Papers | Published:

Reducing the burden of childhood malaria in Africa: the role of improved

Nature volume 444, pages 3948 (23 November 2006) | Download Citation

Subjects

Malaria kills > 1 million children aged < 5 years in sub-Saharan Africa annually. Current control efforts are hampered by increasing drug resistance, unreliable diagnostics, widespread overtreatment and rising drug costs. In this environment, new and widely available malaria diagnostics have the potential to save lives and drastically reduce overtreatment.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    World Health Organization. New Perspectives: Malaria Diagnosis, Report of a Joint WHO/USAID Informal Consultation 25–27 October 1999. WHO/CSD/RBM/200.14; WHO/MAL/2000.1019 (WHO, Geneva, 2000).

  2. 2.

    , & The intolerable burden of malaria: a new look at numbers. Am. J. Trop. Med. Hyg. 64, IV (2001).

  3. 3.

    et al. Estimates of the Burden of Mortality Directly Attributable to Malaria for Children under 5 Years of Age in Africa for the Year 2000: Final Report for the Child Health Epidemiology Reference Group (CHERG) (WHO, Geneva, 2004).

  4. 4.

    , , & The Public Health Burden of Plasmodium falciparum Malaria in Africa: Deriving the Numbers. Disease Control Priorities Project Working Paper No 11 (Fogarty International Center, National Institutes of Health, Bethesda, Maryland, 2003).

  5. 5.

    et al. Hospital-based surveillance of malaria-related paediatric morbidity and mortality in Kinshasa, Zaire. Bull. World Health Organ. 67, 189–196 (1989).

  6. 6.

    World Health Organization. Guidelines for the Treatment of Malaria. WHO/HTM/MAL/2006.1108 (WHO, Geneva, 2006).

  7. 7.

    , , & A prospective evaluation of a clinical algorithm for the diagnosis of malaria in Gambian children. Trop. Med. Int. Health 5, 231–236 (2000).

  8. 8.

    , & Use of clinical algorithms for diagnosing malaria. Trop. Med. Int. Health 7, 45–52 (2002).

  9. 9.

    , , , & Clinical algorithm for malaria during low and high transmission seasons. Arch. Dis. Child. 81, 216–220 (1999).

  10. 10.

    et al. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ 329, 1212 (2004).

  11. 11.

    UN Millennium Project 2005. Coming to Grips with Malaria in the New Millennium. Task Force on HIV/AIDS, Malaria, TB and Access to Essential Medicines, Working Group on Malaria (Earthscan, Sterling, Virginia, 2005).

  12. 12.

    & The detection and treatment of Plasmodium falciparum malaria: time for a change. J. Postgrad. Med. 50, 35–39 (2004).

  13. 13.

    , & Ensuring quality access for malaria diagnosis: how can it be achieved? Nat. Rev. Microbiol. 4 (suppl.), S7–S20 (2006).

  14. 14.

    Rapid diagnostic tests for malaria parasites. Clin. Microbiol. Rev. 15, 66–78 (2002).

  15. 15.

    , , & Malaria misdiagnosis: effects on the poor and vulnerable. Lancet 364, 1896–1898 (2004).

  16. 16.

    & ACP Broadsheet no 148. July 1996. Laboratory diagnosis of malaria. J. Clin. Pathol. 49, 533–538 (1996).

  17. 17.

    , , & Does the availability of blood slide microscopy for malaria at health centers improve the management of persons with fever in Zambia? Am. J. Trop. Med. Hyg. 60, 1024–1030 (1999).

  18. 18.

    et al. Comparison of field and expert laboratory microscopy for active surveillance for asymptomatic Plasmodium falciparum and Plasmodium vivax in western Thailand. Am. J. Trop. Med. Hyg. 67, 141–144 (2002).

  19. 19.

    , , & The contribution of microscopy to targeting antimalarial treatment in a low transmission area of Tanzania. Malar. J. 5, 4 (2006); published online 20 January 2006 (doi:10.1186/1475-2875-5-4)

  20. 20.

    World Health Organization. The Role of Laboratory Diagnosis to Support Malaria Disease Management: Focus on the use of Rapid Diagnostic Tests in Areas of High Transmission. Report of WHO Technical Consultation. WHO/HTM/MAL/2006.1111 (WHO, Geneva, 2006).

  21. 21.

    , , , & The reliability of diagnostic techniques in the diagnosis and management of malaria in the absence of a gold standard. Lancet Infect. Dis. 6, 582–588 (2006).

  22. 22.

    , , & What is clinical malaria? Finding case definitions for field research in highly endemic areas. Parasitol. Today 10, 438–442 (1994).

  23. 23.

    et al. Reducing the Burden of Malaria in Africa: The Role of Improved Diagnostics. WR-419-HLTH (RAND Corporation, Santa Monica, 2006).

  24. 24.

    , & Newer drug combinations for malaria. BMJ 328, 1511–1512 (2004).

  25. 25.

    , , , & Quality of care provided to febrile children presenting in rural private clinics of the Kenyan coast. Afr. Health Sci. 4, 160–170 (2004).

  26. 26.

    et al. Retail supply of malaria-related drugs in rural Tanzania: risks and opportunities. Trop. Med. Int. Health 9, 655–663 (2004).

  27. 27.

    et al. Pharmacopoeial quality of drugs supplied by Nigerian pharmacies. Lancet 357, 1933–1936 (2001).

  28. 28.

    , , , & The use of formal curative services in the management of pediatric fevers in four districts in Kenya. Trop. Med. Int. Health 8, 1143–1152 (2003).

  29. 29.

    et al. Care-seeking patterns for fatal malaria in Tanzania. Malar. J. 3, 27 (2004).

  30. 30.

    , , & Treatment of malaria fever episodes among children in Malawi: results of a KAP survey. Trop. Med. Parasitol. 45, 61–64 (1994).

  31. 31.

    et al. Developing and interpreting models to improve diagnostics in developing countries. Nature S1, 3–8 (2006).

  32. 32.

    et al. Malaria attributable to the HIV-1 epidemic, sub-Saharan Africa. Emerging Infect. Dis. 11, 1410–1419 (2005).

  33. 33.

    & The Burden of Malaria. CTD/MAL/96.10 (WHO, Geneva, 1996).

  34. 34.

    , & in Cost Effectiveness in Health and Medicine (eds Gold, M., Siegel, J., Russell, L. & Weinstein, M.) 247–275 (Oxford Univ. Press, New York, 1996).

  35. 35.

    et al. The burden of malaria mortality among African children in the year 2000. Int. J. Epidemiol. 35, 691–704 (2006).

  36. 36.

    , , & Public spending on health care in Africa: do the poor benefit? Bull. World Health Organ. 78, 66–74 (2000).

  37. 37.

    et al. Averting a malaria disaster in Africa — where does the buck stop? Bull. World Health Organ. 82, 381–384 (2004).

  38. 38.

    et al. Validity, reliability and ease of use in the field of five rapid tests for the diagnosis of Plasmodium falciparum malaria in Uganda. Trans. R. Soc. Trop. Med. Hyg. 96, 254–257 (2002).

  39. 39.

    et al. Comparison of the Paracheck-Pf test with microscopy, for the confirmation of Plasmodium falciparum malaria in Tanzania. Ann. Trop. Med. Parasitol. 100, 115–122 (2006).

  40. 40.

    & New diagnostic tests for malaria. Africa Health Supp. 31 (2001); published online September 2001 <>.

  41. 41.

    , , , & Feasibility and acceptability of the use of artemether-lumafantrin in the home management of uncomplicated malaria in children 6–59 months old in Ghana. Trop. Med. Int. Health 11, 1003–1016 (2006).

  42. 42.

    et al. Amodiaquine alone, amodiaquine+sulfadoxine-pyrimethamine, amodiaquine+artesunate, and artemether-lumefantrine for outpatient treatment of malaria in Tanzanian children: a four-arm randomised effectiveness trial. Lancet 365, 1474–1480 (2005).

  43. 43.

    et al. The difference between effectiveness and efficacy of antimalarial drugs in Kenya. Trop. Med. Int. Health 9, 967–974 (2004).

Download references

Acknowledgements

The views of Dr. Maghill are his personal viewpoints and do not represent official policy of the US Department of Defense or the US Army.

The authors thank T. Brewer and R. Rabinovich (Bill & Melinda Gates Foundation, Washington, USA), P. Duffy (Seattle Biomedical Research Institute, Washington, USA), N. White (Mahidol University, Bangkok, Thailand) and A. Shepherd (Omega Diagnostics Group PLC, Alva, Scotland, UK) for comments on earlier presentations of this work.

Author information

Affiliations

  1. RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, California 90401-2138, USA

    • Maria E. Rafael
    • , Yee-Wei Lim
    •  & Federico Girosi
  2. Michigan State University, B309-B West Fee Hall, College of Osteopathic Medicine, East Lansing, Michigan 48824, USA

    • Terrie Taylor
  3. Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland, 20910, USA

    • Alan Magill
  4. MENTOR Initiative, Old Grammar School House, Newmarket Street, Skipton BD23 2JP, UK

    • Richard Allan

Authors

  1. Search for Maria E. Rafael in:

  2. Search for Terrie Taylor in:

  3. Search for Alan Magill in:

  4. Search for Yee-Wei Lim in:

  5. Search for Federico Girosi in:

  6. Search for Richard Allan in:

Corresponding author

Correspondence to Maria E. Rafael.

About this article

Publication history

Published

DOI

https://doi.org/10.1038/nature05445

This article has not been written or reviewed by the Nature editorial team and Nature takes no responsibility for the accuracy or otherwise of the information provided.

Further reading

Comments

By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate.