Malaria: tracking a serial-killer
There are up to 500 million cases of malaria each year. According to the World Health Organisation, severe malaria kills one child every minute in Sub-Saharan Africa. It is a desperate situation that has lead to cooperative research between Africa and Europe, which may yield a more efficient and effective treatment against malaria in small children.
The parasites responsible for the disease are normally transmitted through the bite of a female mosquito. The parasites enter the blood stream and begin to reproduce in the liver. After destroying the liver cells they enter the blood stream again, this time in very high numbers. At this stage symptoms such as fever appear. The parasites then destroy red blood cells, causing anemia, among other effects.
It is not until the age of five that the human body has developed partial immunity to malaria, making young children almost defenceless against the disease. Unless treated, sufferers of malaria will experience a long phase of vomiting before falling into a coma. At this point administering medication becomes complicated and can only be done intravenously.
In Africa severe malaria will usually be treated with quinine. At the moment trails are under way for an alternative treatment with intravenous artesunate, an artemisinin derivative. It is the aim of an Afro-European research project (funded by the EDCTP) to investigate whether this derivative is more effective than quinine.
Trials are taking place at the Albert Schweitzer Hospital in Gabon, Central Africa, where up to 30 percent of the emergency admissions involving children will lead to a diagnosis of malaria. Blood samples are taken every six hours from patients being treated with the new medication. Experts can then estimate how effective the treatment is by calculating the change in density of parasites in the blood. They can also observe the treatment to assure that there are no adverse side-effects.
Another aim of the research is to improve the treatment administration, so that a child can be treated in three days with just a single dosage each day.
The data from these trials are then sent to the Institute for Tropical Diseases at Tuebingen University in Germany. Biologists study the malaria parasites and the effect upon them by various drugs at various doses. Preliminary results appear positive for the treatment with intravenous artesunate. The studies show that a single daily dose for three days destroys the parasites effectively.
For the researchers in Gabon it is also important to visit the children treated with the artesunate after their hospitalisation for further monitoring and to be sure that the fever has not returned, thus evaluating the efficiency of the treatment.
The researchers visit a five year old child from the village Komi who was treated with intravenous artesunate one month earlier. About four in five children from Komi will suffer malaria before the age of five. The medical examinations show that the child is indeed on the way to a full recovery. The research indicates that the artesunate treatment works faster than quinine and, as far as is known, has fewer side effects.
Although this research could lead to a better method for combating severe malaria in small children, prevention remains a key factor in high risk areas of Africa. As well as improved medical treatment, the simple distribution of mosquito nets and their proper installation can also safe lives.