Malaria Day in The Americas Forum

In commemoration of Malaria Day in the Americas 2016

The Pan American Health Organization, The UN Foundation, The Milken Institute School of Public Health at The George Washington University, and Center for Communication Programs at The Johns Hopkins Bloomberg School of Public Health

Cordially invite you to attend the

“End Malaria for Good” Forum

Featuring videos, presentations and discussions on

The work of the ‘Malaria Champions of the Americas 2016’

malariaevite-2016-americasWHEN: Thursday, November 3, 2016, TIME: 1:00 p.m. to 3:30 p.m.

WHERE: Room B, PAHO Headquarters, 525 23rd Street NW, Washington, DC—20037

RSVP: Please fill out the form at

Light refreshments will be served

Malaria, Lymphatic Filariasis and Insecticide-treated Nets



Throughout Africa one of the main vectors that carry Lymphatic Filariasis (LF) is the Anopheles mosquito, which also carries the malaria parasite. The Carter Center has been promoting use of insecticide treated nets (ITNs) for many years as part of its LF control efforts, but others may not have gotten the message.

The global community is targeting LF for elimination in 2020. The primary strategy is mass drug administration annually with ivermectin and albendazole. The plan is that up to seven annual rounds of drug distribution in endemic communities where 90% of population coverage is achieved is necessary to stop LF transmission. The Carter Center explains that distribution of long-lasting insecticidal bed nets (LLINs) protects pregnant women and children who cannot take drug treatment.

The LF strategy often builds on and integrates with onchocerciasis control efforts where these diseases overlap. The community directed treatment with ivermectin (CDTI) model pioneered by the African Program for Onchocerciasis Control  (APOC), wherein communities or villages plan together the distribution process including selecting their own community directed distributors (CDDs). This model has also been used to distribute ITNs.

20160818_100110-1A second component of the LF strategy is morbidity management which focuses on enhanced personal hygiene or cleaning of the parts of the body that experience lymphedema. Another aspect uses surgery to address some of the worst effects, hydrocele.  While this component does not ‘control’ LF, it is a necessary effort to reduce suffering and the negative stigma from the disease.

To judge whether transmission has stopped and elimination has been achieved Transmission Assessment Surveys (TAS) are conducted with rapid diagnostic tests on young children after at least 5 years of MDA in a community.  Specifically WHO recommends an implementation unit must have completed five effective rounds of annual MDA defined as achieving rates of drug coverage exceeding 65% in the total population.

For example the Carter Center in Support of the Nigerian Federal Ministry of Health worked in Plateau and Nasarawa States through community health education, delivery of long lasting insecticide-treated nets (LLINs) and 33 million drug treatments for lymphatic filariasis and river blindness between 2000 and 2011. “In 2012, it was confirmed (through TAS) that lymphatic filariasis transmission had stopped. Post-treatment surveillance is currently underway to assure that the parasite is not reintroduced into the area.”

Another component of the assessment process is yet to be fully realized. That is the testing of mosquitoes for the presence of microfilariae. This indirectly implies an important role in preventing human-vector contact as would be achieved through the use of ITNs as well as indoor residual spray (IRS).

Vector control can benefit more than one disease. Integrated vector management is seen as a key tool to prevent reintroduction of LF in areas where anopheles mosquitoes carry the disease and where ITN campaigns are successful.

Ultimately the key to benefiting from the disease control synergies provided by insecticide-treated nets is an understanding what if any effect nets have on transmission. This poses a challenge in terms of separating it from the effect of MDAs as well as the fact that MDAs are time-limited. As MDAs are still underway in many places it is incumbent on program managers to monitor and evaluate the impact of all activities, treatment and vector control, over the next decade to determine the success of eliminating LF and hopefully malaria, too.

Malaria, Onchocerciasis and Ivermectin – Possibility of Eliminating Two Diseases

Many tropical diseases are co-endemic in a given country and environment. Therefore, it only makes sense to learn whether there can be common strategies and synergies in disease control and elimination efforts. Onchocerciasis or River Blindness is carried by the black fly (simulium damnosum) that breeds along the banks of fast flowing rivers and malaria are examples.

Onchocerciasis was eliminated in many settings in the Sahel through the process or aerial spraying of these riverbanks to kill the black fly larvae. Though the insecticide used was often the same as used for malaria larviciding, the habitats differed and no synergies were achieved then.


Merck donates ivermectin to achieve control and elimination of onchocerciasis

Through subsequent programs using community directed treatment with ivermectin (Mectizan ®) interventions sponsored by the African Program for Onchocerciasis Control (APOC) it was learned that ivermectin also had beneficial effects on malaria transmission.

Ivermectin had been used in agriculture not only for internal parasites of animals. The agricultural community has long known that ivermectin kills both internal parasites (worms) but is also effective against some external parasites (lice and ticks).

Around 2010 scientists began to consider the anti-mosquito effects ivermectin might have when humans consumed it. It turns out that after a mass distribution in a community of ivermectin for onchocerciasis that mosquitoes feeding on people who had recently swallowed ivermectin would die. This was demonstrated when mosquitoes bit volunteers who took ivermectin of the first few days after consumption died there was no effect in the group not taking the drug.


Ivermectin distribution sessions in a Cameroonian village

Of particular interest was the fact that people who had consumed ivermectin would contribute to mosquito mortality even when they were outdoors. While the effect was not long lasting, the onchocerciasis control programs in the Americas have shown that it is safe to administer the drug two or four times a year.

Research that looks at the malaria parasite concluded that, “it is likely that ivermectin treatment is arresting parasite growth.” The researchers note that, “given the prior use of ivermectin and its safety record in humans and animals, it can be considered in combination therapy with other antimalarials.” The issue of dosage would need to be tested further.  Ivermectin at sub-lethal concentrations even inhibits the sporogony of P. falciparum in An. Gambiae.

Because of the need to find new and complementary tools to eliminate malaria the Malaria Policy Advisory Committee (MPAC) of the World Health Organization’s Global Malaria Program considered at its recent meeting the role of endectocides including ivermectin in the future of malaria control and elimination and the importance of further research.

The future of malaria elimination requires finding new tools to integrate with and the strengthening of existing tools. If these efforts also benefit the control and elimination of other diseases, the public’s health will benefit.

Decreasing Household Costs of Dengue Prevention at Low-Altitudes in Colombia …

… Redirecting Resources into the Hands of People Who Slap Mosquitoes Everyday.

Class members from the course “Social and Behavioral Foundations of Primary Health Care” at the Johns Hopkins Bloomberg School of Public Health write a policy advocacy blog as part of their assignments. Here we are sharing the blog posted by . read more on this and other SBFPHC blog posts by clicking here

Squito(Photo by James Gathany)

Colombia bears high burdens associated with dengue.  During the 2010 epidemic, disability-adjusted-life-years lost were 1178.93 (per 1 million inhabitants) versus just 88.38 averaged for 2011-2012.  Rodriguez et. al (2016) estimated economic burdens higher than $129.9 million USD each year, with most of the burden at the individual household level (46%, 62%, and 64%) for preventing/controlling mosquitos.

The Colombian Ministry of Health and Social Protection uses the 1,800m elevation mark when allocating money to low-altitude departments for dengue-related expenditures.  This suggests that only half of Colombia’s 47 million residents are at risk for dengue.  However, many people vacation at low altitudes where they risk becoming infected and bringing dengue back home.  If low-altitude residents were better equipped to control mosquitos, then both residents and visitors would be better protected.  Unfortunately, low-altitude residents shoulder a greater financial burden for mosquito prevention than the government.  Rodriquez et al. (2016) reported that almost $85 million USD was the highest household burden (for prevention alone) between 2010 and 2012, while the highest government burden was only $35 million USD (for prevention, awareness campaigns, and control combined).

If the Ministry of Health and Social Protection’s vision of equity-based protection and healthcare resources for all is to come to fruition, more money must flow into prevention and control.  Residents should not have to buy expensive sprays when they already live in poverty.  If Ministry-controlled finances were earmarked for inexpensive yet effective household supplies, such as curtains and water container covers, then less money would be required for treatment.  I advocate for reshuffling some of the dengue-related funds to reflect the prevention priority; increase amounts for household prevention and decrease treatment allocations.

Let’s not make low-altitude residents choose between buying expensive sprays or food to eat.  It’s hard enough already just to slap together supper.

Mosquito-Borne and Tick-Borne Illness in Florida: Importance of Surveillance

Class members from the course “Social and Behavioral Foundations of Primary Health Care” at the Johns Hopkins Bloomberg School of Public Health write a policy advocacy blog as part of their assignments. Here we are sharing the blog posted by “jleblan5jhmiedu“. read more on this and other SBFPHC blog posts by clicking here. This posting is particularly relevant today on World Mosquito Day.

Vector-borne diseases make up some of the more common infections throughout the globe. The Centers for Disease Control and Prevention acknowledges mosquito-borne denque mosqdiseases, such as West Nile Virus, and tick-borne infections, such as Lyme disease, have a great impact on the United States. These vectors have found favor in climate change as they continuing to breed and pose a public health risk; carrying infectious agents that may be transmitted to humans through a bloodmeal.

In 2014, the State of Florida Department of Health published their mosquito borne diseases surveillance guidebook. Within these guidelines, specific mosquito-borne infections were addressed in regards to both detecting and preventing such diseases. Unfortunately, since this publication, the Zika virus outbreak developed and was found to have recently reached Miami-Dade county in Florida, where locally transmitted cases were confirmed. Given these locally acquired infections in Florida, the surveillance guidelines should be updated accordingly.

FL Zika

Number of Florida Acquired Zika Virus (gray line: per million)

While the Northeastern regions of the US are known to have their “tick season” in the Spring and Summer, Florida’s climate allows for a year-long risk of contracting a tick-borne diease. The standard lab diauos in newsgnostic criteria for Lyme disease, the ELISA, detects antibodies against the bacterium, Borelia burgdorferi sensu stricto. However, it has continued to demonstrate poor sensitivity and overall reliability. Research from the University of North Florida has identified different strains of Borrelia that cause disease in humans. Thus, should one be infected with one of the different strains of Borrelia, one’s test is likely to be negative despite having actual disease. In recent years, Florida was found to have a 140% increase in Lyme disease cases since 1993 while reports of other tick-borne diseases have also increased. Hence, Florida researchers and public health professionals must partner together to revise and implement more up-to-date/accurate screening and awareness for vector-borne diseases.

Emergency Funding for Zika Virus Response

Class members from the course “Social and Behavioral Foundations of Primary Health Care” at the Johns Hopkins Bloomberg School of Public Health write a policy advocacy blog as part of their assignments. Here we are sharing the blog posted by Hanna B. More of the SBFPHC postings can be read at this link.


On February 22nd, the Presidential office requested $1.9billion in emergency funding to support activities related to Zika virus, but these efforts have dangerously stalled in Congress. To date, nearly $600 million has been redirected by the Obama administration to fund Zika related research, front line response efforts, and vaccine development. More than half of this money was redirected from within the U.S. Department of Health and Human Services (DHHS).


Source: Healthcareit

On August 3rd, Sylvia Burwell, DHHS Secretary, informed Congress that due to the delay in approving the emergency funding, the DHHS had been forced to further reallocate up to $81 million from other programs, including the National Institutes of Health. This was extremely important because it could impact the progression of the vaccine studies currently underway, as Secretary Burwell suggested in her letter to Congress. Her letter also outlined the response by the CDC and predicted that they too would be out of Zika funding by the end of the fiscal year (Sept 2016).

Funding approval for Zika virus related activities from the U.S. is more urgent than ever. As of August 17th, the U.S. has confirmed 14 cases of locally acquired Zika virus disease – all from Florida. This was after the U.S. Centers for Disease Control (CDC) announced on August 2nd that an additional $16 million was awarded to 40 states and territories to support Zika related public health activities.

So what can you do? It is time we let our political leaders know that their constituency will not wait any longer. Follow Secretary Burwell’s lead – petition your local congressional representatives (House, Senate) and let them know this is an issue you care about. Or submit pre-formatted online petitions at Project Hope and AmeriCares. And spread the word and call to action amongst your peers.


Source: Project Hope


Preventing Malaria Drug Resistance in the African Setting …

and Dealing with it Should Resistance Occur

Professor Joseph Ana, Africa Centre for Clinical Governance Research & Patient Safety in Calabar, Nigeria shares his experiences and concerns in this blog.

Drug resistance is one of the biggest challenges facing health care systems in the world today. Around 25,000 people die each year from resistant viral and bacterial infections in Europe, but no new classes of antibiotics have come on the market for more than 25 years. The figures are difficult to obtain for Africa and other developing countries.

Medicine shops may sell inappropriate malaria medicines, thus contributing to resistance

Medicine shops may sell inappropriate malaria medicines, thus contributing to resistance

Drug resistance is considered important in the failure of control and treatment of diseases its consequences, and it is considered to be one of the causes of emergence of new strains of infective organisms and re-emergence of once-controlled diseases. The occurrence and impact of the phenomenon is worse in Africa and parts of Asia for malaria according to WHO and the US CDC. Viral and bacterial diseases are also affected in this region.

Therefore, there is urgent need for global sustained action to prevent drug resistance from happening, and to control it, if it happens. The causes of Drug resistance are varied including lack of or poor implementation of the control of access to drugs, population migration and movement, misdiagnosis, under-treatment and irrational drug prescription and use.

Global Report malaria drug resistanceTo prevent drug resistance, countries need to legislate and implement adequate control of access to drugs, sustain public education on the dangers of drug resistance, educate health workers on and enforce rational drug prescribing and use. Effective monitoring of treatment outcomes is also important to know when drug resistance is occurring. With the global and country by country best efforts drug resistance may still occur because of mutation and adaptation of infective organisms.

For diseases like Malaria for which resistance to the most effective drug today, artemisinin-combination drugs, is being reported from Southeast Asia, the development of new drugs alongside vector control is essential by all countries, particularly in Africa.

Professor Joseph Ana – BM.BCh (UNN), FRCSEd, FRSPH, JtCertRCGP-UK, DFFP (RCOG)-UK, DipUrology-UK, Cert.ClinGov.UK; Lead Consultant Trainer / CEO; joseph ana <>; Contact: Africa Centre for Clinical Governance Research & Patient Safety; @Health Resources International (HRI WA); Consultants in Clinical Governance & Patient Safety (MDCN Accredited CPD Provider); 8 Amaku Street State Housing  (& 20 Eta Agbor Road UNICAL Road),  Calabar, Nigeria.

Visit Website:; email:    Tel: +2348063600642

Disrupting Malaria: How Fyodor Biotechnologies is changing the diagnostics game

Efosa Ojomo, Senior Researcher, Harvard Business School, Forum for Growth and Innovation looks at the new innovation award recipient, the designers of the Urine Malaria Test, and explains how the technology disrupts the system that has made it difficult to reach the average malaria sufferer with appropriate diagnostics and treatment.

In 2015, 214 million people were infected with malaria, 190 million of whom were in African countries. Of those infected, 438,000 died, 91% of who were in Africa. In addition, malaria has significant financial implications on families, companies and countries. Experts estimate that in countries burdened with malaria, the disease is responsible for as much as 40% of public health expenditures, 30 to 50% of in-patient hospital visits, and 50% of out-patient visits.

From a financial standpoint, direct costs of managing the disease is up to $12 billion annually, while the cost in lost economic growth is many times more. Considering the scale of malaria’s impact on Africa, there have been many innovations that have helped curb the spread of the disease, but perhaps one of the most significant is Fyodor Biotechnology’s disruptive Urine Malaria Test (UMT).

UMT-DiagThe UMT, a Significant Malaria Milestone

Fyodor’s UMT is a simple urine test where patients simply pee on a stick in order to find out whether they have malaria. The World Health Organization states that “Early diagnosis and treatment of malaria reduces disease and prevents deaths. Access to diagnostic testing and treatment should be seen… as a fundamental right of all populations at risk.” In other words, if we diagnose early, we will save many more lives and limit transmission.

fyodortableUMT is an inexpensive (introductory price: ~$2 per test to end user) malaria diagnostic test that does not require the expertise of a trained professional. The UMT kit also does not require a lab or special disposal due to its simplicity. It is a three step process that lets patients know, in 20 minutes, if they have malaria.

Why the UMT is Disruptive

The most important hallmark of a disruptive innovation is that it makes complicated and expensive products simple and affordable, enabling many more people in society to benefit from the innovation. The UMT fits this model as the differences between the UMT and existing blood-testing kit below clearly illustrate.

One of the most exciting things about the UMT is Dr. Agbo’s goal to manufacture the product in Africa. “With an investment of $5 million, we can build a fully equipped manufacturing plant in Nigeria. That amount will only get us a building in the United States,” he explained.

Innovation Prize of Africa winners IPA2016winners-1200x590 at Forbes2It is solutions like these that African investors and policy makers need to support in order to get Africa on a path to sustainable economic development. As reported by Forbes, the UMT is an innovative product by Africans for Africans. This is why the UMT is an innovation winner.

(A longer version of this posting appeared on the World Bank Africa Can blog.)

Malaria Plus Brexit – let’s hope no Malexit

brexit and africaNo one knows for certain the full implications of Britain’s narrow vote to leave the European Union (EU). Since Britain has been a major player in malaria research and development aid, questions naturally arise of whether the British exit (Brexit) from the EU will affect development aid and global research generally and malaria aid and research specifically.

Earlier this week the Brookings Institution examined the ways that a Brexit could affect Africa. Here are some of the possibilities adapted to malaria –

  • Volatility in the global economic market will affect not only the British economy but also those of malaria endemic countries, possibly reducing the reducing available funds for national contributions to malaria control at home, a major goal for sustaining malaria control and elimination
  • Britain specifically may not be able to sustain its financial contributions to malaria aid through the Global Fund, bilateral malaria programs and of course it would no longer contribute to the European Development Fund which currently stands at nearly 15% of its total.
  • The British economy which like all modern nations depends on trade would be affected by the need to renegotiate hundreds of trade agreements around the world. Less trade likely means less income and less development aid.

In both 2014 and 2015 the United Kingdom contributed 8% of the total contributions received by the Global Fund to fight HIV, TB and Malaria. In addition “UK’s official development assistance (ODA) is expected to rise to £11.3bn when it hits the 0.7% target. With a population of about 63 million, the figure works out at roughly £137 per Brit.” In 2012 the malaria component was estimated at 2%.

Patrick Vallance and Tim Wells examine the importance of global collaboration on malaria research. This requires the free flow of researchers and their needed supplies across national borders, especially malaria research that has had to date a pan-European character. They describe the collaboration needed “between commercial and non-profit organizations, and between academic science and medicine. Without such partnerships, advances in fighting this deadly disease would not have been possible.”

Vallance and Wells give the example of “GSK’s research site in Tres Cantos, Spain. The lab operates with the support and advice of a broad range of actors, including GSK, the Wellcome Trust, the European Union, and MMV (Medicines for Malaria Venture), as well as various other product-development partnerships and academic centers.” Such efforts may be jeopardized when permits for malaria scientists to work in other countries are more difficult to obtain.

There may be other aid mechanisms too, the Commonwealth Secretariat being one. During World Malaria Day in 2012 the Commonwealth Secretariat pledged to assist in sustaining the gains made in tackling malaria.  We hope that Brexit will not become an exit for malaria commitments and saving lives.

Tanzania – Malaria Indicators Low, Still Need Work

Success in the war against malaria is not guaranteed. Two articles to that effect have appeared The Citizen of Dar es Salaam following presentation of findings from the most recent (2015-16) Tanzania Demographic and Health Survey (DHS)/Malaria Indicator Survey (MIS).

Slide2On Tuesday (21 June 2016) the news story noted the increase in malaria prevalence among children below the age of 5 years, which was attributed to “the decline in the use of mosquito nets and low distribution of nets to households.” Then in a Wednesday (22 June 2016) Editorial, the paper noted that this “backtracking” is a “worrisome situation, for malaria is a problem that puts such a heavy burden on the government and the country’s economy.”

Slide1A look at the preliminary DHS does confirm the concerns about insecticide treated nets (ITNs).  After nearly 10 years of progress, reported ITN availability in households declined. This was reflected in a drop in reported use by children below 5 years of age as well as pregnant women. It should be noted that targets set in 2000 in the Roll Back Malaria Abuja Declaration had been 80% by the year 2010, and those had almost been achieved in 2012, but the fall to around 50% in 2015-16 is discouraging.

Another preventive measure has also faced difficulty. Pregnant women should receive doses of Sulfadoxine-pyrimethamine (SP) as part intermittent preventive treatment (IPT) during antenatal care (ANC).  Until 2012 the recommendation was two contacts, but the World Health Organization has raised this to three or more depending on the number of times a woman attends ANC. So far IPT has not reached 40% or half of the Abuja target.

Slide3This low IPT coverage is ironic since most women attend ANC at least once in Tanzania. At present only 68% of women who had been pregnant received the first dose of IPT even though 98% registered for ANC. Granted that some may have registered in their first trimester when they would not yet be eligible for IPT, but the gap is quite large and signals missed opportunities, which are often caused by stock-outs. Even though the proportion of women attending up to ANC visits could be better, these attendances should produce better delivery of the 3rd IPT dose.

Slide4Malaria can also be controlled through prompt and appropriate treatment. While testing and treatment of children with appropriate artemisinin-based combination therapy (ACT) has increased, this are is still problematic. In particular, while WHO recommends that all cases of fever should be tested, less than a third received a test (rapid diagnostic test – RDT or microscopy). Testing helps distinguish malaria from other fevers, and ACTs should not be given unless malaria is confirmed. We can see that more ACTs are provided than the number who were tested, so treatment based solely on signs and symptoms is still the norm. Again there is need to explore the availability of both RDTs and ACTs as factors that have made these targets difficult to achieve.

Tanzania continues to receive support from the Global Fund and the US President’s Malaria Initiative, among other partners. It is incumbent on all partners, global and national, to use these results as a wake up call to to plan for better delivery of malaria services and thus a reduction of both the economic and health burden of malaria in Tanzania.