CCOAT and IDDO/WWARN TDR post-doctoral fellow led malaria workshop

CCOAT and IDDO/WWARN TDR post-doctoral fellow Dr Daniel Yilma presented his latest malaria research at a recent workshop in Ethiopia. CCOAT’s Professor Karen Barnes presented on ‘Single low dose Primaquine for transmission blocking – to advance elimination’ and Professor Ric Price and Dr Kamala Ley-Thriemer, Menzies School of Health Research, discussed their work on ‘The Challenges in Plasmodium vivax malaria elimination’

Dr Daniel Yilma, pictured above, lead organizer of the workshop from Jimma Univeristy with National Malaria Program of Ministry of Health jointly organized a workshop that was supported by WHO/TDR on 15th November 2021 at Capital Hotel, Addis Ababa, Ethipoia on "“Safe and Effective Use of Antimalarial Treatment for Transmission Blockage and Radical Cure towards Malaria Elimination in Ethiopia: Evidences for Policy”

The main aim of the workshop is for evidence dissemination to strengthen the policy and guideline on safe and effective radical cure and transmission blocking antimalarial treatment implementation in Ethiopia. The workshop was also designed to create a platform for collaboration, scientific dialogue and linking malaria researchers with policy makers and implementers.

The scientific presentation started with two presentations on the impact of radical cure and transmission blocking treatment for malaria elimination at global and regional level and moderated by Dr. Samuel Girma, USAID/PMI. The Challenges in Plasmodium vivax malaria elimination was presented by Dr. Kamala Ley-Thriemer and Prof. Ric Price, Menzies school of health research and Single low dose Primaquine for transmission blocking – to advance elimination was presented by Prof. Karen Barnes,  University of Cape Town. Read full article for more information.

Reaching the unreachable with malaria treatment.

A special permit now allows specially trained malaria programme staff to treat malaria cases, advancing malaria elimination efforts by reaching more of those infected and treating them earlier.

South Africa has set the ambitious target of eliminating the local transmission of malaria by 2023. Currently local malaria transmission occurs along the north-eastern border regions of Limpopo, Mpumalanga and KwaZulu Natal provinces. A key step towards reducing the burden of malaria and advancing its elimination is the decision to permit Malaria Programme Environmental Health Practitioners (EHPs) to treat malaria cases. Up until now this has been the sole preserve of doctors and nurses.

Earlier this year the Director General approved a Section 22(A)15 application which permits malaria programme health workers on the ground (Environmental Health Practitioners, EHPs) to treat malaria cases and thus not only expand the number of professionals able to treat malaria, but also reach more of those infected and treat them earlier. Until now, malaria cases detected in the field were asked to go to the nearest health facility for treatment. However, many would go untreated as they were unable or unwilling to visit these health facilities. Travel costs were prohibitive, people did not appreciate the need for treatment as they were asymptomatic or, as undocumented migrants, they feared attending a public facility. COVID19-related concerns have further contributed to reluctance to seek malaria treatment promptly.

Delays in malaria treatment of even a few days can result in progression from uncomplicated to life-threatening severe malaria and increase malaria transmission in their community. This highlights the public health value of malaria treatment being provided in the field by EHPs, who are best placed to reach unreachable infections.

This intervention has been led by Professor Karen I Barnes, from the Division of Clinical Pharmacology and Founding Director of the UCT MRC Collaborating Centre for Optimising Antimalarial Therapy (CCOAT). She is co-chairs the South African Malaria Elimination Committee. The National Department of Health Directorate of Malaria, Vector- Borne and Zoonotic Diseases and the SAMEC Case Management sub-committee has been key in developing the application and progressing it through to signature by the Director-General. The Limpopo MEC for Health, Dr Phophi Ramathuba was the first to award her province’s malaria EHPs with training certificates, when she led the malaria team on door-to-door community rapid testing & treatment together with launch of indoor residual spraying season.

Most malaria programme EHPs have now been trained how to treat malaria, including the assessment of malaria disease severity, identifying those at higher risk of severe malaria and the appropriate use of first line treatment. UCT-accredited CPD certificates are being issued to those who have successfully completed this training. Pharmacists at selected hospitals who will be responsible for the weekly supply of patient-ready packs of artemether-lumefantrine to trained EHPs have also been trained. Thus, the malaria programmes are now poised to roll out EHP treatment of malaria cases detected during routine field surveys. 

This achievement, together with community health workers now being trained to perform malaria rapid diagnostic tests, will enable the malaria programme to reach most malaria infected individuals and significantly decrease the malaria parasite reservoir. These are key components for reducing the burden of malaria and advancing its elimination in South Africa.

Frank Kagoro and Professor Karen Barnes from CCOAT have published a new study with international colleagues highlighting the need for more rapid dissemination of molecular marker data to monitor artemisinin resistance

Study calls for rapid sharing of data to monitor artemisinin resistance.

A new study has highlighted the need for more rapid dissemination of molecular marker data to monitor artemisinin resistance. The paper, Mapping genetic markers of artemisinin resistance in Plasmodium falciparum malaria in Asia: a systematic review and spatiotemporal analysis, was published in the Lancet Microbe.

The study, conducted in Asia, aimed to develop up-to-date spatial distribution visualisations of the Kelch-13 (K13) markers of artemisinin resistance for policymakers to guide policy decisions. Researchers collated data from 72 studies published between 1 January 2010 and 31 March 2021, comprising K13 markers from 16,613 blood samples collected from 1991 to 2020 from 18 countries. Findings showed a steady increase in the prevalence of 'WHO-validated' K13 markers, reaching 62∙9 per cent in 2018. Overall, the prevalence of C580Y mutation increased from 48∙9 per cent in 2002 to 84∙9 per cent in 2018. Data showed that from 2002 to 2018, there has been a steady increase in geographic locations and the proportion of infected people with 'validated' artemisinin resistance markers.

Strength in standardisation: developing CDISC standards for malaria. “We are now at the forefront of developing a data standard for the malaria research community. The aim of this initiative is to support the efficient, scientifically valid, generation and reporting of malaria clinical data, and to conform to regulatory requirements for registration of new antimalarial compounds,” says Lesley Workman, Coordinator of the WWARN Pharmacology Group who is leading on the CDISC project. Read more

The malaria parasite is adept at developing drug resistance, with resistance to the artemisinin-based compounds that form the backbone of effective malaria treatment spreading rapidly across South East Asia and nearing the Indian border.” says Professor Karen Barnes.  Read a comprehensive article on Malaria in the SADC region and globally here

Evidence to inform equitable dosing in very young and malnourished children. Our research provides health workers and researchers with an improved definition of the day 7 lumefantrine concentration threshold, which will help them to understand if treatment failure is caused by drug resistant malaria parasites or by inadequate drug concentrations, " Professor Karen Barnes (UCT). Visit WWARN for more information

The World Health Organization has recommended the widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine among children in sub-Saharan Africa and in other regions with moderate to high malaria transmission.

Watch the video where Prof Karen Barnes Professor in the Department of Medicine: University of Cape Town and Co-Chair at the South Africa Malaria Elimination Committee and Prof Shabir Madhi, Professor of Vaccinology at Wits University discuss further.

First African antimalarial to enter clinical trial. “We need to debunk the myth that Africa cannot be a source of health innovation,” says Kelly Chibale, director of the Drug Discovery and Development Centre at the University of Cape Town, South Africa. Read the full article here