Combined malaria drugs could cut child deaths

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The study, published in Nature Communications last month (6 June), found that a combination of sulphadoxine-pyrimethamine (SP) and amodiaquine could protect children from malaria transmission during rainy seasons — when new cases of malaria peak due to higher mosquito numbers — and prevent around 80 per cent of both severe and uncomplicated malaria cases. The study, led by Matt Cairns, an epidemiologist from the London School of Hygiene & Tropical Medicine, and involving African researchers, found that monthly administrations of the treatment — known as Seasonal Malaria Chemoprevention (SMC) — can be delivered safely and successfully. Cairns told SciDev.Net: "Where this approach has been used, it has worked very well and prevented around eight out of every ten malaria cases, and a similar number of severe cases which resulted in children needing to be admitted to hospital". This approach would be most effective in the Sahel and Sub-Sahel, a wide belt of land — stretching from the Gambia and Senegal to Sudan — which experiences prolonged dry, hot conditions with seasonal rains only. The region is home to approximately 14 million children aged under five, who are at risk of malaria. Unfortunately the combination will not work in Southern and East Africa because these regions have developed resistance to the trialled drugs, and would thus need a different drug combination, according to Cairns. The clinical trials, which combined satellite maps of rainfall with information on the malaria burden in different areas of Africa, were carried out in Burkina Faso, the Gambia, Ghana, Mali and Senegal. Cairns said there are several challenges to this approach, including funding, awareness creation, and the logistics of large-scale delivery of drugs. But he added: "Similar challenges were faced in the past for other strategies used to control malaria and for the delivery of antiretroviral drugs for HIV, so there is good reason to hope that these challenges can also be overcome for SMC". Willis Akhwale, head of disease control and prevention at the Kenyan Ministry of Public Health, said this approach would not work in areas where malaria transmission is perennial, such as Kenya. "In the Sahel region, it is so dry that most malaria vectors cannot survive there, but when the rains come, the vectors multiply very fast and cause death because [people's] immunity is low," Akwale said. Link to full paper in Nature Communications