on sale; being retreated; and person sleeping under net.

From the CDC: Insecticide-treated bed nets (ITNs) are now a major intervention for malaria control.

Seven years ago, on April 25th, 2000, African leaders from 44 malaria-endemic countries participated in the first-ever African Summit on Malaria, and declared April 25th as Africa Malaria Day. This year, for the first time, the United States will officially commemorate Malaria Awareness Day, celebrating progress and highlighting opportunities in the fight against malaria. To underscore the U.S. commitment to ending malaria related deaths, President Bush embraced the urgency of the cause by designating April 25th, 2007 as Malaria Awareness Day.

Tom Egwang, the director-general of Medical Biotechnology Laboratories in Kampala, Uganda writes in SciDev.Net that Africa should be the driver, not the co-pilot of malaria vaccine development. He writes:

African researchers in resource-poor countries are as competent and knowledgeable as their Northern partners. They publish research articles in leading peer-review journals, present findings at international conferences, read the same literature and attend the same symposia.

So why aren’t they designing malaria vaccines themselves? The stock response to this — as it seems to be to all Africa’s development challenges — is a lack of funds. But putting pen to paper to design a vaccine does not cost money. It takes creativity and innovation — attributes that we on the continent surely possess.

Getting the policy emphasis right

Effective research and development (R&D) does, of course, need funding. But to say that the lack of malaria vaccine R&D in Africa is due to poverty is a lie.

African governments can afford to buy presidential jets and bail out floundering companies. They maintain huge defence budgets and engage in recurrent military adventurism. These actions cost the continent hundreds of millions of dollars — money that could instead be used to develop malaria vaccines.

Similarly, petrodollar profits from oil-rich states like Gabon, Libya or Nigeria could be used to support malaria R&D efforts within and beyond their own borders.

The European Union — a region that has no malaria — currently supports a multi-million dollar network of excellence in malaria research. These funds could, again, have been better spent supporting R&D efforts in Africa.

Misguided funding policies have been accompanied by lopsided training policies that have created a polarised malaria research world.
. . .
African scientists running R&D projects must make herculean efforts to mentor a new generation of Africans to tackle malaria vaccine R&D head-on. This also means lobbying their governments to invest in research — before the North-South divide becomes an abyss.

University curricula should emphasise product development and entrepreneurship. Strategic partnerships with African organisations like the Uganda Industrial Research Institute would facilitate the development of pilot biotechnology projects.

In this way, products developed by academia could be scaled up on a semi-industrial scale for proof-of-concept studies.

African policymakers have hitherto only paid lip service to African science. They must now embrace it as the engine for socio-economic development in Africa, giving it unequivocal and solid financial support.

Transgenenic mosquito larvae (left and right)
have an antiparasitic protein (green)
that wild insects (middle) lack.

© J. Ito and A. Ghosh

Scientists have developed genetically modified mosquitoes that are unable to transmit malaria. This shows real potential for eliminating malaria bearing mosquitoes, and eliminating malaria, without the use of poisonous insecticides

Scientists believe that genetically modified (GM) mosquitoes could become the latest method of targeting the spread of the deadly disease malaria.

The GM strain of malaria-resistant mosquitoes outcompete their natural counterparts when fed malaria-infected blood, researchers from the John Hopkins University in Baltimore claim.

As such they believe that introducing GM mosquitoes (transgenic) into the environment could help to eventually replace natural mosquitoes.

There are still a number of questions and controversies to be addressed before releasing gm mosquitoes into the wild, but this has huge potential for positive impact on the health and economy of many countries around the world, including Ghana.

Researchers led by Marcelo Jacobs-Lorena at the Malaria Research Institute at Johns Hopkins University in Maryland created genetically modified mosquitoes by giving them a gene that made it impossible for them to pass on the plasmodium parasite that causes malaria.
. . .
Over time, the researchers found that the GM mosquitoes slowly became the majority, reaching 70% in nine generations.
. . .
The finding was hailed as welcome proof that GM mosquitoes, made with cheap laboratory techniques, could ultimately have a greater impact on malaria than chemical sprays and other treatments.
. . .
Trials in sub-Saharan Africa, where malaria claims the life of a child every 30 seconds, could be conducted within five years, but scientists will first have to prove as far as possible that the resistance genes will not trigger a more aggressive form of malaria, or spread to other insects.

At a glance

Malaria kills more than 1 million people a year

90% of malaria deaths occur among young children in sub-Saharan Africa

The disease costs Africa $12bn (£6.2bn) in lost GDP and consumes 40% of public health spending

60% of malaria deaths strike the poorest 20% of the global population

71% of all deaths from malaria are in the under-fives

Children can die within 48 hours after the first symptoms appear

Dr. Anarfi Asamoa-Baah of Ghana has just been appointed Deputy Director General of the World Health Organization, WHO. The post has been open since 1993. He was appointed by WHO Director Dr. Margaret Chan, who has promised to make the health of Africans one of her top priorities. Dr. Asamoa-Baah has extensive experience in public health.

Dr. Asamoa-Baah qualified as a Medical Doctor from the Ghana Medical School in 1984 and practised at the Offinso Government Hospital in the Ashanti Region.

He pursued further studies in the UK where he obtained post-graduate qualifications in Community Health Planning, Health Economics and Health Policy Analysis.

Dr. Asamoa-Baah returned home to work with the Ministry, when he was appointed Acting Director of newly created Policy Planning, Monitoring and Evaluation Division.

Dr. Asamoa-Baah joined the WHO in 1998.

Before his appointment, he coordinated the U.N. health agency’s efforts against HIV/AIDS, tuberculosis and malaria — a high-profile role as the Geneva-based body stepped up its fight in recent years against these deadly diseases.

Cycle of malaria infection. Plasmodium parasites can reproduce inside the Anopheles mosquito and be transmitted to people through mosquito bites. In people, the parasites can multiply in the liver and in the red blood cells.

The malaria vaccine currently in clinical trials in Ghana is likely to be ready for general release in 2011. From the Accra Mail:

Dr. Seth Owusu Agyei, Director of Kintampo Health Research Centre (KHRC) in the Brong Ahafo Region has stated that he is very hopeful that by the year 2011, the centre would have come out with a malaria vaccine RTS,S, which is currently going through clinical trials, for use in Ghana and across Africa to control malaria.
. . .

Ghana, Kenya, Gambia, Mozambique, Tanzania and Senegal are the six African countries currently taking part in the phase two trials of the vaccine.

He said that Kintampo Health Research Centre and the Kumasi Center for Collaborative Research at Agogo in the Ashanti Region, were conducting the trials on 540 children aged between five and 17 months, and it would last for 20 months.
. . .

He explained, on the average, children in the district between the ages of 6 months to five years get six to seven malaria attacks in a year.

Again on the average, an individual gets about 270 affective bites from mosquitoes.
. . .

He said malaria causes about twenty thousand deaths worldwide; and hopefully with the introduction of the malaria vaccine ten thousand deaths could be prevented.

Dr Owusu-Agyei stressed that, if the trials prove successful after further scientific research, it was expected that by 2011, the RTS,S would be available for use in Ghana and across Africa.

Depending on the success of the current phase two of the clinical trials, the trials will be expanded to phase three in 2008. Phase two emphasizes safety, phase three emphasizes efficacy. And then by 2011, providing the trials go well, the vaccine could become generally available. The challenge will be meeting the cost and providing the funding, to make the vaccine generally available to all those who need it.

For a vivid account of the effects of malaria, and to understand more of why it is so devastating to individuals and communities, see the description of a malaria attack written by Ryszard Kapuscinski, and posted here.

A malaria vaccine is gradually being introduced in Ghana. This is very good news, malaria is devasting to the health and wellbeing of the individual and the community. As the German Press Agency reports:

Malaria affects between 300 and 350 million people – with around one million deaths a year in Africa. Economic loss because of malaria in the world is estimated at 12 billion dollars annually.

In Ghana, about 22 per cent of deaths in children under five, and about 44 per cent of all out-patient department attendances in hospitals, are caused by malaria.

The health ministry points out that the total cost of treating malaria by the individual, household, employers and government is about one-third of the health budget.

So although malaria is a preventable disease, it still accounts for one of the major contributions to poverty plaguing Africa, thereby slowing progress in development.
. . .
The refreshing news is that a version of the vaccine tested on 100 adult volunteers in the United States and 85 adults in Kenya has been found to be safe.

It has already been administered on about 2,000 children aged one to four years in Mozambique. Its results showed that 18 months after the children were vaccinated, the risk of getting malaria was reduced by one third, and the risk of severe malaria by about one half.

The results also showed that the protective effect of the malaria vaccine did not wane 24 months after the vaccine was administered.

For insight into the devasting effects of the disease, see the description of a malaria attack written by Ryszard Kapuscinski, and posted here.

Malaria is a huge impediment to productivity and development wherever it strikes. That is one reason it is particularly agreeable to see the recent initiatives to reduce and eradicate malaria, and reason to pray that they be successful, in Ghana, and in all other countries.

The Polish journalist Ryszard Kapuscinski has spent much time in many of the countries of Africa and is very fond of the people and the continent. One of his books, Shadow of the Sun, is a collection of essays about different places, people and events he has visited, met, and witnessed throughout the continent. He has suffered from malaria more than once, and provides one of the most vivid written descriptions of the disease. In a chapter he calls “Inside the Mountain of Ice” he writes about the onset of malaria. For those who have never suffered a malaria attack, this provides insight on why it is so devastating.

The first signal of an imminent malaria attack is a feeling of anxiety, which comes on suddenly and for no clear reason. Something has happened to you, something bad. If you believe in spirits, you know what it is: someone has pronounced a curse, and an evil spirit has entered you, disabling you and rooting you to the ground. Hence the dullness, the weakness, the heaviness that comes over you. Everything is irritating. First and foremost, the light; you hate the light. And others are irritating – their loud voices, their revolting smell, their rough touch.

But you don’t have a lot of time for these repugnances and loathings. For the attack arrives quickly, sometimes quite abruptly, with few preliminaries. It is a sudden, violent onset of cold. A polar, arctic cold. Someone has taken you, naked, toasted in the hellish heat of the Sahel and the Sahara, and thrown you straight into the icy highlands of Greenland or Spitsbergen, amid the snows, winds, and blizzards. What a shock! You feel the cold in a split second, a terrifying, piercing, ghastly cold. You begin to tremble, to quake, to thrash about. You immediately recognize, however, that this is not a trembling you are familiar with from earlier experiences – say, when you caught cold one winter in a frost; these tremors and convulsions tossing you around are of a kind that at any moment now will tear you to shreds. Trying to save yourself, you begin to beg for help.

What can bring relief? The only thing that really helps is if someone covers you. But not simply throws a blanket or quilt over you. This thing you are being covered with must crush you with its weight, squeeze you, flatten you. You dream of being pulverized. You desperately long for a steamroller to pass over you.

I once had a powerful malaria attack in a poor village, where there weren’t any heavy coverings. The villagers placed the lid from some kind of wooden chest on top of me and then patiently sat on it, waiting for the worst tremors to pass. The most wretched are those who have a malaria attack and there is nothing to wrap them in. You can see them by the roadsides, in the bush, or in clay huts, lying semicomatose on the ground, drenched in sweat, confused, their bodies rent by rhythmic waves of malarial convulsions. But even snuggled under a dozen blankets, jackets, and coats, your teeth chatter and you moan with pain, because you sense that this cold does not come from without – it’s forty degrees Celsius out there! – but that it’s within, inside you, that these Greenlands, and Spitsbergens are in you, that all those floes, sheets, and mountains of ice are advancing through your veins, muscles, and bones. Perhaps this thought would fill you with fear – were you able to summon the strength to feel anything at all. But the thought occurs just as the peak of the attack, after several hours, is gradually subsiding, and you start a helpless descent into a state of extreme exhaustion and weakness.

The malaria attack is not merely painful, but like every pain also a mystical experience . . . But this moment of discovery, too, passes, and the spirits desert us, depart, and disappear, and that which remains, under the mountain of the most bizarre coverings, is truly painful.

A man right after a strong attack of malaria is a human rag. He lies in a puddle of sweat, he is still feverish, and he can move neither hand nor foot. Everything hurts; he is dizzy and nauseous. He is exhausted, weak, limp. Carried by someone else he gives the impression of having no bones or muscles. And many days must pass before he can get up on his feet again.

Each year in Africa malaria afflicts tens of millions of people, and in those areas where it is most prevalent – in wet, low-lying, marshy regions – it kills one child out of three.

(Shadow of the Sun p.54-56, ISBN: 0-676-97374-4)

The US President has just named Ghana as one of the countries that will receive part of a US 1.2 billion dollar malaria initiative focused on 15 countries.

Accra, Dec. 15, GNA
. . .
Ms Sue K. Brown, Charge d’Affaires of the U.S Mission to Ghana, who briefed the media in Ghana on a White House Summit on malaria, said the initiative called for an ambitious public-private effort to strengthen and expand malaria control efforts in Africa.

The initiative ensures the provision of new effective drugs to rural clinics, at least two doses of medicine for pregnant women to protect themselves and their unborn babies.

It also provides distribution of long lasting insecticide-treated bed nets that prevent mosquito bites and the availability of insecticides to spray on the inside walls of homes to kill mosquitoes that transmit the disease.

She said the initiative since 2005 had reached and saved more than six million people in Angola, Tanzania and Uganda and a series of proven programmes would be launched in other countries to prevent millions of deaths.
. . .
Major Courage Quashigah (rtd) Minister of Health) said Ghana was likely to spend more than 500 million dollars a year in the prevention of malaria.

He noted that malaria was an enemy to human health and impeded economic development considering the huge amount of money spent annually on it.

This is wonderful news. I hope the money is truly forthcoming, and is spent effectively.

For three years there has been no wild polio virus in Ghana. The World Health Organization certifies Ghana as polio free. This is due to an aggressive and comprehensive immunization program. Ghana will have to remain vigilant, as there is still polio that can come across her borders. Three years polio free is mark of pride and achievement, but immunization and vigilance must continue. It is nice to see that the immunization program is accompanied by distribution of insecticide treated nets that help prevent malaria.

Accra, Nov. 9, GNA – Ghana has succeeded in recording no wild polio virus for three-continuous years, a sign of successful eradiation of polio, Dr Kwadwo Antwi-Agyei, Programme Manager of the Expanded Immunisation Programme of the Ghana Health Service, said on Thursday. Speaking to the Ghana News Agency (GNA) in an interview in Accra Dr Antwi-Agyei explained that Ghana, since September 2003 recorded no virus and the only way to maintain a polio-free state was to ensure high immunity levels for children under-five years.
. . .
“Though we will be certified as polio-free, we will still stand at risk once our neighbour Nigeria had more than 500 cases in 2005 and about 847 cases as at October 3, 2006; we have to intensify our high immunity levels and be alert on our borders.”

Dr Antwi-Agyei said though measles was still the leading cause of illness among the vaccine preventive diseases for children under-five years, no death had been recorded for the past two years.
. . .
The (immunization) exercise, which started on November 1 and ended on November 5, combined measles and polio immunisation, administering of vitamin A and distribution of 2.1 million free Insecticide Treated Nets (ITNs) to children less than two years.

After decades of complacency, world health groups are launching an unprecedented assault on the scourge of malaria, but much work remains to be done.
. . .

Long overlooked in the age of the AIDS epidemic, malaria sickens more than 300 million people each year and kills more than 1 million. It also exacts a heavy economic toll. The World Health Organization estimates that the disease costs Africa, which sees 80 percent of the world`s cases, an estimated $12 billion per year in lost income.

Even those who are not killed experience lifelong effects, especially pregnant women and children. Malaria during pregnancy can result in miscarriage and low birth weight, and children who get the disease can grow up with slowed cognitive development.

‘The real tragedy,’ Bilimoria said, ‘is the disease is preventable and curable.’
. . .
And despite the new commitments, there is still a large funding gap, Riggs said. WHO estimates that $4.2 billion per year is needed to scale-up malaria support to reach international targets — far more than the current funding available.

Malaria is one of the biggest killers, and general health threats in Ghana, where it kills around 40,000 people per year. It is a huge health threat in many other countries around Africa and around the world. Researchers in Uganda may have found new information which could lead to a vaccine.

A LANDMARK study by Karolinska Institutet in Sweden and Makerere University has indicated that it might soon be possible to develop a malaria vaccine.
. . .
“For some reason, women in their first pregnancy lose the semi-immunity that is normally found in adults,” said Niloofar Rasti, a KI graduate student who has been working on the study. “The placenta seems to be an anatomically favourable environment for a subpopulation of the parasites.”
. . .
Adults who have been infected several times can become partly immune as their defence system gradually starts to recognise the parasite’s proteins. When the placenta is formed, however, a new environment is introduced with a different set of receptors.

This means that a new growth niche is made available to a subpopulation of the parasites. Earlier studies had suggested that each protein from the parasite attaches to only one specific protein, a receptor, in the placenta.

“Most of the parasites we studied could bind to three different receptors in the placenta,” one of the researchers Niloofar Rasti said.

“This would mean that a future vaccine cannot be based on the principle of one protein-one receptor, as was previously believed.”

The Monitor (Kampala)
September 5, 2006
by Peter Nyanzi