A new approach where malaria is highly seasonal
An opinion published in Trends in Parasitology
A new approach to reducing the incidence of malaria by using trained volunteers in remote, rural areas to provide both treatment and prevention has been proposed in an opinion piece in Trends in Parasitology. The 4 authors from the London School of Tropical Medicine & Hygiene, The Gambia, Ghana and TDR say that effective malaria control is likely to require the use of a combination of the limited number of tools available, and they suggest the use of two of these – home or community case management with intermittent preventive treatment of malaria in children (IPTc) in areas with highly seasonal malaria transmission.
The authors cite past studies that have shown that volunteers with a limited educational background can be taught to diagnose and treat malaria effectively, and that this community case management or home management approach has been recommended by the World Health Organization (WHO) since 2004 and adopted by over 30 countries in sub-Saharan Africa, where the majority of deaths occur from this disease.
However, the community case management approach does not prevent illness, so the authors suggest that the trained volunteers could also provide IPTc, which is a full dose of an antimalarial given several times to children during the malaria season, whether or not they are known to be infected. The technique was first used for pregnant women to prevent maternal anaemia and low birth weight and then used for infants through routine control programmes. It has been shown to reduce the incidence of malaria with 3 courses of treatment.
The challenge is delivering this in areas where there are no routine health services, and to provide it to older children who are also at risk. The authors suggest using the trained community health workers to deliver the IPT to children during the high malaria season, and to deliver treatment during the rest of the year. The opinion piece calls this a potentially promising approach to malaria control, and suggests more research to study this.
For more information, contact Dr Franco Pagnoni