Improving malaria treatment

"WHO (World Health Organization) is releasing the first ever guidance on procuring safe and efficient anti-malarial medicines. The guidelines will help countries select and obtain effective, good quality medicines and save lives by improving the way patients are diagnosed and treated" (WHO).

New guidelines recommend "the use of diagnostic tests and a new artemisinin-based combination therapy". Robert Newman, "director of the WHO global malaria" program, said "It is time to move away from the idea that everyone with a fever is suspected to have malaria" (Bernama).

Tests to determine whether or not malaria is the febrile culprit are necessary to prevent further drug-resistant malaria from developing. However, reliable tests are expensive and unavailable in rural villages, where they are most needed. "The WHO. . . recommended the rural health clinics, where microscopes are often unavailable, use Rapid Diagnostic Tests because they are easy for community health workers to handle" (Bernama).

"Each year there are 250 million cases of malaria and 860,000 deaths as a result. Approximately 85 percent of the deaths are children" (Bernama).

Malaria treatment guidelines: http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html

Bernama. "WHO releases new malaria treatment guidelines." 10 March 2010. http://www.bernama.com/bernama/v5/newsworld.php?id=481148

WHO. "Improving malaria diagnosis and treatment." 09 March 2010. http://www.who.int/en/

Drug-resistant malaria

"In a dusty village near the Thai-Cambodia border, 24-year-old Oeur Samoeun sits on a dark green hammock recovering from a strain of malaria that has resisted the most powerful drugs available. . . Ravaged by days of fever and chills, he is considered lucky: the parasite has left his body. But for many others, the potentially deadly disease never quite disappears."

Pailin province, where Samoeun lives, is the unwitting nursery of drug-resistant malaria. It "is the epicenter of strains of malaria that have baffled healthcare experts worldwide, raising fears a dangerous new form of malaria could already be spreading across the globe."

Last year, a study published by the New England Journal of Medicine "showed that conventional malaria-fighting treatments derived from artemisinin took almost twice as long to clear the parasites that cause the disease in patients in Pailin and others in northwestern Thailand, suggesting the drugs were losing potency in the area." USAID, a U.S. development agency, agrees that traditional arteminsinin-based therapies are "now taking two to three times longer to kill malaria parasites along the Thai-Cambodian border than elsewhere."

Three drug-resistant malaria parasites have emerged from this province over the past five decades. "Thanks to prolonged civil conflict, dense jungles and movement of mass migrants in the gem mines in the 1980s and 90s, the strains multiplied and dispersed through Myanmar, India and two eventually reached Africa."

"Few can say why it is a hotbed for drug-resistant malaria", but experts point to "a combination of sociological factors and a complicated history spanning the Khmer Rouge era when 1.7 million people, nearly a quarter of Cambodia's population, perished from execution, overwork or torture during their 1975-79 rule."

Insurgents clung to Pailin, and it was "one of their last holdouts" before their defeat in the late 1990s. During the era of the Khmer Rouge, people resided in Pailin illegally. When they contracted malaria, they bought medication through black markets and self-medicated.

Self-medication was the only way to curb the rising number of malaria cases, so Cambodia made the decision to make anti-malarial drugs available over the counter. "The strategy carried risks. Easy access reduced the number of cases but also led to incorrect dosages and substandard or counterfeit medicine". Instead of eradicating the malaria parasites, over-the-counter treatments made the parasitic population stronger against widely used medications.

Without adequate drugs to combat the disease, drug-resistant malaria parasites threaten the world. Preventative measures, such as the use of bed-nets to avoid mosquito bites, may be our best defense against malaria. Donate a bed net through Nothing But Nets.

Source:
Win, Thin Lei. Reuters. "Cambodia drug-resistant malaria stirs health fears." 6 March 2010.

Malaria enters the US

"Nearly a dozen cases of Malaria has been confirmed here in the United States. All of the cases were acquired in Haiti after the January 12th, 2010 earthquake" (Gibbons). "Seven emergency responders, three Haitian residents now in the United States and one American traveler are known to have caught malaria in Haiti after the Jan. 12 earthquake, United States health officials said Thursday. Malaria is endemic throughout Haiti, so Haitians now living outdoors and relief workers are 'at substantial risk for the disease,' the Centers for Disease Control and Prevention said" (McNeil).

"Haiti already had a problem with malaria, which is spread by mosquitoes that will have more places to breed in the cities and towns wrecked by the giant quake" (Reuters). Displaced people living in temporary shelters our outdoors are at substantial risk of contracting malaria. Health workers who flooded to Haiti after the earthquake to offer aid are also at risk. "U.S. health officials advise people travelling to Haiti should take medications to prevent malaria" (UPI).

"Six out of eight patients, including seven emergency responders, had been advised to take drugs to prevent malaria but had not done so, the PAHO experts said." Three of the cases that the CDC cited "occurred among Haitian residents traveling to the United States and one case involved a U.S. resident who was visiting Haiti. All are expected to recover fully" (Reuters).

Individuals in Haiti are still at risk. "Each year, Haiti reports about 30,000 confirmed cases of malaria to the Pan American Health Organization, but the CDC estimates as many as 200,000 may occur each year. According to the CDC, malaria transmission peaks after the two rainy seasons -- November to January and again during May to June" (Reuters). The peak season is still months away, but anti-malarial medications are already needed to treat those who are infected and reduce the number of possible cases.

"There is no vaccine against the parasite that causes the illness[,] and it quickly evolves resistance against drugs"; however some drugs are known to treat and reduce malaria illness (Reuters).

The CDC indicates that "anyone traveling to Haiti should take drugs to help prevent infection" (Reuters).


Sources:
Gibbons, Sabrina. WSB News. "Malaria from Haiti Now in US." 4 March 2010.

McNeil, Donald G Jr. The New York Times. "U.S. Warns of Malaria Risk in Haiti". 4 March 2010.

Reuters. "Travelers from Haiti bringing Malaria to the US." 4 March 2010.

UPI. "Malaria Drugs for those going to Haiti." 4 March 2010.

Battling malaria

"Scientists battling malaria have earned a major victory", according to a Nature Genetics study. "Combating malaria resistance is nothing short of an arms race," says author and pediatrics professor, Dr. Philip Awadalla, from the Universite de Montreal. "As the malaria pathogen evolves, researchers must evolve with it to find ways to counter the disease."

Every year approximately 250 million people contract malaria. "Malaria is transmitted when people are bitten by infected mosquitoes. According to the World Health Organization, malaria symptoms include fever, headaches, vomiting and appear within 10 to 15 days after an infected mosquito bite." If left "untreated, malaria can be life-threatening" and may kill "an estimated five million people yearly." At the current level of malaria treatment one million people die annually, and most of those who die are young children.

The team at Universite de Montreal is deciphering the deadly parasite in an effort to eradicate the disease. This "international group of researchers has used genomics [study of organisms' genomes] to decode the blueprint of Plasmodium falciparum -- a strain of malaria most resistant to drugs that causes the most deaths around the world. The discovery may lead to advanced pharmaceuticals to fight the disease and prevent drug resistance".


"The team decoded 200 malaria samples from Asia, Africa, Central America, South America and Papua New Guinea. Their goal was to identify how Plasmodium falciparum strains were becoming resistant to the eight anti-malaria drugs currently available." The team noted how there is "substantial genetic differences in malaria around the world. What has occurred is a combination of genetic drift, where genes segregated over space and time from differential environments, immune pressures and exposures to drugs."

Research discovered that "Plasmodium falciparum recombined fastest in Africa...New clues garnered by this study...will allow pharmaceutical companies to create treatments that target the evolving malaria genome."

Sources:

Mu et al. Plasmodium falciparum genome-wide scans for positive selection, recombination hot spots and resistance to antimalarial drugs. Nature Genetics, 2010; DOI: 10.1038/ng.528

University of Montreal (2010, February 18). Genomic warfare to counter malaria drug resistance. ScienceDaily. Retrieved February 20, 2010, from http://www.sciencedaily.com¬ /releases/2010/02/100216140146.htm

Chemical paths

Frequent use and misuse of antimalarials [drugs that fight malaria] can lead to malaria parasites that are resistant to existing treatments. For this reason, there "is an urgent need for new drugs to combat malaria". "Researchers report that they have discovered -- and now know how to exploit -- an unusual chemical reaction mechanism that allows malaria parasites and many disease-causing bacteria to survive."

The same research team from the University of Illinois, led by Eric Oldfield, developed an inhibitor of a pivotal chemical reaction. This inhibitor may fight malaria [and other bacterial and parasitic diseases] in a manner that is different from the traditional medicines. The situation is dire, according to Oldfield. "The parasites that cause malaria also have become resistant to quinine, chloroquine and now, artemisinin, three common treatments for the disease."

"The new study focuses on an essential chemical pathway that occurs in malaria parasites and in most bacteria but not in humans or other animals, making it an ideal drug target." An enzyme, known as IspH, promotes the assembly of a "class of compounds, called isoprenoids, which are essential to life" and prove to be necessary to the bacteria and parasites that cause disease.

"Isoprenoids are the largest class of compounds on the planet," Oldfield said. "There are over 60,000 of them. Cholesterol is an isoprenoid. The orange beta-carotene in carrots is an isoprenoid. And bacterial cell walls are made using isoprenoids." After a decade of research, scientists believe that they understand the structure and function of IspH and hope that it will "allow them to find a way to... shut down production of isoprenoids in the disease-causing bugs," thereby reducing their numbers.

"We're really at the initial, key stage, which is understanding structure and function and getting clues for inhibitors -- drug leads," he said. "But there are a finite number of proteins unique to bacteria and malaria parasites that can be targeted for the development of new drugs. And everyone agrees that this enzyme, IspH, is a tremendous target."

Further research:
Eric Oldfield et al. Bioorganometallic mechanism of action, and inhibition, of IspH. Proceedings of the National Academy of Sciences, Feb 15, 2010. http://www.news.illinois.edu/WebsandThumbs/Oldfield,Eric/0215pnas.200911087.pdf
The National Institute of General Medical Sciences at the National Institutes of Health funded this research.


Source:
University of Illinois at Urbana-Champaign (2010, February 16). New weapon to fight disease-causing bacteria, malaria developed. ScienceDaily. Retrieved February 16, 2010, from http://www.sciencedaily.com¬ /releases/2010/02/100215173944.htm

Photo source:
http://insciences.org/article_album_file.php?article_id=8350&articlemedia_id=1069

Substandard Medicines

"A high percentage of medicines circulating on national markets", in ten Sub-Saharan African countries, "are of substandard quality and thus may contribute to the growth of drug-resistant strains of Plasmodium falciparum, the most virulent form of malaria." First results of the "large-scale study of key antimalarial medicines" were released for Madagascar, Senegal, and Uganda by the Promoting the Quality of Medicines (PQM) Program, a USAID-funded program.

"Within Madagascar, Senegal and Uganda, the study" focused "on artemisinin-based combination therapy (ACT) products, currently the WHO's recommended form of first-line treatment for uncomplicated malaria, and sulfadoxine-pyrimethamine (SP) products, often used for preventative treatment of malaria during pregnancy." Researchers collected samples from "public and regulated private sectors" and from "informal markets, as many patients obtain their medicines from these sources."

"Substandard and counterfeit versions of antimalarial medicines are highly problematic throughout Africa, Asia and Latin America because of the direct threat they pose to the lives of individual patients as well as their contribution to the development of drug-resistant strains of these diseases." The "study found that approximately 44 percent of sampled medicines from Senegal, 30 percent of samples from Madagascar, and 26 percent of samples from Uganda that underwent full quality control laboratory testing failed such testing and were thus substandard."

"Substandard" medicines are classified as "those that do not meet the quality specifications set for them, primarily because they do not contain the correct amount of the active ingredient(s), do not dissolve properly in the body or include unacceptable levels of potentially harmful impurities." According to the released results, "[n]o samples in the full study completely lacked the active ingredient(s). The results also showed that, as a general rule, when a brand passed or failed in one country, it would also pass or fail in other countries. This indicates that the problem of quality is created at the source, rather than during passage through the distribution chain."

Substandard medicines were not limited to informal markets, and their point of sale varied by country. "In Madagascar, for instance, poor quality medicines appear to be widespread across regions and not limited to any particular type of distributor [public, private, or informal]. In Uganda, samples fared much better in the public sector than in the country's private sector. Despite overall failure rates, this was one of the bright spots the study revealed; in Uganda's public sector, all ACT and SP samples passed quality tests."

The purpose of this study was reveal "the prevalence of substandard antimalarials in Sub-Saharan Africa, which are believed to contribute to antimicrobial resistance of Plasmodium falciparum. Already, Plasmodium falciparum has become resistant to traditional" treatments "such as chloroquine, and more recently to SP products. The sustainability of treatment success depends to a large extent on preventing Plasmodium falciparum's exposure to incomplete doses of these medicines to minimize the possibility of the emergence of drug resistance."

Source:
US Pharmacopeia (2010, February 10). One-third of antimalarial medicines sampled in three African nations found to be substandard. http://vocuspr.vocus.com/vocuspr30/Newsroom/ViewAttachment.aspx?SiteName=USPharm&Entity=PRAsset&AttachmentType=F&EntityID=108111&AttachmentID=f2e22216-44a5-41a2-a9bc-464b7a98e3bf

Malaria vaccine to protect pregant women

"Each year, 25 million pregnant women in sub-Saharan Africa run the risk of contracting malaria." Women who become infected during their first pregnancy are at the most risk for severe anemia and poor fetal growth. "The malaria parasites accumulate in the placenta, resulting in children being born prematurely and underweight." Maternal malaria causes the death of approximately 200,000 infants and 10,000 women each year

"Researchers at the University of Copenhagen have become the first in the world to synthesize the entire protein that is responsible for life-threatening malaria in pregnant women and their unborn children. The protein known as VAR2CSA enables malaria parasites to accumulate in the placenta and can therefore potentially be used as the main component in a vaccine to trigger antibodies that protect pregnant women against malaria. The research team is now planning to test the efficacy of the protein-based vaccine on humans."

"The hope is that within 10 years all African girls could be vaccinated against maternal malaria, thereby preventing more than 200,000 deaths a year." The vaccine "elicits antibodies that stop the [malaria] parasite from binding to the placenta." Laboratory testing is underway, and the vaccine can already be tested in animals.

"These antibodies seem to be effective at preventing the parasite from accumulating in the placental tissue. The next step is to investigate whether we can elicit the same antibodies and so protect against the disease by vaccinating humans. Then the vaccine will be a reality."

Source:
University of Copenhagen (2010, February 5). Vaccine to protect pregnant women from contracting malaria?. ScienceDaily. Retrieved February 12, 2010, from http://www.sciencedaily.com­ /releases/2010/02/100204144433.htm

Lost Code

Although made of few parts, the complete DNA content or genome of a species is extensive and complicated. Plasmodium falciparum, "the most deadly form of malaria", has about 5,300 genes. "Up until now, scientists [had] a good understanding of the gene functions for only about half" of the genes.


Plasmodium falciparum is a tiny parasite that infects the blood of mammals through mosquito bites and is responsible for approximately 1 million human deaths each year. "Using transcriptional profiling," a process by which "gene expression (activity) patterns" are revealed, the research team lead by Prof Zbynek Bozdech (Nanyang Technological University) "has successfully uncovered the gene functions for almost the entire genome, with more than 90 percent of the gene functions from the previously unknown half now better understood."


"Transcriptional profiling is the measurement of the activity of thousands of genes at once," in order to "create a global picture of cellular function. These profiles can, for example, distinguish between cells that are actively dividing, or show how the cells react to a particular treatment. This outcome in infectious disease pathology could potentially be the decade's big breakthrough as it has yielded critical information about how the malaria parasite...responds to existing compounds with curative potential."


"Preventing malaria infection is important because resistance to anti-malaria drugs is a growing problem worldwide. There is currently no vaccine for malaria, which is widespread in poorer countries where it remains a hindrance to economic development. Also of growing concern to scientists is the confirmation of the first signs of resistance to the only affordable treatment left in the global medicine cabinet for malaria: Artemisinin."


"In successfully using transcriptional profiling to study the behavior of the malaria parasite, ...researchers have ventured into the unknown and paved the way for future breakthroughs in healthcare."

Sources:
Gastin, George. "GenomeGradient.jpg" [Photo hosted by wikimedia, shared under CC license] http://commons.wikimedia.org/wiki/File:Genome_gradient.jpg

Nanyang Technological University (2010, February 6). World's first in-depth study of the malaria parasite genome. ScienceDaily. Retrieved February 7, 2010, from http://www.sciencedaily.com /releases/2010/02/100205102607.htm

Protective immunity

Every year approximately a million people die from malaria, a treatable blood disease, and most of those who die are children under the age of five. "A new vaccine to prevent the deadly malaria infection has shown promise to protect the must vulnerable patients--young children--against the disease."

The results found by the international research team, led by the University of Maryland School of Medicine's Center for Vaccine Development (CVD) and the Malaria Research and Training Center at the University of Bamako in Mali, excites the medical community. "In a new study of the vaccine in young children in Mali, researchers found it stimulated strong and long-lasting immune responses. In fact, the antibody levels the vaccine produced in the children were as high or even higher than the antibody levels found in adults who have naturally developed protective immune responses to the parasite over lifelong exposure to malaria."

"In areas of the world such as Africa, where malaria is particularly rampant, the young are most vulnerable to the disease since they have not built up the same natural immunity as adults. A child dies of malaria every 30 seconds, according to the World Health Organization. There are about 300 million malaria cases worldwide each year, resulting in more than one million deaths, most of them African children."

Malaria is a parasite, "spread to humans through mosquito bites". At this time, "no approved vaccine to protect against the condition" exists, although "using bed nets or killing mosquitoes with insecticides can prevent infection. The parasite is treatable using medications, though drug resistance is a relatively common problem. Eradicating the disease has become a priority for scientists and health officials worldwide. An effective and broadly protective vaccine is a key step toward that goal."

This "vaccine, based on a single strain of the falciparum malaria parasite -- the most common and deadliest form of the parasite found in Africa -- targets malaria in the blood stage. The blood stage is the period after the mosquito bite, when the parasite multiplies in the blood, causing disease and death." Before this discovery, "other blood stage vaccines" existed, but none of them exhibited "the ability to prevent malaria disease."

In addition to preventing malaria, the vaccine (at all three tested doses) "proved to be safe and well tolerated" in each of the 100 Malian children administered with the drug. A new trial is already planned to test more subjects and to examine "whether the vaccine -- though it is based on a single strain of malaria -- can protect against the broad array of malaria parasites that exist."

Sources:
University of Maryland Medical Center (2010, February 6). New malaria vaccine is safe and protective in children, scientists find. ScienceDaily. Retrieved February 6, 2010, from http://www.sciencedaily.com­ /releases/2010/02/100203201425.htm

Digestive enzymes

"Malaria causes more than two million deaths each year, but an expert multinational team battling the global spread of drug-resistant parasites has made a breakthrough in the search for better treatment" (McGill). Examining the way malaria parasites reproduce, a team led by John Dalton, has identified "a plan of attack" to develop new and urgently needed treatments, which combat malaria.

The secret lies in how the parasites propagate. "Malaria parasites live inside our red blood cells and feed on proteins". They break down the proteins to "use the proceeds (amino acids) as building blocks for their own proteins". Once they "a sufficient size they divide and burst out of the red cell, entering another and repeating the process until severe disease or death occurs."

Specialized digestive enzymes of the parasites "enable them to undertake this process." Researchers have now developed three-dimensional structures of these two enzymes and "demonstrated how drugs can be designed to disable the enzymes."

"By blocking the action of these critical parasite enzymes, we have shown that the parasites can no longer survive within the human red blood cell," Dalton explains. "The team is putting their findings into action immediately and is already pursuing anti-malarial drug development."

Publications: The discovery will be published in the Proceedings of the National Academy of Sciences, and is the result of collaboration including Australia’s Queensland Institute of Medical Research, Monash University and the University of Western Sydney, Wroclaw University of Technology in Poland and the University of Virginia in the U.S.

Read more about digestive enzymes and malaria

Source:
McGill University (2010, January 29). Breakthrough could lead to new treatment for malaria. ScienceDaily. Retrieved January 31, 2010, from http://www.sciencedaily.com¬ /releases/2010/01/100128165850.htm

Genetically-engineered malaria vaccine

Scientists have created a "weakened strain of the malaria parasite" that "will be used as a live vaccine against the disease." This type of vaccine "has proven successful in eradicating smallpox and controlling diseases such as flu and polio" (Walter). It has already been advantageous in animal studies, and it is hoped that it will prove successful when it enters human trials (slated for early next year).

Professor Alan Cowman, head of the Walter and Eliza Hall Institute's Infection and Immunity division, said that "in developing the vaccine the research team...deleted two key genes in the Plasmodium falciparum parasite - which causes the form of malaria most deadly to humans" (Walter). "The deletions did not affect the parasites throughout most of the life cycle," but "by removing the genes the malaria parasite is halted during its liver infection phase, preventing it from spreading to the blood stream where it can cause severe disease and death" (Cowman; Walter). The photo to the left shows the parasitic cells during the liver stage (WT is normal).

The fact that the deletion of the genes "did not result in any observable defect during blood-stage replication...indicated that gene deletions did not affect the sexual stages of the parasite" (Cowman). "Although two genes have been deleted the parasite is still alive and able to stimulate the body's protective immune system to recognize and destroy incoming mosquito-transmitted deadly parasites" (Walter).

"Similar vaccines" have "been tested in mice and offered 100 per cent protection against malaria infection." Cowman "said it was hoped the vaccine would produce similar results in humans" (Walter). Whenever working with an attenuated [definition: weakened] strain of a disease, mutation is always a concern. Some people fear that the parasite will mutate to a viable form, thereby infecting individuals through the vaccine. "Professor Cowman said it was unlikely the weakened parasites used in the vaccine would regain their potency as the genes had been deleted from the genome and could not be recreated by the parasite" (Walter).

The fact that two essential genes have been deleted "make it extremely unlikely that the attenuated parasite vaccine could restore its capacity to multiply and lead to disease." The scientists believe that their "genetically attenuated parasite approach provides a safe and reproducible way of developing a whole organism malaria vaccine," which has the unique ability of being nearly 100% effective (Walter).


Sources:
Cowman, Alan F. et al. "Preerythrocytic, live-attenuated Plasmodium falciparum vaccine candidates by design." 10 June 2009.

Walter and Eliza Hall Institute (2009, August 24). First Genetically-engineered Malaria Vaccine To Enter Human Trials. ScienceDaily.

Malaria in Ghana

New Release: 24 July 2009 reports prevalence of fake drugs in Ghana

Despite increased prevention efforts, Ghana is struggling to control endemic Malaria. Major roadblocks include economic deterioration, reduced effectiveness of indoor spraying & bed nets, and the importation of fake drugs to treat malaria.

In early July, US President Obama visited Ghana and "reaffirmed the United States' commitment to fighting malaria and other pressing global health needs" (Malaria Policy, President). For Ghana, the fight against malaria is one of medical and economic concern. "One infected person can indirectly infect 100 others that is how efficient the malaria mosquito is" (Afiriyie). Malaria is detrimental to the population of Ghana and the economic standing of the country. All are effected by the "debilitating effects of malaria on adult victims...In addition to time and money spent on preventing and treating malaria, it causes considerable pain and weakness among its victims. This can reduce peoples' working abilities. The adverse impact of the disease on household production and gross domestic product can be substantial. Malaria therefore is not only a public health problem but also a developmental problem." Apart "from the negative effect of lost productivity on the major sectors of the economy, malaria has negative effects on the growth of tourism, investments and trade especially in endemic regions" (Asante 8).

Every year, "huge sums of money" are "spent on malaria" treatment "even though the disease could be prevented," with the establishment of well-funded programs (Joy). Some methods of malaria control include bed-nets (mosquito nets that drape the beds to prevent mosquito bites during the night) and indoor spraying. Unfortunately, there is some indication that "Indoor Residual Spraying will never eliminate malaria in Ghana". "Hayford Siaw, Executive Director of Volunteer Partnerships for West Africa (VPWA) has expressed concern" over the investments in bed-nets and indoor spraying, saying that "The indoor residual spraying is no more effective than the bed nets, about 25% effective". Effectiveness of indoor treatment is reduced by a "genetic pre-disposition of some malaria mosquitoes" to "only bite outdoors" (Afiriyie). Still, the bed nets and indoor spraying do reduce the number of malaria cases and should not be abandoned. Other methods of eradication should be used in tandem with indoor treatments in order to effectively eliminate malaria in the region.

Ghana is working to establish and maintain programs that will diminish the mosquito population that carries malaria. "Zoomlion, a waste management company that works to improve sanitation throughout the country and fight malaria," maintains "a total of 420 'spraying gangs'" that "periodically spray mosquito breeding sites in order to stop the spread of malaria." This agency "aims to educate communities on sanitation issues and to engage young people in the cause. Their efforts have greatly improved waste issues in the region." (Malaria Policy, Ghana).

The sanitation progress is a step in reducing the "more than 3 million cases of malaria" that "are reported every year in Ghana, more than 900,000 of those cases are young children" (USAID). "45 per cent of child mortality rate recorded nationwide" in 2008 "was caused by malaria" (Joy).

International programs and various governments have stepped up to provide support for Ghana's anti-malaria campaign. It is reported that in December of 2008, China provided "medical assistance to some health practitioners in the country" of Ghana, in order to support their education about anti-malaria practices (Ghana News). In 2006 & 2007, Cuba also donated to Ghana in order to help fund the country's eradication program. Other nations have continuously provided their support to Ghana.

But, news journals have recently revealed that some anti-malarial drugs entering Ghana are fake. "Quantities of a prescription medication used throughout the world for treating malaria have been identified as lacking any active ingredient and presumably counterfeit. These are being removed from the market in Ghana, where they were discovered recently and confirmed as fake last Friday" (Pierson).

The drug (sold as Novartis Coartem{R}) lacked the ingredients necessary to effectively treat malaria. "This drug is an artemisinin-based combination therapy" and it is "recommended by the World Health Organization (WHO) for treating "uncomplicated" malaria" (Pierson).

"It has been estimated that up to 15% of all sold drugs are fake, and in parts of Africa this figure exceeds 50% , which paints a grim picture of health delivery in Ghana and elsewhere in Africa. China is emerging as a source country of counterfeit drugs. India and other Asian countries are" also "emerging as sources"(Ghanian).

"A major barrier in combating malaria throughout much of the developing world is the widespread presence of counterfeit and adulterated drugs, which undermines the public health. Not only do these drugs fail to deliver the appropriate treatment to individual patients--putting their lives at risk, but they contribute to the growth of drug-resistant strains of malaria, one of the greatest challenges to malaria control today" (Pierson).


"The FDB [Food & Drug Board] knows more than anyone that the drug counterfeit business is a multi-million dollar business globally, which is gaining roots in Ghana, the emerging gateway to everything...The production of substandard and fake drugs is a vast and under-reported problem, particularly affecting poorer countries. It is an important cause of unnecessary morbidity, mortality, and loss of public confidence in medicines and health structures" (Ghanian).

"Mr. Anthony Ofori, Brong Ahafo Regional Co-coordinator of Malaria Control," requests "effective collaboration between non-governmental organisations (NGOs), corporate bodies and the health authorities in the campaign against malaria in the country" (Joy). Malaria is endemic throughout the entire country (See map). Ghana is in dire need of positive international assistance in the war against malaria.

Note About Malaria:
"Malaria is integrally tied to maternal and child health in Africa." Each year pregnant women and children suffer and die from the infectious parasite. "Effective malaria control programs" are "vital to helping health systems adequately care for mothers and children," (Malaria Policy, President). "The effect of malaria on people of all ages is quite immense. It is however very serious among pregnant women and children because they have less immunity" (Asante 7).

A Note about Donations:
If you would like to donate to the cause, please visit the Malaria No More site.
At this time, Infectious Bite is not accepting donations. Please donate directly to a reputable agency.

Sources:
Afiriyie, Constance. Volunteer Partnerships for West Africa. "Indoor Residual Spraying will never eliminate malaria in Ghana."

Asante, Felix Ankomah. Kwadwo Asenso-Okyere. Economic Burden of Malaria in Ghana.

Ghanian Journal, The. "Let's do away with fake drugs". 24 July 2009.

Ghana News Agency (via fmprc.gov). China donates anti-malaria drugs to Ghana.

Joy Online. Ghana needs effective collaboration in malaria campaign.

Malaria Policy Center: President Obama Visits Ghana and Reaffirms U.S. Commitment to Fight Malaria.

Malaria Policy Center: Ghana fights malaria by improving sanitation.

Pierson, Francine. US Pharmacopeia. "Counterfeit Antimalarial Drug Discovered in Ghana with Aid of USP Drug Quality and Information Program". 22 July 2009.

USAID Press Release. USAID Administrator Tours Ghana Malaria Control Center.

Malaria in China

China has seen a resurgence of Malaria in recent years. "China reported about 24 million malaria cases in the 1970s, the number of cases declined to several hundred thousand by the late 1990s. However, the disease recently has "re-emerged" in China's central and southern provinces, possibly as a result of insufficient prevention work" (Global).

China suffers from Falciparum malaria which "is the most deadly among the four main types of human malaria. Although great success has been achieved since the launch of the National Malaria Control Programme in 1955, malaria remains a serious public health problem in China" (Lin). "Falciparum malaria was endemic in two provinces of China during 2004–05" (Lin). "The 'level one' areas have an annual malaria incidence of more than one case per 10,000 people, while the 'level two' regions have an annual incidence of less than one per 10,000 people" (Global).


Map provided by Travax

"Imported malaria was reported in 26 non-endemic provinces. Annual incidence of falciparum malaria was mapped at county level in the two endemic provinces of China: Yunnan and Hainan. The sex ratio (male vs. female) for the number of cases in Yunnan was 1.6 in the children of 0–15 years and it reached 5.7 in the adults over 15 years of age" (Lin).

The recent resurgence of malaria in China has prompted "China's Ministry of Health" to draft a "plan to eliminate malaria from the country by 2015" (Xinhuanet). "Central and local governments will provide funding for the malaria control programs, an unnamed official from the health ministry's disease control department said." "The plan aims to reduce malaria incidence to less than one case per 10,000 people in high-burden regions and to no cases in low-burden regions between 2010 and 2015" (Global).

Sources:
Global Health Reporting. "Malaria | China Develops Nationwide Malaria Eradication Plan". 10 April 2009.

Lin, Hualiang. Liang Lu, Linwei Tian, Shuisen Zhou, Haixia Wu, Yan Bi, Suzanne C Ho, Qiyong Liu. Spatial and temporal distribution of falciparum malaria in China.

Xinhuanet. "China lays out plans to quell malaria" http://news.xinhuanet.com/english/2009-04/10/content_11163891.htm 10 April 2009.