Chemoprevention is an important method of disease prevention that involves the use of drugs to prevent the occurrence of illness. For malaria, we focus on chemoprevention strategies most appropriate for the settings in countries where we work. These strategies include seasonal malaria chemoprevention for children under five and intermittent preventive treatment in pregnant women.
Other diseases can also sometimes be prevented through mass drug administration (MDA), which is the administration of drugs to entire populations for disease control and elimination. We have significant experience of conducting MDAs in South Sudan and Ethiopia for neglected tropical diseases (NTDs): onchocerciasis, schistosomiasis, soil-transmitted helminths, lymphatic filariasis and trachoma. We are also seeking to integrate NTD management with existing community based health initiatives. Our experience in long-lasting insecticidal net distribution and seasonal malaria chemoprevention administration is being used to improve mass drug administration for NTDs.
Malaria vaccines are an area of intensive research. Although there is currently no vaccine in use, trials are underway and it is hoped that one will be available for widespread use within the next decade. Vaccine development is a costly but potentially revolutionary area of malaria prevention, and one that requires ongoing funding. A vaccine will not, however, be 100 percent effective so all other prevention and control activities will need to remain in place.
Intermittent preventive treatment
Intermittent preventive treatment involves the administration of a full course of anti-malarial drugs to vulnerable subjects at specified times regardless of whether or not they have malaria. It is particularly targeted at children and pregnant women in high risk areas. Intermittent preventive treatment for malaria in pregnancy is provided to women in high malaria burden countries during during their pregnancy to protect both them and their unborn child from malaria.
Seasonal malaria chemoprevention
In the continued fight against malaria, there is an increased recognition of the need to tailor interventions to suit local conditions and specific contexts. For the 25 million children aged between three months and five years who live in areas across the Sahel, where malaria incidence increases with the rainy season, the World Health Organization recommends seasonal malaria chemoprevention (SMC) as an effective tool to prevent malaria.
SMC involves the provision of malaria treatment at monthly intervals during the rainy season, and has been proven to be effective in reducing cases of malaria by 75 percent. If this level of prevention is achieved at scale, this would transform the lives of those most at risk by avoiding infection and consequently reducing the demand for treatments at community and facility level, improving school attendance, and decreasing government expenditure on malaria – freeing up these funds for use elsewhere. If widely deployed in the Sahel, SMC could make an important contribution to reducing the global malaria burden.
Malaria Consortium is continuing to work across the Sahel region to help protect millions of children from malaria during the rainy season. We are working with national governments and international donors to help secure additional resources so that more children can benefit from this highly effective approach to malaria prevention, both now and into the future.
Read more about this project here.
Spotlight on artemisinin combination therapies
There are a number of anti-malarial drugs which have seen widespread use over the last century, including quinine, chloroquine, mephloquine, sulfadoxine-pyrimethamine and amodiaquine. Misuse of these drugs, however, has led to growing resistance from malaria parasites.
Over the last decade new artemisinin based drugs - artesunate, artemether and dihydroartemisinin - have become available. In an attempt to prevent resistance, these drugs are now used in combination with drugs from a different class forming artemisinin combination therapies (ACTs).
ACTs are currently the quickest acting and most effective anti-malarial drugs available and they are also safe for pregnant women to use after the first trimester. However, they are expensive and time-intensive to produce, which has restricted availability and use of these vital drugs. At present ACTs have a short shelf life, therefore stock needs to be carefully planned and managed to prevent wastage.