Malaria shortens the lives of millions in sub-Saharan Africa and other regions in the tropics globally. While the annual toll of this mosquito-borne killer has been gradually shrinking, thanks to numerous advances in medicine and sanitation (as well as the increasing use of indoor-residual spraying of DDT), the loss of over 600,000 people, mainly infants and toddlers, plus the economy-sapping effects of recurrent fevers, makes malaria control a crucially-important world health goal.
Currently, malaria control for African children is greatly limited in effectiveness. Prevention methods mostly rely on insecticide-treated bednets (ITNs), spraying of indoor insecticide, and the use of artemisinin-based combination therapy (ACT). New strategies for hindering malaria in children of endemic regions are in high demand as African children under the age of 5 are at greatest risk.
In a recent study conducted by Dr. Grant Dorsey and colleagues at the University of California San Francisco, the administration of a monthly drug combination was shown to prevent malaria in children living in regions with year-round transmission. Researchers enrolled 400 infants from the Tororo District Hospital Maternal and Child Health Clinic in the malaria-endemic region of eastern Uganda in the study to determine the efficacy of three anti-malarial regimens.
The children were treated from ages 6 months to 2 years with one of three medications monthly sulfadoxine-pyrimethamine (SP), daily trimethoprim-sulfulamethoxazole (TS), and monthly dihydroartemisinin-piperaquine (DP). Monthly SP was found to have no protective efficacy against malaria and was also associated with an increased risk of moderate-severe anemia. Daily TS was found to have a 28% protective efficacy against malaria. Monthly DP had the highest efficacy prevention rate of 58% and also reduced the risk of moderate-severe anemia by 47%.
There were no differences in the incidence of malaria between the medications in the 1-year study period after the treatments were stopped, indicating that none of the regimens allowed for the development of an immunity to the disease.
While the 58% malaria efficacy of monthly DP is already impressive, researchers assume that the efficacy of the medication is actually higher. In the study, the children were treated at home by their parents with no supervision. A blood analysis of the children enrolled in the research suggests that frequent non-adherence to the administration of the drug occurred.
While researchers note that future studies should to be conducted to evaluate the malaria efficacy of monthly DP in other regions and to monitor the continued efficacy in eastern Uganda, monthly DP gives early indications as a promising treatment in Uganda where effective control methods are imperative.
ACSH s Dr. Elizabeth Whelan had this comment: The global toll of malaria rose precipitously to over one-million preventable deaths during the years after our EPA, in one of its first acts, banned the pesticide, leading to a worldwide loss of this highly effective and safe preventive agent. Now progress is being made, again; if this monthly combination pill shows anything like its amazing efficacy as monitored in this pilot study, the huge benefits will indeed be miraculous. We can only hope.
