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Old drug, new tricks to fight malaria in West Africa

Source: Thomson Reuters Foundation - Wed, 11 Sep 2013 13:34 GMT
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Two-year-old Aissata Dia is tended by her grandmother as she recovers from malnutrition and malaria at a nutrition centre at Selibaby's hospital, in Mauritania's Guidimakha region. Photo June 3, 2012. REUTERS/Susana Vera
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DAKAR (Thomson Reuters Foundation) – A new way of using an old drug is proving to be a breakthrough in combating seasonal malaria in West Africa, which kills tens of thousands of children every year according to Medicins Sans Frontieres (MSF).

The medical charity says seasonal malaria chemoprophylaxis or SMC, a pioneering approach that uses sulfadoxine/pyrimethamine (Fansidar®), reduced the number of cases of simple malaria by 66 percent during trials in Mali and Chad between July and October last year.

The trials, which involved 160,000 children in Koutiala, southern Mali, and 10,000 children in Moissala, southern Chad, also resulted in 70 percent fewer hospital admissions and 75 percent fewer blood transfusions due to malaria.

“Fansidar was widely used to treat malaria throughout the world but has been phased out and replaced by artemesinin combination therapies (ACT), partly because of the build-up of resistance,” MSF Tropical Medicine Adviser Estrella Lasry told Thomson Reuters Foundation by phone.

“Now, the new approach uses Fansidar with amodiaquine to prevent malaria in children between the ages of 3 months and 5 years by providing 12 doses over four months to maintain an adequate level of antimalarial drug in their blood during peak malaria season,” she said. 

This rainy season, MSF is also providing SMC to 184,000 children throughout Niger, where malnutrition and malaria occur at around the same time of year, a combination that frequently leads to death.

Niger is still recovering from the West Africa Food Crisis 2012 and there is always a shortfall of food just before the harvest. Meanwhile, climate change has led to longer and more unpredictable rainy seasons, producing ideal breeding grounds for the Anopheles mosquito, the only vector for the disease.

“Undernourished children have less immunity to illnesses generally, and so are more susceptible to contracting malaria with complications. Malaria also weakens the metabolism and leads to loss of appetite in young children,” said Lasry.   

More than 600,000 people die from malaria every year, 90 percent of them in sub-Saharan Africa and most of them children, according to the World Health Organisation. 

The World Malaria Report 2012 states that SMC could provide important reductions in infant and child mortality, given that malaria killed an estimated 200,000 children under the age of five in the Sahel countries in 2010 who could have been given SMC. 

“In parts of West Africa, a child might get 3 or 4 clinical attacks of malaria a year. Sleeping under a bed net cuts that down to 1 or 2 attacks, but using SMC increases protection by a further 80 percent. It’s pretty dramatic,” said Dr Brian Greenwood, Professor of Clinical Tropical Medicine at the London School of Hygiene and Tropical Medicine. 

Last week, MSF announced an emergency response to a spike in malaria in Am Timan, in the Salamat region of Chad, 400 km (250 miles) east of Moissala where the SMC pilot is being expanded. MSF said its doctors had treated 1,400 patients for malaria in Am Timan in a two-week period in August.

“Chad is an ideal place to roll out SMC because malaria happens in those three or four months of the rainy season. It could save thousands of lives,” Greenwood said.

Vaccine only hope for CAR

Despite its success in many parts of West Africa, the new approach cannot be used in the Central African Republic, where 70 percent of paediatric deaths in the northwest of the country are thought to be caused by malaria.

The WHO recommends that SMC be used only in places where more than 60 percent of malaria cases occur in less than four consecutive months.

“The malaria season in CAR, from May till October, is longer and prevalence in the low season is higher, so the seasonal malaria chemoprophylaxis currently being used in Niger does not work here,” said Ellen van der Velden, MSF Head of Mission in CAR.

However, a new vaccine for malaria is on the horizon.

“By far the greatest international health interventions in our time have been through vaccinations, so the ultimate solution to malaria would involve a vaccine,” said Greenwood. “There used to be very little money for malaria research, however, since early 2000, funding has gone up from around $10-20 million to $2 billion and that has really made it possible to develop something new,” he said.

 “It may not be as good as the one-off measles vaccine, but in the next 10 years we will have partially effective malaria vaccine that can be used in combination with insecticide-treated bed nets, household spraying and SMC [in some areas] to start reducing the malaria map,” he added.

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