Researchers trying to create the world’s first malaria vaccine are launching a massive medical trial as early as next month involving 16,000 children that could be the largest such trial ever conducted on children in Africa.

British-drugmaker GlaxoSmithKline PLC is teaming with the PATH Malaria Vaccine Initiative, which is an anti-malaria charity funded by the Bill & Melinda Gates Foundation, and clinics and research centers in Africa to develop a malaria vaccine.

"This is probably going to be one of the largest studies in infants and in children in Africa," said Joe Cohen, a top vaccine researcher for GlaxoSmithKline.

Malaria, caused by parasites and spread by mosquitoes, kills nearly 1 million people every year, most of them children in Africa. The trial may start as early as next month, and should be well under way by January, said Cohen.

The massive vaccine trials will be conducted in Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique and Tanzania. Dr. Christian Loucq, director of the Malaria Vaccine Initiative, said the project has been working over the past year to upgrade laboratory, computer and other equipment in those countries, train technicians, and even help develop local equivalents of the U.S. Food and Drug Administration to ensure the trials are properly monitored.

The Malaria Vaccine Initiative has so far spent $107 million on the project and has not yet calculated how much more it will spend. GlaxoSmithKline has spent $300 million so far, and estimates it will spend up to $100 million more.

Researchers working on the trial said in an interview in Johannesburg that much of the groundwork already has been laid in preliminary trials involving 4,000 children conducted since 2003. They said that even if their vaccine does not succeed, the widespread investment needed to conduct the trials means that Africa will be left with better communications, research and other infrastructure that could be used in the search for vaccines against other diseases such as AIDS.

While the researchers were optimistic, it will be several years before they know whether their vaccine candidate is safe and effective enough for wide use.

The preliminary trials showed the vaccine was likely to be at least 30 percent effective against mild malaria cases and about 50 percent effective against severe malaria. That may sound low compared to, for example, the injectable polio vaccine that is at least 90 percent effective. But researchers have found it difficult to pin down a vaccine for parasites, and further tests may show the GlaxoSmithKline candidate is more effective, Cohen said.

Dr. Michel Van Herp, an epidemiologist with the aid group Medecins Sans Frontieres, said a vaccine might have to be more effective than the GlaxoSmithKline candidate has been shown to be so far to be worth the effort of putting it in use. But he acknowledged that matching the effectiveness of the polio vaccine has proven difficult, and said a partially effective vaccine "at least will reduce the workload on the health sector."

Medecins Sans Frontieres, also known as Doctors Without Borders, is not involved in vaccine research, but is at the forefront of treating malaria among the poor in Africa and elsewhere.

The vaccine would have to be used along with preventive measures like mosquito nets and insecticides to save lives.

Dr. Eusebio Macete, who is director of the Manhica Research Centre in Mozambique and was involved in some of the early field trials, said stopping any percentage of the disease would be welcomed in areas "where people are dying every day of malaria."

"It’s a huge, huge burden, this disease," Macete said. "Whatever percentage we can get will be useful in reducing the impact of the disease."

After years of death and despair, opportunity has finally begun knocking at the door of malaria eradication.  A report released in September by the World Health Organization (WHO) showed promising signs of progress in the fight against the disease that kills one million people every year.

It found that, between 2000 and 2006, more than 25 countries managed to cut their malaria death totals in half. What’s more, the total number of infections around the world now stands at 247 million, down from the 350-500 million estimated in WHO’s 2005 report.

These drops are credited to what the report calls “a renewed assault on malaria,” which includes ever-more effective and affordable anti-malaria pills as well as a greater distribution of insecticide-laced bed nets to repel mosquitoes that carry the disease.

This is good news indeed, especially since malaria often doesn’t get the attention it deserves.

But the worst thing the world can do now is to stop and celebrate. That’s because these steps forward are just the beginning of a long road ahead. Malaria still kills some 3000 people every day in sub-Saharan Africa alone, mostly children under five.

Nearly half the world’s population lives in areas where malaria is a constant threat. Yet despite recent improvements, far too few people have access to life-saving medicine and only 2 per cent of African children sleep under a bed net.

Aside from the overwhelming human toll, the disease also wreaks havoc on economies and on social stability. The UN says that in Africa, where most cases occur, malaria costs $12 billion a year in lost GDP. Add to that the resulting poverty and increased health care costs and it becomes clear that the disease hurts far more than just those infected.

So if the battle against malaria is going to be won, we must maintain and even step up our “renewed assault.”

There’s little doubt that malaria can be completely eradicated. As the latest statistics prove, we have the knowledge and tools to defeat the disease. All that remains is to stir up enough political will.

Any global leader with enough compassion and foresight will find a wonderful opportunity to make a real difference in the world by investing in malaria treatment and prevention.

Such an investment wouldn’t even cost that much. According to the UN, just $2 billion a year is needed to halve the global impact of malaria by 2010. Even simple bed nets, which help drastically reduce the number of cases, cost less than $10 a piece to produce and ship.

Yet right now the world spends a mere $600 million on the disease.

When you consider that makeup and perfume is a $33 billion industry, or that Europeans and Americans spend just under $20 billion a year on pet food, $2 billion a year for malaria prevention is a tiny investment with a huge return.

Even in the U.S., where dire economic turmoil makes increased funding for international development very unlikely, whoever wins the upcoming election will find a straightforward and affordable way to begin restoring America’s image abroad by taking the lead on malaria eradication.

At around the same time that the WHO released its 2008 malaria report, Bill and Melinda Gates were co-hosting the UN Malaria Summit, which brought together politicians, celebrities and activists to discuss ways to tackle the disease.

What resulted from the meeting was the Global Malaria Action Plan, step-by-step instructions on how the world can improve distribution of life-saving drugs and bed nets, while also increasing funding for malaria research.

The plan estimates that more than four million lives can be saved by 2015.

This means time is of the essence. If the world can build upon its small successes, malaria can go the way of smallpox, which was eradicated in 1977. That accomplishment is heralded as one of the greatest achievements of modern medicine.

But if global attention wavers, millions of men, women and children will continue to suffer and die, not just at the hands of tiny mosquitoes, but also as a result of our indifference.

The Global Fund to Fight AIDS, Tuberculosis and Malaria is pleased to announce that its Board has approved 94 new grants worth US$2.75 billion over two years. It is the eighth time the Global Fund Board approved new proposals to support programs fighting the three diseases and it is the largest round in the history of the organization, well over twice the size of any previous round.  The decision was made in New Delhi over the weekend, where the Global Fund held its board meeting.

Round 8 now brings the Global Fund’s overall portfolio to US$ 14.4 billion in 140 countries. 

“This is the highest amount of new financing approved by the Global Fund ever. These new resources will significantly help the world in achieving global targets such as universal access to AIDS treatment and prevention, and cutting the number of deaths from tuberculosis and malaria by half by 2015,” said Rajat Gupta, Chair of the Global Fund Board.

“This exceptional expression of increased demand requires a renewed resource mobilization effort,” said Michel Kazatchkine, the Executive Director of the Global Fund. “We have a fantastic message to bring back to the rich nations of the world: Programs to fight these three diseases save lives, reduce disease burdens, and strengthen health systems. We are asking you for resources for an effective way to reduce the gap between rich and poor and build a better and safer world.”

Of the approved proposals, the majority of resources go to malaria programs accounting for 51 percent.  Proposals for AIDS and tuberculosis account for 38 percent and 11 percent, respectively, of the approved funding.

Ninety percent of the approved grants today are for low-income countries, with the majority of resources – 77 percent – for Africa and the Middle East. Asia and the Western Pacific will receive 14 percent of the newly approved funding, Latin America and the Caribbean 6 percent, and Eastern Europe and Central Asia 6 percent.

The Global Fund’s next funding round will be approved in November 2009.

In a separate development, Friends of the Global Fund South- and West Asia was launched in New Delhi.  Friends South- and West Asia will be a leading advocate for programs supported by the Global Fund in the region. The new advocacy organization will also seek to help Global Fund recipient countries to get the best possible results from the grants that they receive.  Its Board of Directors and Advisory Board include a number of leading regional business leaders, health experts and academics.

Friends South- and West Asia is the latest such organization to be established since the Global Fund’s creation in 2002 and joins a network of associations around the world including the United States, Japan, Europe, Africa and Latin America

www.mrcglobal.org/rfp

Deadline for proposal submission: 16 January 2009

The McLaughlin-Rotman Centre for Global Health (MRC) and its Ethical, Social and Cultural Program (ESC) for the Grand Challenges in Global Health (GCGH) Initiative are pleased to invite individuals, institutions, organizations and companies from the developing world to submit proposals to carry out projects that will facilitate the implementation and use of technologies in the developing world that arise from the GCGH projects.

The goal of this Request for Proposals (RFP) is to select and commission research on strategies that will facilitate the implementation and appropriate use in the developing world of technologies that arise from the GCGH projects related to diagnostics, modified insect vectors, nutritionally enhanced foods, and vaccine delivery.

Attached is the advertisement that we are currently circulating internationally. We invite you to consider this RFP for any related work you may be involved in and would also be grateful if you could kindly forward this advertisement to any of your colleagues who may be interested in applying.

Please visit www.mrcglobal.org/rfp for further information. The deadline to submit proposals is January 16th, 2009.

Giha HA, Elghazali G, A-Elgadir TM, A-Elbasit IE, Elbashir MI. Severe malaria in an unstable setting: clinical and laboratory correlates of cerebral malaria and severe malarial anemia and a paradigm for a simplified severity scoring. Eur J Clin Microbiol Infect Dis. 2008 Nov 12. [Epub ahead of print]
An interpretation of historical, clinical, and laboratory data was made to identify the correlates of and the diversity between cerebral malaria (CM) and severe malarial anemia (SMA) in a setting of low, seasonal, and unstable malaria transmission in eastern Sudan. Hemoglobin (Hb), random blood glucose (RBG), and anti-MSP antibodies were measured. Results showed that SMA and CM were significantly different with regard to age, malaria history, fever duration, convulsions, and hepatosplenomegaly…

Kursula I, Kursula P, Ganter M, Panjikar S, Matuschewski K, Schüler H. Structural Basis for Parasite-Specific Functions of the Divergent Profilin of Plasmodium falciparum. Structure. 2008 Nov;16(11):1638-48
Profilins are key regulators of actin dynamics. They sequester actin monomers, forming a pool for rapid polymer formation stimulated by proteins such as formins. Apicomplexan parasites utilize a highly specialized microfilament system for motility and host cell invasion…

Pombi M, Caputo B, Simard F, Di Deco MA, Coluzzi M, Della Torre A, Costantini C, Besansky NJ, Petrarca V. Chromosomal plasticity and evolutionary potential in the malaria vector Anopheles gambiae sensu stricto: insights from three decades of rare paracentric inversions. BMC Evol Biol. 2008 Nov 10;8(1):309. [Epub ahead of print]
In the Anopheles gambiae complex, paracentric chromosomal inversions are non-randomly distributed along the complement: 18/31 (58%) of common polymorphic inversions are on chromosome arm 2R, which represents only ~30% of the complement. Moreover, in An. gambiae sensu stricto, 6/7 common polymorphic inversions occur on 2R. Most of these inversions are considered markers of ecological adaptation that increase the fitness of the carriers of alternative karyotypes in contrasting habitats...

Behrens RH, Carroll B, Smith V, Alexander N. Declining incidence of malaria imported into the UK from West Africa. Malar J. 2008 Nov 10;7(1):235. [Epub ahead of print]
Two thirds of all falciparum malaria cases reported in the United Kingdom (UK) are acquired in West Africa (WA). To ensure recommendations and guidelines for malaria prophylaxis in travellers to West Africa correlate to the risk of infection, a study was undertaken to examine recent trends and predict future patterns of imported malaria acquired by UK residents visiting West Africa and West African visitors to the UK between 1993 and 2006...

Beare NA, Harding SP, Taylor TE, Lewallen S, Molyneux ME. Perfusion Abnormalities in Children with Cerebral Malaria and Malarial Retinopathy. J Infect Dis. 2008 Nov 10. [Epub ahead of print]
In patients with cerebral malaria (CM), retinal angiography allows the study of infected central nervous system microvasculature in vivo. We aimed to examine retinal perfusion in children with CM by use of fluorescein angiography to investigate the pathophysiology of CM...

Durand PM, Naidoo K, Coetzer TL. Evolutionary patterning: a novel approach to the identification of potential drug target sites in Plasmodium falciparum. PLoS ONE. 2008;3(11):e3685. Epub 2008 Nov 10
Malaria continues to be the most lethal protozoan disease of humans. Drug development programs exhibit a high attrition rate and parasite resistance to chemotherapeutic drugs exacerbates the problem. Strategies that limit the development of resistance and minimize host side-effects are therefore of major importance. In this study, a novel approach, termed evolutionary patterning (EP), was used to identify suitable drug target sites that would minimize the emergence of parasite resistance...

Hargreaves S. Malaria advances still not reaching patients, warns charity. Lancet Infect Dis. 2008 Nov;8(11):667
A new report from the international medical organisation Médecins Sans Frontières (MSF) says that measures to ensure new diagnostics and artemisinin-based combination therapy (ACT) actually reach patients are now crucial. Merely shipping drug treatment to resource-poor countries is not enough, say the authors, citing weak distribution and health systems and a lack of qualified staff as just some of the problems. The report was published in the wake of the high-level UN Millennium Development Goal m...

The MIM Website is now bilingual, available both in English and French.

To access the French version, click http://www.mimalaria.org/fr/

L’Initiative multilatérale sur le paludisme (MIM) fut établie en 1997 avec mission de renforcer et de soutenir la capacité des pays d’Afrique sévèrement touchés par le paludisme à effectuer les recherches nécessaires au développement et à l’amélioration des outils servant à.. Lire plus

The Multilateral Initiative on Malaria (MIM) is now accepting abstracts for the Fifth MIM Pan-African Malaria Conference to be held 2-6 November, 2009 at the Kenyatta International Conference Centre (KICC), Nairobi, Kenya.

MIM Conferences are currently the largest meetings worldwide entirely devoted to malaria research and control and provides a unique forum for the malaria community including junior scientists to meet senior researchers and discuss recent findings, representatives of the malaria stakeholders to identify priority research areas, translation of operational problems to researchable questions and available research results into policy and operational guidelines.

A limited number of scholarships are available for junior scientists/researchers from malaria endemic countries.

Visit www.mimalaria.org/pamc for more information, online registration and abstract submission.

Researchers from Nijmegen and Leiden have found potential malarial therapeutic targets that may in the development of a vaccine to treat the disease.

They have identified a large number of parasite proteins that help in bringing human malaria vaccine closer to reality.

Malaria is spread by mosquito bite, once injected the parasites migrate to the liver where they mature and then their sporozoites (infective cells) are released into the blood, causing disease and fatal complications.

During the study the researchers genetically modified the proteins essential for sporozoite development, and could weaken these parasites such that they invade liver cells and stimulate an immune response, but don”t develop further.

Previous studies have shown how to successfully vaccinate mice using a rodent malaria which had one of these liver stage genes removed, specifically p36p.

The researchers showed the first transition of such a vaccination from the rodent system to humans, by inactivating the equivalent gene (p52) in the major human malaria parasite, P. falciparum. These human parasites are unable to develop in liver cells.

The researchers believe that the findings may open up new pathways for its use as a human vaccine.

The findings are published October 31st in the open-access journal PLoS Pathogens

Incidence of malaria in Gambia has plunged thanks to an array of low-cost strategies, offering the tempting vision of eliminating this disease in parts of Africa, a study published Friday by The Lancet said.

At four key monitoring sites in the small West African state, the number of malarial cases fell by between 50 percent and 82 percent between 2003 and 2007, its authors found.

The tally of deaths from malaria, recorded at two hospitals where there had been a total of 29 fatalities out of 232 admissions in 2003, fell by nine-tenths and 100 percent in 2007. A fall of 100 percent means that no deaths attributed to malaria occurred that year.

"A large proportion of the malaria burden has been alleviated in Africa," the study concludes.

The authors also found a substantial shift in the age of Gambian children being admitted for care -- from an average of 3.9 years in 2003 to 5.6 years in 2007.

This is important because young children and infants bear the brunt of malaria mortality.

According to figures released on September 18 by the UN’s World Health Organization (WHO), around 247 million cases of malaria occurred in 2006, causing nearly a million deaths, mostly of children aged under five.

Gambia’s success is due to a combination of several factors that have especially benefited pregnant women and children, says the paper.

These include distributing insecticide-treated bed nets; programmes to spray homes; and the use of the more powerful drugs to replace treatments to which the malaria parasite has become resistant.

"(...) Increased investment in malaria interventions in Africa can have a major effect on reducing morbidity and mortality from the disease," said one of the authors, David Conway, of the London School of Hygiene and Tropical Medicine.

"We need to consider the possibility of future elimination of malaria from some areas in Africa but we also emphasize the importance of continuous surveillance, and there is no room for complacency with this disease."

A study out today shows a dramatic fall in the number of people dying from malaria infection in coastal Kenya. The research, funded by the Wellcome Trust and the Kenya Medical Research Institute (KEMRI), highlights the importance of the prevention and rapid treatment of malaria infection in preventing a potential resurgence of the disease.

Malaria is one of the world’s biggest killers, responsible for over a million deaths every year, mainly in children and pregnant women in Africa and south east Asia. It is caused by the malaria parasite, which is injected into the bloodstream from the salivary glands of infected mosquitoes.

In areas where transmission rates of malaria are high, death occurs most frequently in young children, usually as a result of severe anaemia. Surviving children rapidly develop immunity to the disease and severe malaria is rarely seen in older children. Where transmission rates are lower, the proportion of older children infected with malaria increases – in older children, malaria can lead to even more serious complications as the parasites reach the brain.

Researchers from the KEMRI-Wellcome Trust programme in Kilifi, eastern Kenya, have analysed eighteen years of detailed hospital surveillance data in a large endemic area of the Kenyan coast to look at whether incidence of malaria have been falling and what impact this will have on disease and mortality in the population. The results are published today in the journal The Lancet.

Whilst the researchers found that transmission rates for malaria have been steadily falling over the past ten years, the number of cases of severe malaria only began to fall more recently. However, the past five years have seen a remarkable fall of over 75% in the number of severe malaria deaths from malaria, down from 10.8 per 10,000 to 1.2 per 10,000.

"These are incredibly positive findings and reflect what is being seen along the east African coast," says Professor Kevin Marsh, head of the KEMRI Wellcome Trust programme and a researcher at the University of Oxford. "It gives us hope that tackling malaria across the continent is an achievable goal."

Professor Marsh and colleagues believe that a number of reasons may be behind this dramatic reduction in incidence of the disease, reflecting the success of control measures and early treatment. These include changes since the mid ’90s in the first line therapy, with new drugs replacing the previously widely-used treatment, chloroquine, which had become ineffective due to drug-resistance.

Other factors that may have contributed to the decline include the increasing use of insecticide-treated bednets and better management of mosquito breeding sites.

Researchers had predicted that falling transmission rates would have left older children unexposed to malaria and therefore with no immunity, resulting in an increase in cases of cerebral malaria. In fact, whilst they indeed found a small rise in the number of cases of cerebral malaria, this was more than offset by the marked decrease in severe malarial anaemia and other forms of malaria.

"There are many factors that may have contributed to this dramatic reduction in malaria deaths, but one thing is clear: we must not become complacent," says Professor Marsh. " As transmission rates continue to fall, younger children are growing up with less exposure to malaria. It’s essential that we maintain control measures, look for new ones and emphasise early treatment to prevent a resurgence of this deadly disease."

The findings have been welcomed by Dr Mark Walport, Director of the Wellcome Trust.

"These are important results - they show that malaria can be controlled in parts of the world where for centuries it has been a major killer of children and pregnant women," says Dr Walport. "These findings should provide encouragement to those dedicated to the control and ultimately the eradication of malaria.

No one can doubt that over the past few years, Africa has embarked on a path of unprecedented economic growth and social development. Several countries on the continent have made significant strides on delivering better education, health, and poverty reduction results. At the same time, African leaders have taken concrete steps toward improving governance, and have initiated reforms to boost trade and make the investment climate more attractive. Even though poverty has not been eradicated, the growth indicators, which show an average of 5.4% GDP per capita over the past decade, suggest an emergent continent on the path of securing a more prosperous future for its people.

This is unlikely to be sustained unless the productivity of Africa’s human capital is guaranteed.  The good news is that massive efforts by the international community and African countries themselves have resulted in thousands of lives being saved and many healthier. Still, millions of Africans die every year unnecessarily from entirely preventable causes. Malaria is one of these causes, a disease that infects more than 500 million people around the world, mostly women and children. Over 90 percent of the million worldwide annual deaths from malaria occur in Africa. This ruthless disease is estimated to cost the continent about US$12 billion a year in lost productivity. A growing Africa cannot afford this burden. There is no question that the progress already achieved will be seriously undermined if the magnitude of the disease continues at current levels.

Of all the issues Africa still faces, malaria is what one can call “a low hanging fruit”. Global partners and countries have seized the intense focus and energy around malaria by making a commitment to eliminate it from the continent. Our optimism and bold ambition are not unfounded.  We have effective medicines, bed nets and a wealth of knowledge being shared across countries and programs. We have the resources to take on regional interventions that cross borders, like the mosquitoes themselves. The international community, under the umbrella of the Roll Back Malaria Partnership, has been mobilized – governments, NGOs, global organizations, research institutions, and the private sector are working together to halve malaria deaths by 2010. Artists worldwide are putting human voices and faces behind the numbers to make malaria resonate for those unaware of its impact.  Health workers in Africa are helping people affected by malaria and parents are increasingly taking more measures to protect themselves and their children. The war to eliminate this scourge is spreading.

African countries are leading this war, but they cannot do it alone. The global community needs to help Africa massively scale up malaria control efforts. Partners have entirely subscribed to this vision and will support African countries in their efforts to provide universal coverage with effective malaria control methods to the entire Sub-Sahara African population at risk of malaria.  As one of the three largest malaria control financiers, the World Bank is contributing significantly to the progress being made.  Through its Booster Program for Malaria Control in Africa, the Bank has committed about US$470 million to malaria control efforts in Africa and plans to commit significantly more so that several countries can quickly ramp up their efforts to bring the disease under control. Responding to the urgency of the disease and with clear evidence of African countries’ commitment to doing something about it, other partners are also putting more resources on the table. The Global Fund provided more funding for malaria programs in its last round than ever before. The United Kingdom recently announced it would buy 20 million bed nets for Africa.

Increased funding is important and necessary, but it is not sufficient. The world needs to know about the progress made in the fight against malaria.  Action by African artists and musicians in this regard has been successful. The 2005 AFRICA LIVE: Roll Back Malaria Concert – a two-day stadium show in Dakar featuring seventeen of Africa’s most celebrated musicians – reached the hearts and minds of more than a billion people in broadcast coverage worldwide We need to support more of these endeavors that show malaria’s human side. A faceless disease will not be enough to spark off the commitment needed to control it.

We have before us an extraordinary window of opportunity to improve the future prospects for millions of people in Africa.  This opportunity may not come again. We have an obligation to turn the current momentum into concrete results, to help Africa defeat malaria.  Africa’s time is now and malaria’s time is up. Working together we will ensure that future generations stay alive to eat well, go to school, enjoy clean water and electricity, and fuel Africa’s transition into prosperity and sustained growth

Applications are now being accepted through December 1, 2008, for the 2010 Cunningham Memorial International Fellowship. The award is given annually to citizens or permanent residents from countries outside the United States and Canada who have both an undergraduate degree and a master’s level library degree and are working or preparing to work in a health sciences library in their countries.

The program will provide a three-week learning experience including attending MLA 2010 and a one-to-two week stay at one or more medical library host sites.  Two Cunningham awards of $3500 each are available.

The Cunningham Fellowship was established in 1967 and named in honor of Eileen Cunningham.

Go to www.mlanet.org/awards/grants/ for links to a fact sheet and application.

For more information, please contact:

Lisa C. Fried
Credentialing, Professional Recognition, and Career Coordinator at

Tel. 312.419.9094, ext 28 or
E-mail: mlapd2@mlahq.org

Deadline for applications: 15 December 2008

In collaboration with the University of Siena Medical School, Novartis Vaccines is organising a two-year Masters Programme in Vaccinology and Clinical Development which will start in May 2009.

The purpose of this Masters is to provide graduates in Medicine with training on all aspects of developing vaccines, from basic research to clinical development, health authority approval and beyond.

Students will participate in real life clinical and regulatory activities within the company and will be intensively involved in development programs.

The two year Masters will be completed with a dissertation leading to an M.Sc. degree from the University of Siena.

A 2-year grant will be provided to students who are accepted.

We are confident that participation in this Masters will prepare the students for a career in academia, public health or vaccine clinical development within the pharmaceutical industry.

In the enclosed brochure you will find more information about the Masters programme and the procedures to be followed for the application.

Apply by sending your curriculum vitae and a letter of motivation to vaccines_master.nvdit@novartis.com before December 15th, 2008.

For further information concerning applications, please consult the university website:

http://www.unisi.it/ammin/udss/affari_generali/stranieri_english.htm

For further information, contact:

Audino Podda, MD                                                                                  
Head, Clinical Development      
Novartis Vaccines Institute for Global Health (NVGH)                                   
Via Fiorentina, 1
53100 Siena
Tel. +39 0577 243496
Cell +39  335 70 26 950 

email audino.podda@novartis.com

Ouma C, Davenport GC, Were T, Otieno MF, Hittner JB, Vulule JM, Martinson J, Ong’echa JM, Ferrell RE, Perkins DJ. Haplotypes of IL-10 promoter variants are associated with susceptibility to severe malarial anemia and functional changes in IL-10 production. Hum Genet. 2008 Oct 30. [Epub ahead of print]
Plasmodium falciparum malaria is one of the leading global causes of morbidity and mortality with African children bearing the highest disease burden. Among the various severe disease sequelae common to falciparum malaria, severe malarial anemia (SMA) in pediatric populations accounts for the greatest degree of mortality…

Kyabayinze DJ, Tibenderana JK, Odong GW, Rwakimari JB, Counihan H. Operational accuracy and comparative persistent antigenicity of HRP2 rapid diagnostic tests for Plasmodium falciparum malaria in a hyperendemic region of Uganda. Malar J. 2008 Oct 29;7(1):221. [Epub ahead of print]
Parasite-based diagnosis of malaria by microscopy requires laboratory skills that are generally unavailable at peripheral health facilities. Rapid diagnostic tests (RDTs) require less expertise, but accuracy under operational conditions has not been fully evaluated in Uganda. There are also concerns about RDTs that use the antigen histidine-rich protein 2 (HRP2) to detect Plasmodium falciparum, because this antigen can persist after effective treatment, giving false positive test results in the absence of infection…

McCallum FJ, Persson KE, Mugyenyi CK, Fowkes FJ, Simpson JA, Richards JS, Williams TN, Marsh K, Beeson JG. Acquisition of growth-inhibitory antibodies against blood-stage Plasmodium falciparum. PLoS ONE. 2008;3(10):e3571. Epub 2008 Oct 29.
Antibodies that inhibit the growth of blood-stage Plasmodium falciparum may play an important role in acquired and vaccine-induced immunity in humans. However, the acquisition and activity of these antibodies is not well understood. METHODS: We tested dialysed serum and purified immunoglobulins from Kenyan children and adults for inhibition of P. falciparum blood-stage growth in vitro using different parasite lines...

van Schaijk BC, Janse CJ, van Gemert GJ, van Dijk MR, Gego A, Franetich JF, van de Vegte-Bolmer M, Yalaoui S, Silvie O, Hoffman SL, Waters AP, Mazier D, Sauerwein RW, Khan SM. Gene disruption of Plasmodium falciparum p52 results in attenuation of malaria liver stage development in cultured primary human hepatocytes. PLoS ONE. 2008;3(10):e3549. Epub 2008 Oct 28
Difficulties with inducing sterile and long lasting protective immunity against malaria with subunit vaccines has renewed interest in vaccinations with attenuated Plasmodium parasites. Immunizations with sporozoites that are attenuated by radiation (RAS) can induce strong protective immunity both in humans and rodent models of malaria. Recently, in rodent parasites it has been shown that through the deletion of a single gene, sporozoites can also become attenuated in liver stage development and, importantly, immunization with these sporozoites results in immune responses identical to RAS...

Tatem AJ, Guerra CA, Kabaria CW, Noor AM, Hay SI. Human population, urban settlement patterns and their impact on Plasmodium falciparum malaria endemicity. Malar J. 2008 Oct 27;7(1):218. [Epub ahead of print]
The efficient allocation of financial resources for malaria control and the optimal distribution of appropriate interventions require accurate information on the geographic distribution of malaria risk and of the human populations it affects. Low population densities in rural areas and high population densities in urban areas can influence malaria transmission substantially. Here, the Malaria Atlas Project (MAP) global database of Plasmodium falciparum parasite rate (PfPR) surveys, medical intelligence and contemporary population surfaces are utilized to explore these relationships and other issues involved in combining malaria risk maps with those of human population distribution in order to define populations at risk more accurately...

Download GMAP at: www.rollbackmalaria.org/gmap/

Four million malaria deaths can be diverted by 2015 cites RBM Partnership

More than 4 million lives can be saved by 2015 if resources are scaled up, reports a new malaria elimination plan today, launched by members of the international community attending the UN Summit in New York.

The Global Malaria Action Plan (GMAP) details how to accelerate action against malaria, across countries and regions, leading to elimination of the disease. Developed through the framework of the Roll Back Malaria (RBM) Partnership, it rallies 30 endemic countries and regions and 65 international institutions behind an unprecedented effort to achieve more rapid results against malaria.

Malaria affects half of the world’s population – 3.3 billion people in 109 countries – causing nearly 1 million deaths per year. According to GMAP’s projections, more than 4.2 million lives can be saved between 2008 and 2015, if the plan is put into action. In addition, millions of dollars of lost GDP can be recovered and critical healthcare resources freed up in regions to tackle other health and social challenges.

Effective malaria control will cost only a fraction of the losses that endemic countries endure today due to malaria, the GMAP posits. Africa alone is estimated to lose at least $12 billion per year in direct costs and much more in GDP losses. Achieving full control in all endemic countries, including strengthening health systems, will cost approximately $5.3 billion in 2009, $6.2 billion in 2010 and $5.1 billion annually from 2011 to 2020.

“The action plan that we are putting forward to global leaders today is a historic milestone in the fight against malaria,” said Professor Awa Marie Coll-Seck, Executive Director of the RBM Partnership. “Putting the plan into action should now become the next priority for the international community," Coll-Seck added, explaining that implementing the plan will help achieve six of the eight Millennium Development Goals.

The GMAP offers a comprehensive blueprint for reducing malaria. It provides timelines for delivering nets and drugs to all people at risk in Africa, Asia-Pacific, the Americas, the Middle East and Eurasia. It also outlines a strategy for increasing investment in research for new tools to eliminate and eventually eradicate malaria globally. Research will cost at least $750 million annually over the next ten years, according to the plan’s estimates.

"In Ethiopia, we provided universal access to protective nets in 18 months only,” said Dr Tedros Adhanom, Ethiopia’s Minister of Health and Chair of the RBM Partnership Board. “The challenge now is to make such successes work on a larger scale and in all affected regions.

This is what the Global Malaria Action Plan will help us do."

Reflecting malaria’s global scale, the plan is being launched today in all malaria endemic regions, including in the Philippines, Kenya, Mali and Brazil. It is endorsed politically at a UN Malaria Summit taking place at UN headquarters in New York.

During the New York launch event, co-hosted by the Bill & Melinda Gates Foundation, Malaria No More, the British Government as well as the UN Special Envoy for Malaria, heads of state, business leaders, and international celebrities are expected to pledge their commitment to turning the RBM plan into action.

In his opening address at the UN General Assembly earlier this week, Secretary-General Ban Ki-moon requested world leaders to honor their commitments to achieve the Millennium Development Goals, including Goal 6 which addresses malaria, AIDS and tuberculosis. Mr. Ban cited leadership and partnerships as vital ingredients in combating malaria and other pressing global challenges.

Similar calls to action were echoed by several heads of states at this week’s commencement of the 63rd Session of the General Assembly, including African Union President Jakaya Mrisho Kikwete and G8 leaders US President George W. Bush and French President Nicolas Sarkozy.

Earlier this month at a malaria awareness campaign in Paris, Nicolas Sarkozy, speaking as President of the Council of the European Union, urged his international counterparts to mobilize around efforts to eradicate malaria.

The Global Malaria Action Plan is available for download at: www.rollbackmalaria.org/gmap/

Bill Gates announced today that the Bill & Melinda Gates Foundation will provide $168.7 million to PATH for its Malaria Vaccine Initiative to develop vaccines for malaria—a disease that kills thousands of African children every day.

The PATH Malaria Vaccine Initiative (MVI) is working with GlaxoSmithKline Biologicals to develop a first-generation vaccine candidate, known as RTS,S, which could become the first-ever approved malaria vaccine. With the new grant announced today, MVI will support the development of next-generation vaccines that could provide even greater and longer-lasting protection.

"I’m very hopeful that the malaria vaccine currently in advanced testing will be proven effective, but that will just be the first step," said Gates, co-chair of the Gates Foundation. "Now it’s time to develop a new generation of vaccines that are even more effective, and could someday help eradicate malaria altogether."

Gates announced the new funding at the UN Millennium Development Goals Malaria Summit, a meeting of heads of state, CEOs, UN officials, and other leaders. At the event, the Roll Back Malaria Partnership launched the Global Malaria Action Plan, a comprehensive global strategy to fight malaria. The Gates Foundation grant and other commitments announced today will help address key priorities in the Action Plan.

Grant to Support Research on a New Generation of Malaria Vaccines

The Gates Foundation grant will support MVI’s efforts to expand its vaccine R&D pipeline with projects ranging from early-stage laboratory research to advanced clinical testing.  MVI will work with partners to discover new antigens and adjuvants that could lead to more effective vaccines, and develop new tools to select the most promising candidates for further development.

MVI will also work to foster a more competitive vaccine marketplace and help ensure that future vaccines will be affordable and accessible in developing countries.  They will conduct market assessments, demand forecasting, and modeling studies to guide policymakers and vaccine manufacturers, and partner with vaccine makers in developing countries to keep costs low.

"These new funds are recognition that we have a solid research and development strategy, and the team to deliver on it," said Dr. Christian Loucq, Director of MVI. "This commitment should signal to potential research partners that the time is ripe to work with us to help defeat this horrible disease. Already, we have added to our roster of partners and entered into collaborative agreements on vaccine components, ways to boost their potency, and methods for testing their biological activity."

"Our strategy for developing a malaria vaccine follows the PATH approach to neglected diseases, which has shown that investment in core areas of research and development, particularly vaccine technology, does yield important advances," said Dr. Christopher J. Elias, president and CEO of PATH. "The PATH Malaria Vaccine Initiative is now ready to accelerate further the development of what the world urgently needs: safe, effective, and affordable vaccines that reduce the suffering caused by malaria."

The grant addresses one of the priorities in the new Global Malaria Action Plan, released today by the Roll Back Malaria Partnership. The plan provides a unified global strategy for fighting malaria, including greater use of today’s tools, and research on vaccines and other new technologies.

"The Global Malaria Action Plan makes a compelling case for greater investment in malaria," said Gates. "If we have the chance to save millions of lives, and a clear plan to make it happen, we have an obligation to act. We’re committed to supporting a range of efforts to make the Action Plan a reality—today’s grant is just the first step."

New Malaria Control Success in Zambia and Ethiopia

Gates hailed new data from the World Malaria Report, released last week by WHO, showing encouraging progress against malaria in several African countries through 2006. He also highlighted more recent data from Zambia and Ethiopia that further demonstrate the impact of aggressive, large-scale malaria control programs.

The Zambian health ministry reported this week that since 2006, malaria control efforts have helped to reduce malaria parasite prevalence in children by 50 percent. Since 2002, the percentage of households with at least one insecticide-treated mosquito net has increased from 14 percent to 60 percent, and malaria control successes have helped to reduce overall child mortality by 29 percent.

Earlier this month, Ethiopia’s health ministry announced that it has reached nearly 70 percent of households in high-risk areas with at least one insecticide-treated mosquito net and/or indoor residual spraying, and that effective malaria treatment with artemisinin-based combination therapy is now available nationwide.

"The good news from Ethiopia and Zambia demonstrates that extraordinary progress can be made against malaria, even in the poorest and most remote communities," said Gates. "By building on and replicating these successes globally, we can save millions of lives."

Both countries are partners in the Malaria Control and Evaluation Partnership in Africa (MACEPA), a PATH initiative that is funded by the Gates Foundation

African malaria research experts have welcomed today’s announcements by Roll Back Malaria (RBM) and the Bill & Melinda Gates Foundation which pledged continued support and additional funding for malaria vaccine research.

AMANET (African Malaria Network Trust), with headquarters in Dar-es-Salaam, Tanzania and INDEPTH Research Network (the International Network for Demographic Surveillance of Populations and their Health in Developing Countries), with headquarters in Accra, Ghana, are two African research institutions currently building research capacity and searching for a malaria vaccine. Their trial sites are spread throughout Africa, and have candidate malaria vaccines being tested in Burkina Faso, Gabon, Ghana, Kenya, Mali, Sudan, Tanzania and Uganda.

Recent reports on the incidence of malaria showcase progress in providing access to short-term malaria control tools – specifically, preventive measures such as long lasting insecticidal nets (LLINs) and indoor residual spraying.

Good progress is also being made in the early diagnosis and correct appropriate treatment to cure malaria particularly in children under five years of age and pregnant women; these two constitute the most vulnerable groups in much of sub-Saharan Africa.

The enhanced malaria control as envisaged in the ambitious new Global Malaria Action Plan, when successfully implemented, will reduce malaria disease burden considerably, though in the long-term, the reduction to near zero will depend on entirely new malaria control tools. There is need therefore to focus on researching, developing and deploying the next generation of efficacious malaria control tools – and especially a successful malaria vaccine.

“Africa is where malaria strikes the hardest,” says Professor Wen Kilama, the Managing Trustee of AMANET. “Some 800 000 Africans – mainly children younger than five – die from malaria each year. This is over 90% of the global mortality from malaria, according to World Malaria Report 2008.

“Malaria also compounds Africa’s poverty and slows down its socio-economic development. It costs Africa at least USD 12 billion a year in direct losses and many times more than that in lost economic growth when examined over a long term. It is thus crucial that African scientific organisations are equipped and involved in searching for new and more effective malaria control tools,” argues Professor Kilama.

“As efforts to treat and prevent malaria are continuously being frustrated because the malaria parasite and mosquitoes are increasingly resistant to medicines and insecticides, an effective vaccine against malaria will help. Vaccines, in general, are the backbone of public health interventions, especially in poor countries, where they help contain or even eradicate leading killers. The Bill and Melinda Gates Foundation support for next generation malaria vaccines will greatly enhance current combined global efforts against malaria,” said Professor Kilama.

Speaking at the eighth INDEPTH Annual General Meeting being held in Dar es Salaam, Dr Osman Sankoh, the Executive Director of INDEPTH Network, says that malaria vaccine research in Africa has begun to provide critical leads towards an effective malaria vaccine for Africa. Commenting on just released funding commitments, Dr Sankoh said: “Sustainability of funding is so important, as effective research in Africa entails building capacity and strengthening health facilities. We are heartened by today’s announcements made by RBM and other partners, and look forward to playing our part in the global efforts to control and eventually eradicate malaria.”

Issued on behalf of AMANET & INDEPTH

By Meropa Communications, Johannesburg, South Africa, tel +27-11-772-1000

For further information or to schedule interview, please contact:

Charles Wanga, AMANET, P +255-22-2700018 M +255-78-433-7232

Samuel Mikenga, INDEPTH, P +233 21 519 395 M +27-72-529-6769

Khomotso Makuse P +27-11-7721000 Email kgomotsom@meropa.co.za or Maria Djordjevic M +27-82-334-6192 Email mariad@meropa.co.za

Sponsored by the UNICEF/UNDP/World Bank/WHO  Special Program for Research and Training in Tropical Diseases (TDR)

Organized by WHO/HQ Health Security and Environment Hosted by Faculty of Science and Techniques, University of Bamako, Mali

Dates: 3-7 December 2008

Application deadline:  15 October 2008

http://www.who.int/tdr/grants/grants/bl5_laboratory_biosafety.htm

Introduction

Vector-borne diseases occurring in more than 100 countries and affecting about half of the world’s population are emerging and resurging. Consequently, they result in high burden of disease. This worsening situation reflecting an inadequate impact of control measures is due to various factors including poor implementation of interventions, limited resources, and development of resistance to insecticides. However, it is generally recognized that effective prevention strategies can reverse this trend, and vec tor control is a key component of such strategies aiming at interrupting transmission. In addition, genome sequencing of the main vectors of malaria, dengue, and Human African Trypanosomiasis (HAT) carries the promise of radically improved vector control methods but this new approach will require careful and coordinated development, corroboration, and field evaluation.

TDR has participated for the past ten years with other organizations, in facilitating the development of genetically modified malaria and dengue vectors for interrupting pathogen transmission. This activity is actually mainly supported through the Gates Foundation Grand Challenges for Global Health projects on vector control. Therefore, TDR new strategy is focusing on the requirements to be addressed for potential field deployment of the genetic control methods. Most importantly, these include ensuring the  new methods are efficacious and particularly safe for humans and the environment.

In order to address this key aspect, TDR new strategy will help building capacity in Disease Endemic Countries (DECs) to prepare them to acquire the knowledge and experience necessary for the application of biosafety and biosecurity regulatory principles and practices. More specifically, it will strengthen their capabilities for effective and timely assessment and management of the potential risks for humans and the environment of the use of genetically-modified vectors(GMV) in view of the implementation of effective and safe genetic control tools for interrupting pathogen transmission. For this purpose, TDR has funded a project for developing best practice guidance for deployment of genetic control methods in disease endemic countries. In addition, TDR has already funded a biosafety training course for Africa and will be funding two others for Asia and Latin America. Furthermore, TDR has fund ed the  course, object of this call, to focus mainly on laboratory biosafety and biosecurity and complementing the three Regional biosafety training courses.

Objectives of the course

The course aiming at training the potential trainers in laboratory biosafety and biosecurity will run in theoretical and practical aspects for five days with the following specific objectives:

1. Highlighting the importance of implementation of biosafety and biosecurity standards to protect personnel and environment through good practices as well as safeguarding the GMVs 
2. Providing proper information to laboratory management and personnel on the principles and practices of laboratory biosafety and biosecurity guidelines.
3. Stressing the need for institutions and laboratories in Disease endemic countries to implement effective biosafety and biosecurity principles  and practices

Course content

Biosafety

1. Introduction. Principles of Laboratory Biosafety
2. Hazards and risks associated with handling of GMVs
3. Laboratory Biosafety Protocols
4. Containment Levels: Facility Design and Work Practices
5. Laboratory Animal facility
6. Biological Safety Cabinets
7. Accidents in handling GMVs/ Reporting of Accidents
8. Sterilization and Disinfection in the Laboratory
9. Risk assessment
10. Safe Handling of Laboratory Equipment and Materials
11. Personal Protective equipment PPE
12. Waste Disposal
13. Transport and Transfer of GMVs

Biosecurity

1. Introduction

2. Laboratory Biosafety VS Laboratory Biosecurity

3. Principles of Laboratory Biosecurity

4. Components of a biosecurity programme:

   - Risk assessment

   - Physical security

   - Personnel management

   - Accountability of GMVs

   - Biosecurity issues in transfer of  GMVs

   - Information security

   - Management of biosecurity activities

Course language: English

Participants eligibility

Decision makers, laboratory managers and researchers working or having the back ground knowledge on vector research and/or control from vector-borne disease endemic countries are mainly expected to participant in this course.

Selection Criteria

1. Good knowledge of vector biology and molecular entomology
2. Demonstrated experience in laboratory research on disease vectors
3. Basic knowledge and experience in laboratory biosafety and biosecurity
4. Involvement in development and implementation of laboratory based research projects
5. Ability to apply the training skill in home institution
6. Fluency in English
7. Availability for the entire duration of the course

Application procedure

All applications must be submitted using the application form (in MS Word format) to be downloaded from http://www.who.int/tdr/grants/grants/bl5_laboratory_biosafety.htm 

The completed application form, with a letter of recommendation from their institution should be sent electronically to: mohammadia@who.int 

1. All applications must be received by the deadline of 15 October 2008
2. Successful applicants will be notified by 1 November 2008
3. Course dates: 3-7 December, 2008
4. Course Venue: Faculté des Sciences et Techniques, Universite de
5. Bamako, Bamako, Mali

Course Coordinator:

Dr Ali A. Mohammadi
Scientist, Biosafety
Health security and Environment
World Health Organization
20 Avenue Appia
CH-1211  Geneva
Switzerland

Tel: +41 22-791 1804
Fax: +41 22-791 4666

E-mail: mohammadia@who.int

Mather MW, Vaidya AB. Mitochondria in malaria and related parasites: ancient, diverse and streamlined. J Bioenerg Biomembr. 2008 Sep 24. [Epub ahead of print]
Parasitic organisms have emerged from nearly every corner of the eukaryotic kingdom and hence display tremendous diversity of form and function. This diversity extends to their mitochondria and mitochondrion-derived organelles. While the principles of the chemiosmotic theory apply to all these pathogens, the differences from their hosts provide opportunities for therapeutic development. In this review we discuss examples of mitochondrial systems from a deep-branching phylum, Apicomplexa. Many important human pathogens, such as malaria parasites, belong to this phylum. Unique features of their mitochondria are validated targets for drugs that are selectively toxic to the parasites…

Chaudhuri R, Ahmed S, Ansari FA, Singh HV, Ramachandran S. MalVac: Database of malarial vaccine candidates. Malar J. 2008 Sep 23;7(1):184. [Epub ahead of print]
The sequencing of genomes of the Plasmodium species causing malaria, offers immense opportunities to aid in the development of new therapeutics and vaccine candidates through Bioinformatics tools and resources…

Vigan-Womas I, Guillotte M, Le Scanf C, Igonet S, Petres S, Juillerat A, Badaut C, Nato F, Schneider A, Lavergne A, Contamin H, Tall A, Baril L, Bentley GA, Mercereau-Puijalon O. An in vivo/in vitro model of Plasmodium falciparum rosetting and autoagglutination mediated by varO, a group A var gene encoding a frequent serotype. Infect Immun. 2008 Sep 22. [Epub ahead of print]
In the Saimiri sciureus monkey, erythrocytes infected with the varO antigenic variant of the Plasmodium falciparum Palo Alto 89F5 clone bind uninfected red blood cells ("rosetting"), form autoagglutinates and display a high multiplication rate, three phenotypic characteristics associated with severe malaria in human patients. We report here that varO parasites express a var gene presenting the characteristics of group A var genes, and show that the varO-DBL1alpha1 domain is implicated in the rosetting of both Saimiri sciureus and human erythrocytes...

Noland GS, Hendel-Paterson B, Min XM, Moormann AM, Vulule JM, Narum DL, Lanar DE, Kazura JW, John CC. Low prevalence of antibodies to pre-erythrocytic but not blood-stage Plasmodium falciparum antigens in an area of unstable as compared to stable malaria transmission. Infect Immun. 2008 Sep 22. [Epub ahead of print]
According to entomological studies conducted over the past 30 years, there was low malaria transmission in suburb of Dakar but little evidence of it in the downtown area. However; there was some evidence of local transmission based on reports of malaria among permanent residents. An entomological evaluation of malaria transmission was conducted from May 2005 to October 2006 in two areas of Dakar...

Aonuma H, Suzuki M, Iseki H, Perera N, Nelson B, Igarashi I, Yagi T, Kanuka H, Fukumoto S. Rapid identification of Plasmodium-carrying mosquitoes using loop-mediated isothermal amplification. Biochem Biophys Res Commun. 2008 Sep 19. [Epub ahead of print]
With an aim to develop a quick and simple method to survey pathogen-transmitting vectors, LAMP (loop-mediated isothermal amplification) was applied to the identification of Plasmodium-carrying mosquitoes, specifically a Plasmodium-transmitting experimental model using rodent malaria parasite (Plasmodium berghei) and anopheline mosquitoes (Anopheles stephensi). The detection sensitivity limit of the LAMP reaction amplifying the SPECT2 gene was determined to be 1x10(2) purified Plasmodium parasites, estimated to be sufficient for reliable identification of infectious mosquitoes...

Li L, Bian L, Yan G. A study of the distribution and abundance of the adult malaria vector in western Kenya highlands.  Int J Health Geogr. 2008 Sep 22;7(1):50. [Epub ahead of print]
A sharp rise in the malaria mortality rate has been observed recently in western Kenya. Malaria is transmitted by mosquito vectors. Malaria control strategies can be more successful if the distribution and abundance of mosquito vectors is predicted. However, how mosquito vectors are distributed in space remain poor understood, and this question is rarely studied using spatial methods. This study aims to provide a better understanding of the distribution and abundance of mosquito vectors

Half of the world’s population is at risk of malaria, and an estimated 247 million cases led to nearly 881 000 deaths in 2006. The advent of long-lasting insecticidal nets and artemisinin-based combination therapy, plus a revival of support for indoor residual spraying of insecticide, presents a new opportunity for large-scale malaria control. The World malaria report 2008 describes the global distribution of cases and deaths, how WHO-recommended control strategies have been adopted and implemented in endemic countries, sources of funding for malaria control, and recent evidence that prevention and treatment can alleviate the burden of disease.

Download the full report [pdf 4.9Mb] Corrigenda to the printed report

Summary & Key points English [pdf 144kb] | French [pdf 121kb] | Spanish [pdf 103kb] | Chinese [pdf 515kb] | Russian [pdf 150kb] | Arabic [pdf 100kb] | Portuguese [pdf 50kb]

New report finds more funding leading to increased coverage of malaria control interventions

The global burden of malaria remains enormous, but access to malaria control interventions, especially bednets in Africa, increased sharply between 2004 and 2006, says a new report released today.

"With dramatic increases in funding and intense momentum towards reducing the malaria burden in recent years, we have a greater need for reliable information and analysis," said WHO Director-General Dr Margaret Chan. "This report begins to answer that need. Progress in malaria control has accelerated dramatically since 2006, especially in the wake of the UN Secretary-General’s call for universal malaria control coverage by the end of 2010. We expect these expanded efforts to be reflected in future reports."

The World malaria report 2008, which draws upon data collected between 2004 and 2006, paints a complex picture. Some highlights are:

• New methods estimate that the number of malaria cases in 2006 was 247 million.
• Small children remain by far the most likely to die of the disease.
• Malaria deaths have declined in several countries, and a few African nations have managed to reduce deaths in half by following the recommended measures.
• As of 2006, more funding resulted in accelerated access to malaria interventions, including bednets and effective medicines.
• In Africa, the artemisinin-based combination therapy (ACT), which is recommended by WHO, reached only 3% of children in need.

Bednet coverage increasing

The report finds that recent increases in malaria funding were beginning to translate into coverage of key malaria interventions, especially bednets, by 2006. The percentage of children protected by insecticide-treated nets increased almost eightfold, from 3% in 2001 to 23% in the 18 African countries where surveys were held in 2006. Procurement of antimalarial medicines also increased sharply between 2001 and 2006. About 100 million people, including 22 million in Africa, were protected by indoor spraying of insecticide.

However, much more work remains to be done. In Africa, only 125 million people were protected by bednets in 2007, while 650 million are at risk.

"Malaria is a primary cause of child mortality," said Ann M. Veneman, Executive Director of the United Nations Children’s Fund (UNICEF). "If the availability of bednets and other key interventions can be increased, lives can be saved."

Positive impact

For the first time, three African countries reported dramatic reductions in malaria deaths by 50% or more. Eritrea, Rwanda and Sao Tome and Principe achieved this result between 2000 and 2006/2007 through a mix of bednet distribution, indoor spraying, improved access to treatment and advances in disease surveillance. Furthermore, significant improvements were observed in other African countries such as Madagascar, Zambia and the United Republic of Tanzania.

Six more countries reported a fall in malaria deaths by 2006: Cambodia, the Lao People’s Democratic Republic, the Philippines, Suriname, Thailand and Viet Nam.

"We know that malaria control interventions work and that we can make rapid progress towards ending malaria deaths," said Ray Chambers, the United Nations Secretary-General’s Special Envoy for Malaria. "Now is the time to expand these results to all of Africa and the rest of the world."

According to data from national malaria control programmes, Africa had a larger increase in funding than any other region between 2004 and 2006. The investments were led by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and supported by bilateral and multilateral organizations and national governments.

In other regions, sources of funding were highly variable, but national governments provided the bulk of monies. While funding for malaria was higher than ever before in 2006, it is not yet possible to judge which countries have adequate resources and there are still significant gaps.

For more information please contact:

Dick Thompson
News Team Leader
WHO, Geneva
Telephone:  +41 22 791 1492
Mobile:  +41 79 475 5534        
E-mail: thompsond@who.int

Fadela Chaib Telephone: +41 22 791 3228        
Mobile: +41 79 475 5556        
E-mail: chaibf@who.int

AT FIRST blush, the change seems like staggeringly good news. The World Health Organisation (WHO) has just issued a new report on malaria. The agency’s experts estimate that each year there are some 250m cases of malaria globally. That is a huge fall from the previous 350m-500m figure in a 2005 report.

A happy confluence of funding, political will and practical tools is indeed making a difference. Drug treatment that combines artemisinin, a powerful anti-malaria treatment, with other medicines, and the use of insecticide-embedded bed nets, are particularly effective.

Thanks to that, 20-plus countries outside Africa have seen their malaria burden decline in recent years. And even within Africa, which accounts for most of the world’s 880,000 or so malaria deaths each year, a handful of countries have made excellent progress. The number of new malaria cases in Eritrea fell by more than a half between 2001 and 2006. Rwanda and São Tomé and Príncipe made big gains too.

Sadly, the bigger reason for the seeming drop in the total number of malaria cases is the way the WHO counts them, a tricky task in countries with weak health-care systems. Previous reports relied on estimates dating back to the 1950s and 1960s in some countries outside sub-Saharan Africa. The new methodology takes the actual number of malaria cases reported by local health authorities as a starting point. Nearly half the fall comes thanks to counting cases in India by the new method.

The report comes on the eve of a United Nations malaria summit in New York on September 25th. Governments, philanthropic outfits (notably the Gates foundation), activists and celebrities will launch a new global strategy and collect hefty pledges in its support. Campaigners say that malaria’s moment has finally arrived.

If so, the assembled worthies may pay attention to a point made by Amir Attaran of the University of Ottawa. He argues that malaria and similar diseases need to be monitored like the weather, with what he calls “sentinel surveillance networks” throughout the developing world. This is essential both to measure malaria incidence more accurately and to assess the success or failure of various policies.

With enough time and effort, big reductions in malaria caseloads reported in future WHO studies could even be cause for celebration rather than embarrassment.

The World Health Organization (WHO) has cut its global estimate of yearly malaria cases by more than 100 million, according to a report released Thursday by the health agency. Almost all of that downward revision was attributable to updated surveillance numbers — mostly in Asia, and particularly in India — rather than a measurable reduction of actual malaria cases, agency staff said.

The last World Malaria Report in 2005, tallied the global incidence rate at between 350 million and 500 million new cases of malaria per year. The current report downgrades that figure to 247 million. Likewise, where the last report claimed that the disease kills "more than 1 million" people each year, the 2008 update, which is based on 2006 data (the most recent numbers available), suggests that figure is now closer to 800,000.

The impact of malaria, however, is still massive. "Whether it’s 200 million or 500 million [cases], that’s a lot of infections with a big health burden and a big economic burden," says Bernard Nahlen, deputy coordinator of the U.S. President’s Malaria Initiative — especially, he says, "for something that is treatable and to a large extent preventable. If your child’s life can be saved by treatment for 50 cents, you should treat."

But the WHO’s correction comes less than a year after the United Nations made a similar announcement, acknowledging last November that its AIDS-battling agency, UNAIDS, had overstated its estimates of the global HIV burden by about 6 million cases; that agency revised its numbers also based on newer and more accurate surveys. At the time, the U.N. came under fire from critics for inflating its estimates in order to exaggerate the urgency of the epidemic — and to spur bigger donations.

There may have been some truth to that argument. Money funneled to HIV and malaria control has soared in the last decade, to almost $9 billion and roughly $1 billion a year, respectively (those figures, too, are hazy estimates), although in the case of HIV especially, money has not always been channeled into disease-control programs based on the best scientific evidence. (That’s particularly true for politically sensitive — and, therefore, under-funded or ignored — interventions that aim to prevent high-risk sex and drug abuse.)

In large part, such massive miscalculations have less to do with politics than with the simple fact that epidemiology involves an inordinate amount of guesswork. Routine re-evaluations of existing data often result in data shifts, sometimes huge ones, which global health experts and epidemiologists have come to expect. "If you go up to a little clinic in Africa, first of all, the staff are overwhelmed with patients," says Nahlen, who used to do monitoring work for WHO. The data, if it’s properly recorded, then goes up to the officials, who may also be overwhelmed. Those records then get passed along to WHO. "It’s sometimes hard to know what these numbers actually mean," he says.

The WHO ascribes most of the current revision to a reassessment of the malaria epidemic in Asia (although the vast majority of malaria cases and deaths still occur in Africa, where the numbers for the continent remain mostly unchanged). Much of the Asian data, which was used in the 2005 WHO report to predict which regions had malaria-carrying mosquitoes — and therefore higher disease incidence — was already 40 years old, says Mac Otten, coordinator of the surveillance, monitoring and evaluation unit at the WHO’s Global Malaria Program. Over the past four decades, the situation across Asia has changed dramatically. "With urbanization, deforestation and then malaria control, [the data] is just out of date," he says. Malaria zones in Asia, especially India, where much of the revision took place, have become "patchy," as Otten puts it.

Epidemiologists are often described by the media as "disease detectives," who use statistical tools — carrying out the occasional survey, for example, or, in the case of malaria, using temperature and terrain maps to help predict where disease-carrying mosquitoes may live — to hunt down and eliminate global killers. The comparison is useful for another reason: Disease trackers, like crime solvers, often spend a lot of time sifting through a few, imperfect clues — hunches, really — to piece together a fuller picture. But that picture often ends up being indistinct as well. The WHO says, for example, that the "confidence interval" of its new estimate — the numerical range within which scientists believe the actual malaria incidence most likely lies — is 189 million cases to 327 million cases per year.

It is an enormous but unavoidable margin of error. Unlike in developed countries, such as the U.S., that have the infrastructure to compile more detailed population-wide medical records, disease surveillance in places like the Democratic Republic of the Congo, a large central African country with few doctors, few roads, limited medical infrastructure and a recent history of bloody conflict, is a much more difficult undertaking. Officials have trouble counting births and deaths in some regions, let alone getting a sense of how many people may have suffered from a particular disease.

What’s more, even where records exist, there is usually no way to confirm their validity. Doctors in the developing world often lack lab facilities to authenticate cases of suspected malaria. Perhaps more often, they never even get to see patients who have the disease — many patients either cannot afford the time or money to see a doctor or they simply self-diagnose and take cheap over-the-counter medications to battle malaria-like symptoms. The WHO estimates that nationally reported (but often unvalidated) malaria cases account for just 40% of the global estimate; the other 60% comes from "detective work" by epidemiologists.

The fuzzy math aside, the good news is that malaria control efforts are working. The 2008 World Malaria Report singles out Eritrea, Rwanda, Sao Tome and Principe, and the Tanzanian region of Zanzibar for their remarkable improvements in cutting malaria illness and death. Since 2000, all of them have managed a greater than 50% drop in both rates, and all of them have done it through a combination of familiar methods: using long-lasting insecticidal bed nets to prevent mosquito bites; treating the disease with the newer, more effective artemisinin-based combination drug therapy; and spraying homes with insecticide. In these countries, there is little doubt that interventions are working, but the impact doesn’t translate to a measurable reduction in global figures because the populations involved are relatively small. Larger countries like Nigeria have been slower to implement prevention and treatment programs.

But similar programs are underway across much of Africa, and so malaria workers are newly optimistic. "When the coverage of the malaria interventions — the nets, the medicines and the spraying — was high, cases came right down and deaths came down as well," says Otten. With luck, for the next World Malaria Report, global figures will be more accurate still — and they’ll be falling because real people are really healthier.

TRANSVAC is a 10 million Euro EC-funded project to accelerate the pharmaceutical and clinical development of promising vaccine candidates for public health use, and aims to bridge the gap between academic research and early phase clinical development, through carefully managing the advancement of promising vaccine candidates from preclinical animal experiments to proof-of-principle studies in humans.

TRANSVAC is managed by the European Malaria Vaccine Initiative and the TB Vaccine Initiative, under the guidance of the TRANSVAC Coordinator. In order to support the TRANSVAC Programme Manager in the day-to-day running of TRANSVAC, a Project Manager and Trainee Project Manager are required. These posts present an exciting and unique opportunity for two individuals to be part of an unprecedented advancement of the European vaccine development infrastructure, and provide excellent opportunities for personal and professional development in a multinational environment.

Responsibilities:

1. Facilitate delivery of projects to agreed time lines, quality and budget
2. Drive progression of the project within the defined parameters
3. Ensure the project team adherence to group policies, standards and procedures, legal requirements and good practices
4. Provide guidance and leadership to the cross-functional members of the Project teams
5. Drive continuous improvement across the project
6. Identify and drive the communication and inter-personal relationships within the project
7. Clearly identify and solve problems, as well as implementing plans to eliminate any forthcoming issues and problems
8. Ensure the preparation and presentation of reports, project budgets and financial evaluations to tight deadlines
9. Provide the Senior Management with key project information throughout the project
10. Understand and promote the project goals and objectives
11. Manage complex relationships with project participants and ensure participant satisfaction
12. To escalate items appropriately through the governance structure and ensure contractual obligations are met
13. Provide input to strategic management
14. Organisation of meetings and workshops

Essential Skills/Competencies for both positions:

•          A high standard of written and spoken English
•          Organised, with drive and motivation
•          Hold, or be about to complete, one of the following: MBA, PhD, or other relevant biology-related degree (e.g. microbiology, vaccine development etc.)
•          Strong co-ordination skills and ability to work in a team
•          Good communication and presentation skills
•          Demonstrated ability to deliver results against deadlines, to a high level of quality
•          The ability to travel occasionally to international meetings, conferences, workshops etc.
•          Competent with Microsoft Office
•          Management experience (for Project Manager position only)

Desired Skills/Competencies:

•          People management experience
•          Experience in managing projects
•          Knowledge of poverty related diseases and/or the vaccine development process
•          Experience in preparing and maintaining websites

On offer to the successful candidates are superior benefits packages and career development opportunities in a dynamic and stimulating environment. Both positions will include a comprehensive project management training package. The posts will be based in Berlin or in a member country of the TRANSVAC consortium. Informal enquiries regarding the posts may be made to Dr. Roland Ventura (ven@ssi.dk).

If you feel that you possess the relevant skills and working background please send a Curriculum Vitae and cover letter explaining:

1. Your preferred choice of post (Project Manager or Trainee Project Manager (or both))
2. Your suitability for the post(s)
3. Your salary range expectations

Applications providing all of the requested information should be received no later than 17:00 (CET) on Friday the 17th of October 2008, and sent by email to:

Dr. Odile Leroy
Executive Director
oly@ssi.dk

Oshaughnessy PT. Parachuting Cats and Crushed Eggs: The Controversy Over the Use of DDT to Control Malaria. Am J Public Health. 2008 Sep 17. [Epub ahead of print]
The use of DDT to control malaria has been a contentious practice for decades. This controversy centers on concerns over the ecological harm caused by DDT relative to the gains in public health from its use to prevent malaria. Given the World Health Organization’s recent policy decisions concerning the use of DDT to control malaria, it is worth reviewing the historical context of DDT use. Ecological concerns focused on evidence that DDT ingestion by predatory birds resulted in eggs with shells so thin they were crushed by adult birds. In addition, DDT spraying to control malaria allegedly resulted in cats being poisoned in some areas, which led to increased rodent populations and, in turn, the parachuting of cats into the highlands of the island of Borneo to kill the rodents, a story that influenced the decision to ban DDT spraying. I focus on this story with the intention of grounding the current debate on lessons from the pas …

Lundie RJ, de Koning-Ward TF, Davey GM, Nie CQ, Hansen DS, Lau LS, Mintern JD, Belz GT, Schofield L, Carbone FR, Villadangos JA, Crabb BS, Heath WR. Blood-stage Plasmodium infection induces CD8+ T lymphocytes to parasite-expressed antigens, largely regulated by CD8{alpha}+ dendritic cells. Proc Natl Acad Sci U S A. 2008 Sep 17. [Epub ahead of print]
Although CD8(+) T cells do not contribute to protection against the blood stage of Plasmodium infection, there is mounting evidence that they are principal mediators of murine experimental cerebral malaria (ECM). At present, there is no direct evidence that the CD8(+) T cells mediating ECM are parasite-specific or, for that matter, whether parasite-specific CD8(+) T cells are generated in response to blood-stage infection. To resolve this and to define the cellular requirements for such priming, we generated transgenic P. berghei parasites expressing model T cell epitopes. This approach was necessary as MHC class I-restricted antigens to blood-stage infection have not been defined. Here, we show that blood-stage infection leads to parasite-specific CD8(+) and CD4(+) T cell responses…

Mayor S. WHO report shows progress in efforts to reduce malaria incidence. BMJ. 2008 Sep 17;337:a1678. doi: 10.1136/bmj.a1678
…The World Malaria Report 2008 found an estimated 247 million cases of malaria and 881 000 deaths from the disease, mostly among children in Africa, meaning that it remains one of the world’s leading causes of death. However, several countries had achieved a sharp fall in the number of people affected by malaria after increasing control measures.

Eritrea, Rwanda, São Tomé and Príncipe, and Zanzibar (in Tanzania) each reported reductions of 50% or more in the number of malaria cases and deaths between 2000 and 2006 or 2007...

Pages F, Texier G, Pradines B, Gadiaga L, Machault V, Jarjaval F, Penhoat K, Berger F, Trape JF, Rogier C, Sokhna C. Malaria transmission in Dakar: a two-year survey. Malar J. 2008 Sep 16;7(1):178. [Epub ahead of print]
According to entomological studies conducted over the past 30 years, there was low malaria transmission in suburb of Dakar but little evidence of it in the downtown area. However; there was some evidence of local transmission based on reports of malaria among permanent residents. An entomological evaluation of malaria transmission was conducted from May 2005 to October 2006 in two areas of Dakar...

Hetzel MW, Obrist B, Lengeler C, Msechu JJ, Nathan R, Dillip A, Makemba AM, Mshana C, Schulze A, Mshinda H. Obstacles to prompt and effective malaria treatment lead to low community-coverage in two rural districts of Tanzania. BMC Public Health. 2008 Sep 16;8(1):317. [Epub ahead of print]
Malaria is still a leading child killer in sub-Saharan Africa. Yet, access to prompt and effective malaria treatment, a mainstay of any malaria control strategy, is sub-optimal in many settings. Little is known about obstacles to treatment and community-effectiveness of case-management strategies. This research quantified treatment seeking behaviour and access to treatment in a highly endemic rural Tanzanian community. The aim was to provide a better understanding of obstacles to treatment access in order to develop practical and cost-effective interventions...

Zikusooka CM, McIntyre D, Barnes KI. Should countries implementing an artemisinin-based combination malaria treatment policy also introduce rapid diagnostic tests?  Malar J. 2008 Sep 15;7(1):176. [Epub ahead of print]
Within the context of increasing antimalarial costs and or decreasing malaria transmission, the importance of limiting antimalarial treatment to only those confirmed as having malaria parasites becomes paramount. This motivates for this assessment of the cost-effectiveness of routine use of rapid diagnostic tests (RDTs) as an integral part of deploying artemisinin-based combination therapies (ACTs)…

The African Malaria Network Trust (AMANET) is pleased to announce the expansion of its web based training. AMANET has launched today an Advanced Course on Health Research Ethics, which becomes the fourth web-based course provided by AMANET and funded by the European-Developing Countries Clinical Trials Partnership (EDCTP).  Other ongoing AMANET web-based courses are Basic Health Research Ethics (English version), Basic Health Research Ethics (French version) and Basic Good Clinical Practice.  All courses are freely available at http://webcourses.amanet-trust.org/.

The Basic Health Research Ethics Course provides a basic understanding of ethical issues and equips trainees (members of ethics committees, health researchers, scientists and other key personnel in health research) with the necessary tools and knowledge required to safeguard the safety and welfare of human research participants.

The Advanced Health Research Ethics (HRE) Course  aims to flag topical ethical issues that are relevant to health research in developing country settings particularly in Africa, and explores various schools of thought regarding contemporary ethical challenges and dilemmas.

Commenting on the launch, Prof Wen Kilama, AMANET Managing Trustee, said “Since the founding in 1995 of the African Malaria Vaccine Testing Network (AMVTN) the predecessor of AMANET, we have been very much concerned not only on attaining high scientific standards  in health research undertaken in Africa, we have further aspired at attaining high ethical standards. But given the ever increasing challenges to health researchers particularly in Africa, AMANET has found it appropriate to launch this Advanced Course on Health Research Ethics, which will address newer challenges and contemporary issues likely to face African health researchers.”

“I very much hope that this course will benefit not only health researchers, but also managers of health research institutions, researchers in other fields, policy and decision makers, sponsors of health research undertaken in developing countries, regulatory authorities, and professional bodies” added Prof Kilama,

The Advanced HRE course has seven modules namely; Ethical Principles in Health Research and Review Processes; Responsibilities in Health Research; Ethical Issues in Research Design and Recruitment of Research Participants; Models and Practicalities of Community Engagement; Ethical Issues in International Collaborative Health Research; Animal Research Ethics; and Ethical Issues in Traditional Medical Practice and ‘Research.

 “It is hoped that successful completion of the course will bring participants up to date with topical ethical issues surrounding current research practices, and enable them to effectively address pertinent ethical and practical challenges of research from the design stage, through the implementation stage, to post-research stage. Indeed the ultimate goal is to enhance the protection of the welfare of research participants in the wake of increasing volume of health research in the developing world” said Dr Aceme Nyika, AMANET Ethics Coordinator, one of the Facilitators for the online course.

Dr Roma Chilengi, AMANET Clinical Trials Coordinator and Facilitator for this course said “The faculty for the course constitutes one of the best in Africa as far as health research ethics is concerned. It’s been rewarding developing this and the preceding HRE course. As faculty, we have probably learned ethics all over and are very excited to take HRE training to a higher level and wider audience, for free”

AMANET continues to strengthen human resource capacity required for ethical and high standard research in Africa. AMANET has organized short-term training workshops which have benefited over 1000 African health researchers and scientists: Good Clinical Practices (GCP), Good Laboratory Practices (GLP), Health Research Ethics, molecular biology and immunology, and data management.

# # #

For further information contact:

Dr Charles L. Wanga
Communications Officer
African Malaria Network Trust [AMANET]
PO Box 33207
Dar es Salaam, Tanzania.
Email : clwanga@amanet-trust.org 
www.amanet-trust.org 
Tel: +255 22 2700018
Fax: +255 22 2700380

The war against malaria in tropical countries was fought and lost in the 20th Century on the basis of faulty intelligence, a ’dodgy dossier’ which argued that the same methods used to tackle the disease in temperate countries would also work in the tropics.

Eradication failed in almost every tropical and sub-tropical country, because tactics that had been proven to work in countries such as the USA, Greece and Italy were also deployed in tropical countries, despite the existence of evidence that they would they not work, particularly in sub-Saharan Africa.

Dr. Colin Sutherland, a Senior Lecturer at the London School of Hygiene & Tropical Medicine, who is contributing to a session entitled ’How science addresses developing world issues’ at the BA Festival of Science in Liverpool today, explains: ’Previous efforts to eradicate malaria, if considered on a nation-by-nation basis, only succeeded in countries where the Plasmodium parasite was weak and its mosquito vector was vulnerable, particularly where populations were wealthy enough to afford the best tools available.

’The failure to eradicate malaria in tropical countries, where the parasite is now at its strongest, and the mosquitoes are doing very well, thank you very much is, in part, due to the miscalculation that a one-size-fits-all approach would be effective in every setting – a miscalculation that could have been avoided if we had heeded the evidence from Africa over half a century ago’, he adds.

Dr. Sutherland cautions against the obsession among the western media with the ’scientific breakthrough’, a concept which consequently dominates popular notions of science. Although breakthroughs do occur, and are undoubtedly newsworthy when they do, it is the careful synthesis of incremental advances in knowledge, and the dissemination of that knowledge to key decision-makers, health ministries and governments that will help us win the war against malaria. Today’s session will look at ways of best achieving this, with a particular focus on open access publishing. It will also emphasise the importance of training and support for high calibre African scientists.

’In the war against malaria, knowledge is the most powerful weapon we have’, concludes Dr. Sutherland.

All current anti-malaria drugs target the parasite that causes the disease, but those are becoming less effective due to increasing drug resistance. Now, Howard Hughes Medical Institute researchers report that they may be able to fight malaria by targeting human liver cells instead of parasites.

HHMI international research scholar Maria M. Mota and her colleagues have identified a receptor on human liver cells that appears to help the malaria parasite sneak inside to fully develop. The SR-BI receptor is normally an entry point for HDL cholesterol and other lipids from the bloodstream into liver cells, which break them down. But new experiments show that the malaria parasite may also be using this doorway. When scientists disabled the SR-BI receptor, they saw a dramatic reduction in the number of infections from two species of malaria in mouse and human cells. The experiments are presented in the September 2008 issue of Cell Host & Microbe.

“This study establishes the first clear molecular link between malaria infection and cholesterol uptake pathways, thus describing a new intervention strategy in the fight against malaria,” says Mota, a faculty member at the Instituto de Medicina Molecular at the University of Lisbon in Portugal.

Malaria parasites enter the human bloodstream via mosquito bites and travel to the liver, where they burrow into liver cells, multiply, and return to the bloodstream to wreak havoc on the body.

Previous research had linked the lipoprotein clearance rate by the liver to increased malaria infection, so Mota thought the parasite might enter liver cells by hijacking the liver’s own cellular machinery. The group focused its attention on the part of liver cells that filter fatty molecules like cholesterol and other lipids out of the bloodstream.

Mota’s team used RNA interference (RNAi) to examine the receptors that filter lipoproteins. The RNAi technique permitted the researchers to create cell lines with specific genes inactivated. They then tested each cell line to see how it responded to the malaria parasite. “We looked through 53 lipoprotein receptors and found one that really stood out from the rest,” Mota says. That receptor was SR-BI (class B, type I scavenger receptors). Removing SR-BI cut down infections in these cells more than any other receptor they tested.

To confirm their suspicions about SR-BI’s key role in malaria, the team conducted a series of experiments that examined mouse cells, human cells, and living mice. First, they induced mouse cells to produce much more of the protein than usual. When they exposed those cells to the parasite that causes malaria in mice, they found the cells were infected more readily than cells with a normal amount of the receptor. The team then tested the receptor’s role in a line of human cells with a human-specific malaria parasite, and got similar results.

Cells in living animals often respond differently than cultured cells, so Mota’s team explored SR-BI’s role in live mice. First they suppressed the gene for SR-BI in these mice, and later injected them with a malaria-causing parasite. Forty hours after exposure, the researchers examined whether the parasite infected the animals’ liver cells. They found that the mice with reduced SR-BI had liver infection levels 50-70 percent lower than the normal mice.

Read full story at: http://www.hhmi.org/news/20080910mota.html

It has been a bad few months for mosquitoes. First, billionaire Bill Gates resigned his Chairmanship of Microsoft to concentrate on funding the fight against malaria.

Next, scientists in Australia invented a new drug that prevents the malaria parasite binding with human red blood cells, thereby preventing its spread. However, the mosquitoes are regrouping in the world’s malaria capital.

Statistical data obtained from Apac District Health Department shows there were 88,286 reported cases of malaria in Apac district between January and June 2008. That is approximately 467 people diagnosed with malaria everyday. But it is business as usual for Apac, where the malaria incidence rate is arguably the highest in the world.

The claim is backed by studies conducted in Apac by the National Malaria Control Programme of Uganda’s Ministry of Health, with funding from USAID, the American government’s international development agency. They determined the local Entomological Inoculation Rate (EIR), that is, "how many times somebody can get bitten at night by one specific species, the female anopheles mosquito, the one that transmits malaria parasites," elaborates Dr. Matthew Emer , the Apac District Health Officer. "Anybody living in Apac is bitten by an infected mosquito, i.e. one able to transmit the malaria parasite, about six times in a night. That translates to about 1,560 times per person per year."

In comparison, Kampala residents receive an average of seven infected bites per year.

The most recent study to track EIR in Apac was carried out by the Malaria Control Programme between January and March 2008, as it assessed the feasibility of using the chemical DDT (dichlorodiphenyltrichloroethane) as a deterrent to mosquitoes. Earlier studies conducted by the Epidemiological Surveillance Division of the Ministry of Health in 2001-02 had mapped EIR in seven Ugandan districts. They found Apac to not only have the highest incidence in the country (at 1,586 infected bites per year), but also amongst the highest reported in Africa. These studies, along with existing data on global EIRs, show Apac to have the highest malaria levels on record.

Big threat

The malaria burden is hardly surprising. Over one-quarter of Apac district’s land area is covered by swamps and it is bordered by freshwater bodies like Lake Kwania and the Victoria Nile. Brick-making enterprises, which create pools of stagnant water, are scattered around it. These are ideal habitats and breeding grounds for anopheles mosquitoes, and help make malaria the district’s single biggest threat to public health. EIRs are also astonishingly high in Lango sub-region (where Apac is situated) as a whole, with 314,796 reported cases of malaria in the first six months of 2008.

Records at Apac Hospital’s outpatient department reveal malaria to be the highest cause of sickness in the district, with nearly 40% of those admitted, ultimately proven to have malaria. Nearly all detected malaria cases are of the strain plasmodium falciparum, which can prove fatal. Infants, young children and pregnant mothers are at greatest risk, with Apac Hospital estimating that up to 80% of patient deaths in its paediatric ward are related to malaria. In June alone it admitted 206 inpatients (and 610 outpatients) under the age of five who tested positive for malaria, of whom seven eventually died. Of 32 pregnant mothers diagnosed for malaria and automatically admitted during the same period, there was one fatality. The ratio of male to female inpatients contracting malaria, or dying from it, was roughly equal.

However, many malaria cases may be completely unreported. Dr. Alfred Acana, Director of Apac Hospital, observes that "patients come literally having diagnosed themselves, saying ’I have malaria’. Ideally all of them should have a blood slide to check if their complaints are related to malaria," but only "40-50% actually have blood slides done."

He refers to the tendency of local people classifying any ailment as ’malaria’. "Many go and treat themselves symptomatically with anti-malarials [but] it may not be malaria they’re treating. If they’re lucky it is malaria, then they get better."

Read full story at: http://allafrica.com/stories/200809110933.html

Sometimes even fetuses need to take matters into their own hands. Researchers have discovered a genetic mutation that protects a child from the devastating effects of a mother’s malaria infection.

“The fetus is individually trying to figure out how to ensure its own survival,” says Patrick Duffy, a malariologist at Seattle Biomedical Research Institute, who led the study along with colleague Atis Muehlenbachs.

Placental malaria occurs when parasite-infected blood cells latch onto the placenta, bringing the wrath of the maternal immune system with them.

While mothers may experience few symptoms, thanks to years of malaria exposure, for the children, the disease can result in low birthweight and even stillbirth. Women that live in places rife with malaria, such as sub-Saharan Africa, are usually most at risk.

Millions at risk

More than 30 million women are at risk of the disease, which causes about one-third of stillbirths in malaria-endemic areas.

Among 565 women in the Tanzanian district of Muheza, Duffy’s team noticed that a mutation in a fetal gene called sFlt1 seemed to spare the foetus from malaria, yet only during a mother’s first pregnancy.

For first-time mums, all of 75 children with two copies of the mutation were delivered alive. Yet among first children with another version of sFlt1, common in places without malaria, 10% did not carry to term. These children were also more than twice as likely to be born underweight as children with the protective version of the gene.

This version of sFlt1 seems to cut down on maternal inflammation and protect first-borns, says Duffy.

Alternate role?

After bearing one or two more children, mothers develop antibody resistance to placental malaria, allowing children without the non-protective mutation to survive. “This is the first resistance gene identified for any infectious disease that functions in [the womb],” he says.

Stephen Rogerson, an immunologist at the University of Melbourne, Australia, says the study makes a good case for sFlt1’s role in placental malaria, but he wonder whether the version of the gene that seems to predispose first-borns to placental malaria – called SS – might have some other positive role.

“The fact that SS is still around in the Tanzanian population, although at lower levels than in non-malaria-exposed Europeans," he says, "is also in keeping with the idea that the SS type may be protecting against something else.”

Indeed, 68% of Americans and 88% of Britons have the SS version of sFlt1 that could put their unborn children at risk. In malaria-endemic Tanzania, about a third of people have this mutation.

Journal reference: Proceedings of the National Academy of Sciences (DOI: 10.1073/pnas.0803657105)

Scientists suggest that the best way to treat malaria is to avoid using same drug for everyone, and opt for multiple first-line therapies.

With the help of a computer model, a research team from Princeton University and Resources for the Future has found that many governments worldwide are recommending the wrong kind of malaria treatment.

Despite the availability of many drugs many countries have been recommend using what is known as a single first-line therapy- that is, using one drug repeatedly with many patients.

Lead researcher Maciej Boni said that countries could cut the death rate and forestall the development of drug resistance if a variety of different drugs were distributed to patients.

This approach, known as multiple first-line therapies or MFT, can be use

by making sure different drugs cost about the same, so that patients would not be forced into buying the cheapest available drug.

“What we found is that using multiple first-line therapies is the best way to avoid treatment failures and to delay the development of resistance for as long as possible,” said Boni, who recently has joined the staff of the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam.

Boni, a mathematician and an evolutionary biologist, along with co-authors, Ramanan Laxminarayan and David Smith, designed a computer model with inputs based on more than 100 years of malaria field research.

They simulated dozens of treatment paths for a malaria outbreak among patients contrasting many variations of the status quo strategy of using a single first-line therapy with one employing MFT.

They found that there were major benefits to employing an MFT strategy, namely, fewer cases of malaria, fewer unsuccessful drug treatments, and a very significant delay in the onset of drug resistance in the parasites.

However, the researchers suggested that multiple effective therapies may not always be available. In some African countries where drug-resistance is already widespread, the only effective therapies are a class of drugs known as artemisinin-based combination therapies (ACTs).

“MFT does not necessarily solve all our problems,” said Boni. “Antimalarial drug development needs to continue with the hope of producing novel and highly effective antimalarials that can be deployed alongside ACTs.”

The study appears in Proceedings of the National Academy of Sciences.

Culleton RL, Mita T, Ndounga M, Unger H, Cravo PC, Paganotti GM, Takahashi N, Kaneko A, Eto H, Tinto H, Karema C, D’Alessandro U, do Rosario V, Kobayakawa T, Ntoumi F, Carter R, Tanabe K. Failure to detect Plasmodium vivax in West and Central Africa by PCR species typing. Malar J. 2008 Sep 11;7(1):174. [Epub ahead of print].
Plasmodium vivax is estimated to affect 75 million people annually. It is reportedly absent, however, from west and central Africa due to the high prevalence of the Duffy negative phenotype in the indigenous populations. Despite this, non-African travellers consistently return to their own countries with P. vivax malaria after visiting this region. An attempt was made, therefore, to detect the presence of P. vivax parasites in blood samples collected from the indigenous populations of west and central Africa…

Agomo PU, Meremikwu MM, Watila IM, Omalu IJ, Odey FA, Oguche S, Ezeiru VI, Aina OO. Efficacy, safety and tolerability of artesunate-mefloquine in the treatment of uncomplicated Plasmodium falciparum malaria in four geographic zones of Nigeria. Malar J. 2008 Sep 9;7(1):172. [Epub ahead of print].
The combination of artesunate and mefloquine has been reported to be effective against multi-drug resistant Plasmodium falciparum malaria, which has been reported in Nigeria. The objective of this multi-centre study was to evaluate the efficacy, safety and tolerability of the co-packaged formulation of artesunate and mefloquine in the treatment of uncomplicated malaria in two weight groups: those between 15 - 29kg and [greater than or equal to]30kg, respectively…

Schwarz NG, Adegnika AA, Breitling LP, Gabor J, Agnandji ST, Newman RD, Lell B, Issifou S, Yazdanbakhsh M, Luty AJ, Kremsner PG, Grobusch MP. Placental Malaria Increases Malaria Risk in the First 30 Months of Life. Clin Infect Dis. 2008 Sep 9. [Epub ahead of print]
Plasmodium falciparum infection during pregnancy is associated with stillbirth, fetal growth restriction, and low birth weight. An additional consequence may be increased risk of malaria in early life, although the epidemiological evidence of this consequence is limited...

Schmidt NW, Podyminogin RL, Butler NS, Badovinac VP, Tucker BJ, Bahjat KS, Lauer P, Reyes-Sandoval A, Hutchings CL, Moore AC, Gilbert SC, Hill AV, Bartholomay LC, Harty JT. Memory CD8 T cell responses exceeding a large but definable threshold provide long-term immunity to malaria. Proc Natl Acad Sci U S A. 2008 Sep 9. [Epub ahead of print]
Infection of mice with sporozoites of Plasmodium berghei or Plasmodium yoelii has been used extensively to evaluate liver-stage protection by candidate preerythrocytic malaria vaccines. Unfortunately, repeated success of such vaccines in mice has not translated readily to effective malaria vaccines in humans. Thus, mice may be used better as models to dissect basic parameters required for immunity to Plasmodium-infection than as preclinical vaccine models. In turn, this basic information may aid in the rational design of malaria vaccines...

Boni MF, Smith DL, Laxminarayan R. Benefits of using multiple first-line therapies against malaria. Malar J. 2008 Sep 2;7(1):169. [Epub ahead of print]
Despite the availability of many drugs and therapies to treat malaria, many countries’ national policies recommend using a single first-line therapy for most clinical malaria cases. To assess whether this is the best strategy for the population as a whole, we designed an evolutionary-epidemiological modeling framework for malaria and compared the benefits of different treatment strategies in the context of resistance evolution. Our results show that the population-wide use of multiple first-line therapies (MFT) against malaria yields a better clinical outcome than using a single therapy or a cycling strategy where therapies are rotated, either on a fixed cycling schedule or when resistance levels or treatment failure become too high....

Muehlenbachs A, Fried M, Lachowitzer J, Mutabingwa TK, Duffy PE. Natural selection of FLT1 alleles and their association with malaria resistance in utero.  Proc Natl Acad Sci U S A. 2008 Sep 8. [Epub ahead of print]
Placental malaria (PM) caused by Plasmodium falciparum contributes significantly to infant mortality in sub-Saharan Africa and is associated with pregnancy loss. We hypothesized that fetal genes that modify PM would be associated with fetal fitness. During PM, placental trophoblasts produce soluble fms-like tyrosine kinase 1 (sFlt1), also known as soluble VEGF receptor 1, an angiogenesis inhibitor associated with preeclampsia…

Rodrigues CD, Hannus M, Prudêncio M, Martin C, Gonçalves LA, Portugal S, Epiphanio S, Akinc A, Hadwiger P, Jahn-Hofmann K, Röhl I, van Gemert GJ, Franetich JF, Luty AJ, Sauerwein R, Mazier D, Koteliansky V, Vornlocher HP, Echeverri CJ, Mota MM. Host Scavenger Receptor SR-BI Plays a Dual Role in the Establishment of Malaria Parasite Liver Infection.  Malaria Journal 2008, 7:142
An obligatory step of malaria parasite infection is Plasmodium sporozoite invasion of host hepatocytes, and host lipoprotein clearance pathways have been linked to Plasmodium liver infection. By using RNA interference to screen lipoprotein-related host factors, we show here that the class B, type I scavenger receptor (SR-BI) is the strongest regulator of Plasmodium infection among these factors. Inhibition of SR-BI function reduced P. berghei infection in Huh7 cells, and overexpression of SR-BI led to increased infection. In vivo silencing of liver SR-BI expression in mice and inhibition of SR-BI activity in human primary hepatocytes reduced infection by P. berghei and by P. falciparum, respectively…

There’s no magic bullet for wiping out malaria, but a new study offers strong support for a method that effectively delays the evolution of drug resistance in malaria parasites, a University of Florida researcher says.

David Smith, associate director of disease ecology at UF’s Emerging Pathogens Institute, said the study will guide scientists and policy makers in extending the longevity of current artemisinin-based malaria drugs combined with partner drugs. Smith is a co-author of a report on the study, scheduled to publish online this week in the Proceedings of the National Academy of Sciences and in print on Sept. 16.

Smith collaborated with lead author Maciej Boni of Resources for the Future and Princeton University, and Ramanan Laxminarayan, also with RFF, to create mathematical models assessing the strategic effectiveness and clinical outcomes of using one, two and three first-line drug therapies to treat malaria within a population over a 20-year period. Their results show that using two or three drugs simultaneously reduced the total clinical cases and number of failed treatments , and slowed the rate at which drug-resistant genes spread within the parasites that cause malaria: Plasmodium falciparum, P. vivax, P. malariae and P. ovale.

"The models indicate that we can slow the evolution of resistance to current artemisinin-based therapies if nations use them in combination with two or more partner drugs," Smith said. "Currently, most nations don’t do this. They use one therapy at a time, wait for it to fail, and then switch to a different therapy."

Artemisinin-combined therapies, or ACTs, are currently not widely implemented due to operational challenges and expense, Smith said. But he said the study offers compelling evidence for global leaders to collaborate and overcome these issues.

"This is not to say that implementing multiple first-line therapies solves all of our malaria problems," Boni said. "Anti-malarial drug development needs to continue so that we have novel and highly effective anti-malarials that can be plugged into the recommended strategy of deploying multiple therapies."

In the past century, chloroquine and sulfadoxine-pyrimethamine were widely used to combat malaria, but the parasites eventually evolved resistance leading to the drugs’ failure. Artemesinin drugs, derived from the herb Artemisia annua, are relatively new and the malaria parasite does not yet appear to have a resistance to it. They work by triggering chemical reactions which damage the Plasmodium parasite.

"We don’t have anything in the pipeline after ACTs, and it’s basically just a matter of time until drug resistance evolves and artemisinin also fails," Smith said. "So the question becomes how do we keep ACTs in our arsenal for as long as effectively possible?"

The researchers’ models also show that cycling through single drugs accelerated the rate at which malaria parasites evolved drug resistance. Smith said this occurred because cycling a single drug degraded the parasite’s average fitness, which made it easier for drug-resistant genes to spread throughout the parasite population.

The cycling models predicted a declining therapeutic value of a single drug within 3.54 years, versus a longer effective therapeutic value of 9.95 years when three drugs were used in equal proportions within a population. The research was funded in part by grants from the Bill and Melinda Gates Foundation, and the National Institutes of Health.

"Using multiple first-line drugs reduces the selection pressure for resistance to a single drug," Smith said. "This is one way to make the ACTs last longer and benefit more people."

Co-author Laxminarayan, a senior research fellow at RFF, said ACTs are the best treatment option for malaria, now as well as in the foreseeable future.

"Novel treatment strategies improve our ability to delay the emergence of drug resistance without the need to deny treatment," Laxminarayan said.

Wil Milhous, associate dean for research at the University of South Florida’s College of Public Health, said the research is "clearly a superb breakthrough in mathematical modeling applied to malaria drug deployment." Milhous has worked to develop new drugs for malaria for more than 25 years and is unaffiliated with the study.

"We have done the math in drug development, but only in terms of the cost of goods for drug combinations to include advanced preclinical and clinical testing. These are extremely time-consuming and costly but critical to regulatory approval," Milhous said. "Now we have a highly quantitative reality check that poor implementation strategies doom drugs to failure."

In work that could lead to new ways of detecting and treating malaria, MIT researchers have used two advanced microscopy techniques to show in unprecedented detail how the malaria parasite attacks red blood cells.

The researchers’ images show red blood cell membranes becoming less flexible, which causes the cells to clump as they try to navigate tiny blood vessels. They also show the destruction of hemoglobin, the critical molecule that red blood cells use to carry oxygen.

The images are made possible by microscopy techniques that reveal tiny vibrations in red blood cell membranes.

"By studying the way the cell membrane vibrations progressively change as the malaria parasite matures inside the cell, we can study the changes in its mechanical, elastic and dynamic properties," said Michael Feld, director of MIT’s George Harrison Spectroscopy Laboratory and a professor of physics.

Feld and Subra Suresh, dean of MIT’s School of Engineering, are senior authors of a paper on the work to be published in the Proceedings of the National Academy of Sciences the week of Sept. 1.

The study establishes the first experimental connection between cell membrane vibration and the pathological state of a living cell.

"You can establish a measurement of membrane-fluctuation changes as a function of the gradual progression from a healthy state to a severely pathological state," said Suresh, who has appointments in materials science and engineering, biological engineering, mechanical engineering and the Harvard-MIT Division of Health Sciences and Technology.

It has been known for more than a century that red blood cell membranes continuously undulate. These vibrations are difficult to study because the measurements involved are so tiny (nanometer, or billionth of a meter, scale), and occur in just microseconds.

Suresh and colleagues have previously shown that the cell membranes of red blood cells invaded by the malaria parasite lose their elasticity, as proteins transported from the parasite attach to the membranes and make them significantly stiffer.

In the new paper, the researchers describe using a technique called diffraction phase microscopy to image living cells over the first 48 hours of malaria parasite maturation inside the cell. They showed that infection reduces elasticity and decreases the vibration frequency of the cell membrane.

The team also used a technique called tomographic phase microscopy, which was developed in Feld’s laboratory and is based on the same concept as a CT scan: To create a 3D image, the researchers combine about 100 two-dimensional images taken from different angles. Those images are produced with a technique known as interferometry, in which a light wave passing through a cell is compared with a reference wave that doesn’t pass through it.

The technique allowed them to study changes in the refractive index of a cell, which is a measure of how much the speed of light is reduced as it passes through the material.

Images generated by tomographic phase microscopy revealed the degradation of hemoglobin as the malaria parasite interacted with the cell.

In the future, the microscopy technology could be used to develop a diagnostic tool that would detect malaria or other human diseases by measuring cell membrane properties. It could also be used to test the efficacy of potential drugs.

The current project got underway about two years ago, after Suresh gave a talk at the Spectroscopy Laboratory on his work studying the mechanical stiffness of malaria-infected red blood cells. Feld and his colleagues were already working on microscopy techniques to visualize red blood cells, so the groups decided to collaborate.

"This project brought physics, engineering, materials science, and cell biology all to bear on a problem of infectious disease," said Suresh.

Lead authors of the paper are YongKeun Park, a graduate student in the Harvard-MIT Division of Health Sciences and Technology, and Monica Diez-Silva, a microbiologist trained at Institut Pasteur and currently a postdoctoral fellow in the Department of Materials Science and Engineering (DMSE). Other authors are Gabriel Popescu, now at the University of Illinois at Urbana-Champaign; George Lykotrafitis, a DMSE postdoctoral fellow; and Wonshik Choi, a postdoctoral associate in the Spectroscopy Lab.

 The South African government is poised to change its regulations for medications, allowing appeals against approvals on unscientific grounds and giving the health minister final say on new treatments.

Opponents say the amendment will strike a blow to evidence-based scientific evaluation of medicines, giving political views precedence over safety and necessity.

The Parliamentary Portfolio Committee on Health approved the Medicines and Related Substances Amendment Bill this week (25 August), which will create a new regulatory authority to replace the 43-year-old Medicines Control Council that currently oversees new medicines entering the market.

The legislation will allow the health minister to make a final decision on all new medicines and potentially pass treatments that have not undergone full scientific testing.

The minister can decline to register products which have passed clinical trials, says Ruth Rabinowitz, an opposition health committee member, calling the legislation ’’counterfeit".

The amendment will also introduce an appeals process, whereby any person can oppose the approval of a medicine.

Announcing the bill, James Ngculu, chairperson of the portfolio committee, argued that though some medications might work for individuals, they might be bad for communities, and people had the right to object to medicines on unscientific grounds.

Thami Mseleku, director-general of South Africa’s health department, claimed the measure would empower members of public to challenge medical decisions on political and economic grounds.

But Mike Waters, health spokesman for opposition party the Democratic Alliance, says the legislation has "opened a can of worms," and created a "bureaucratic nightmare".

Vicki Ehrich, chief operating officer of the Pharmaceutical Industry Association told SciDev.Net that they "strongly advocated" to the portfolio committee that the registration of medicines should be based only on safety, quality and effectiveness and are now "greatly concerned" that this has been replaced by an appeals process.

"This is contrary to our stance that registration should be separate from such considerations," she told SciDev.Net.

"A further concern is that the appeals process itself could be abused and used to delay entry of products to market, for example by competitors."

Abieda Williams, of the Pharmaceutical Industry Association and who testified against the proposals, says the amendment is modelled on a Brazilian system, which led to "significant delays" in medicine approval. As a result, she says, citizens in urgent need of medications that lack approval are suing the Brazilian government.

The bill is expected to be passed into law by the full parliament when it reconvenes in September.

Nongovernmental organisations the Treatment Action Campaign and the AIDS Law Project, acting on behalf of South African HIV patients, say they will take legal action if it is passed. They argue that antiretroviral medications — which the government has opposed in the past — could be blocked

MAKERERE University Medical School is preparing to carry out trials on a malaria vaccine. The African Malaria Network Trust (AMANET) has announced that the GMZ2 vaccine trials will be carried out in Iganga and Mayuge districts.

“Before the end of this year, we shall give the medical school a grant of over 300,000 Euros for capacity building to help them prepare for the trials,” said Prof. Wen Kilama, the managing trustee of AMANET.

The money will be used to train personnel in addition to recruiting and sensitising participants for the trial. Makerere University Medical School is one of the 21 institutions across Africa, which are benefiting from AMANET’s projects.

AMANET is also carrying out trials on three other malaria vaccines. These are: MSP3 LSP in Burkina Faso and Tanzania, AMA1 in Mali and GMZ2 in Gabon.

About 400 people in Uganda die from malaria everyday. The country’s efforts to fight the disease have largely depended on the distribution of insecticide-treated mosquito nets and residual spraying.

However, in May, internal residual spraying in northern Uganda was stopped following a High Court injunction. This was after environmental activists petitioned over the use of the DDT chemical.

While opening the sixth Basic Research Ethics Workshop for African ethics committees at Munyonyo Commonwealth Resort on Monday, health state minister Emmanuel Otaala said: “Our research must be geared towards finding suitable drugs and vaccines for diseases like malaria, tuberculosis and AIDS, which are the main causes of high mortality and morbidity rates on the continent.”

Otaala urged researchers to follow proper ethical practices while carrying out medical trials on human beings.

“There is evidence that some trials have violated the rights of those on whom they are carried out. The poverty in most parts of Africa has made Africans vulnerable to coercion and exploitation by people carrying out medical trials. I urge researchers to protect the participants,” Otaala said.

Kilama also called for the establishment and strengthening of ethics review committees to ensure that medical research participants are well protected.

The Bill & Melinda Gates Foundation announced on 3 September 2008 that it is now accepting grant proposals for Round 2 of Grand Challenges Explorations, a five-year US$100 million initiative to encourage bold and unconventional research on new global health solutions. Proposals for six topics will be accepted online at www.gcgh.org/explorations through November 2, 2008.

Round 2 follow on the heels of the initiative’s first funding round, which closed in May of this year, and generated nearly 4,000 applications from scientists in more than 100 countries. Two new topics are being introduced in Round 2 along with the initial four topics from Round 1.

One of the primary objectives of Grand Challenges Explorations is to involve scientists around the world who do not typically work in global health. This includes those with innovative ideas in Africa, Asia, and other parts of the developing world; people working in the private sector; and young investigators.

The initiative uses an agile, accelerated grantmaking process. Applications are two pages, and preliminary data about the proposed research are not required. In addition, the online application process has been streamlined for Round 2.

The topic areas for which proposals will be accepted in Round 2 are:

1. Create new vaccines for diarrhea, HIV, malaria, pneumonia, and TB.
2. Create new tools to accelerate the eradication of malaria.
3. Create new ways to protect against infectious diseases, including alternatives to traditional vaccination.
4. Create new drugs and delivery systems to limit the emergence of resistance in the disease-causing agent.
5. Create new ways to prevent or cure HIV infection that fall outside current research on vaccines and other biomedical and behavior-change strategies.
6. Explore the basis for latency in TB, with the goal of discovering new ways to identify and eliminate latent infection.

The foundation and an independent group of reviewers will select the most innovative proposals, and grants will be awarded within approximately three months from the proposal submission deadline. Initial grants will be $100,000 each. Projects showing success will have the opportunity to receive additional funding of $1 million or more. Round 1 grants are expected to be announced in October.

Full descriptions of the topic areas and application instructions are available at www.gcgh.org/explorations.

When:
Friday, September 26, 2008 8:00 am - 4:00 pm

Where:
Jurys Hotel Washington
1500 New Hampshire Avenue
Washington, DC 20036
USA

Register at: https://www.regonline.com/builder/site/Default.aspx?eventid=652554

We invite you to a Consultative Forum on the Affordable Medicines Facility-malaria (AMFm) at Jurys Hotel in Washington, DC, on Friday September 26th, 2008.

AMFm is the operational version of the "global subsidy" for malaria drugs first proposed in 2004 by an Institute of Medicine Committee. The purpose of AMFm is twofold: 1) provide widespread financial access to artemisinin-combination therapies (ACTs) and 2) delay the emergence of resistance to artemisinins. AMFm has been approved by the Board of the Roll Back Malaria Partnership and in November, the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria will continue its deliberatations about hosting AMFm.

The purpose of this forum is to discuss the rationale for AMFm, and to explore biomedical, economic and operational challenges related to AMFm.

We would be most appreciative if you could register as soon as possible if you plan to attend. Please forward this invitation to others who you think would be interested in this event. Space is limited but we would like to accommodate as wide a range of perspectives as possible. Attendance at this all-day meeting, including lunch, is free of charge, but you must register in advance.

A webcast of this event is provided by kaisernetwork.org, a free service of the Kaiser Family Foundation and will be available after 9 a.m., September 29th, 2008 at http://www.kaisernetwork.org/healthcast/rff/26sep08.   Along with the webcast, a transcript will also be available.

Sincerely,

Barry R. Bloom
Dean, Harvard School of Public Health
Chair, AMFm Consultative Forum

Ramanan Laxminarayan
Senior Fellow, Resources for the Future

Dates: 23-27 February 2009
Venue: Dar es salaam, Tanzania
Deadline for applications: 31 October 2007

http://www.amanet-trust.org/ext/news/AHRECall2009.html

Background/Rationale

The high disease burden of African countries, the emergence of new diseases, and efforts to address the10/90 gap, have led to an unprecedented increase in health research activities in Africa. In light of the generally poor health delivery systems, the lower levels of education, and poverty of communities and governments, it has become imperative that HRE in Africa be strengthened in order to minimise the risk of unethical research being conducted on the poor populations.

Historically, research participants and research institutions have been exposed to abuse and are inadequately prepared to handle complexities that characterize justice and beneficence desirable for research involving human participants and communities.  This is ever so important in the less developed world where regulatory systems are either very weak or non existent in majority of cases.

Over the next three years, and through a grant from The Bill and Melinda Gates Foundation, AMANET will organize a series of 5 workshops on Advanced Health Research Ethics (HRE) primarily for health investigators and secondarily for Ethics Committee members and policy makers. Since the workshops will be at an advanced level, basic HRE training will be a pre-requisite. The first Advanced HRE workshop was held in Dar es Salaam from 23 to 27 June 2008.

Precedence:

AMANET continues to champion the need for training in biomedical research ethics to various stakeholders of research in Africa. With regard to health research ethics for ethics review committees, the following workshops have been organized by AMANET:

• Workshops on Ethics in Health Research in Africa,  in Kenya (Kisumu, 2001), Ethiopia (Addis Ababa,   2001), South Africa (2002, Pretoria), Gabon, (Libreville, 2002), Sudan (Khartoum, 2003), Cameroon (Yaoundé, 2003), Ethiopia (2007), Ghana (2008) Senegal (in French, 2008), Uganda (2008) and Tanzania (Dar es Salaam, 2005, 2006 and 2007)
• The first Advanced Health Research Ethics Workshop for investigators was held in Tanzania, in June 2008.
• Workshop on Standard Operating Procedures for Ethics Review of Health Research in Africa, 17-21 February 2003, Entebbe, Uganda;
• Workshop on Advanced Ethics in Biomedical Research that Involves Human Subjects, 1-3 December 2004, Zanzibar, Tanzania; and
• Workshop on Protection of Human Research Participants: Writing of Standard Operating Procedures for Ethics Review Committees in Eastern Africa: 29-31 August 2005, Dar es salaam, Tanzania.

Reports on the above activities are available in the various issues of the AMANET Newsletter available online at: www.amanet-trust.org.  

Workshop Pedagogical Methods

The workshop will apply participatory approaches including overviews, case studies, discussion groups, panelists, and participants presentations and other interactive and adult teaching/learning methods. To broaden discussions special panels for some of the topics will be convened. Lecture type presentations will be followed by question and answer sessions. Experienced facilitators have been carefully selected from within Africa.  

Workshop Participants (Selection)

Senior investigators and research project Principal Investigators (PIs) are encouraged to apply. Junior investigators who have successfully completed basic Health Research Ethics (HRE) course available on the AMANET website are also eligible. Participation in the AMANET online HRE Discussion Forum will be considered in the selection process. The online Discussion Forum can be accessed via the AMANET website; some of the case studies discussed online will be used during the workshop. The target candidates are health researchers, but few places may be available for applicants outside these criteria. Interested candidates who meet the selection criteria should submit their applications by 31 October 2008.

Workshop Objectives

This workshop aims firstly to flag topical ethical issues that are relevant to health research in developing country settings, and secondly to explore various schools of thought with the aim of coming up with well thought out positions and/or recommendations. Examples and case studies pertinent to Africa will be used. The following are the highlights of the topics to be covered:

• Applying Ethical principles in Health Research and Ethical review process
• Responsibilities in Health Research
• Ethical issues in research design and recruitment of research participants.
• Research with vulnerable persons and groups
• Legal and social issues in Health Research Ethics
• Ethical Issues in international collaborative health research 
• Models and practicalities of community consultation
• Ethical issues surrounding the 10/90 gap
• Ethical issues in traditional medical practice and “research”
• Professional Ethics
• Animal Research Ethics

Workshop Outcomes

By the end of the five day workshop, it is further hoped that:

• Participants will be brought up to date with topical ethical issues around current research   practices;
• Participants will be able to address ethical issues at the design stage of health research and be able to enhance the protection of the welfare of research participants when implementing health research protocols.  

Language:

The workshop will be conducted in English; there will be no translations to other languages.

Workshop Reports:

Three participants will be nominated to be rapporteurs for the workshop. Proceedings will be recorded for publication in the AMANET newsletter and will be available for participants. 

AMANET Scholarship

Selected participants will be awarded scholarships by AMANET, which will cover costs for economy class airfares (where needed), visas, tuition and accommodation and meals.

Timelines:

• This call sent out on or before 05 September 2008
• Applications should reach AMANET secretariat no later than 31 October 2008
• Please note that only short-listed candidates will be contacted, a list of selected candidates will be made available on the AMANET web site. Selected participants will be informed by 30 January 2009

Applications (with brief CVs and one-half page justification) should be submitted by email to: 

The Managing Trustee,
African Malaria Network Trust,
Tanzania Commission for Science and Technology Building,
PO Box 33207,
Dar es Salaam, Tanzania.
E-mail: info@amanet-trust.org
Fax: +255 22 2700380
www.amanet-trust.org

Acknowledgements

The workshop is supported by a grant to AMANET from the Bill and Melinda Gates Foundation on strengthening institutional health research ethics capacity in Africa.

Blanco YC, Farias AS, Goelnitz U, Lopes SC, Arrais-Silva WW, Carvalho BO, Amino R, Wunderlich G, Santos LM, Giorgio S, Costa FT. Hyperbaric oxygen prevents early death caused by experimental cerebral malaria. PLoS ONE. 2008 Sep 4;3(9):e3126.
Cerebral malaria (CM) is a syndrome characterized by neurological signs, seizures and coma. Despite the fact that CM presents similarities with cerebral stroke, few studies have focused on new supportive therapies for the disease. Hyperbaric oxygen (HBO) therapy has been successfully used in patients with numerous brain disorders such as stroke, migraine and atherosclerosis…

McCollum AM, Basco LK, Tahar R, Udhayakumar V, Escalante AA. Hitchhiking and selective sweeps of Plasmodium falciparum sulfadoxine and pyrimethamine resistant alleles in a population from central Africa. J Pharmacol Exp Ther. Antimicrob Agents Chemother. 2008 Sep 2. [Epub ahead of print]
Sulfadoxine pyrimethamine (SP) resistance in Plasmodium falciparum is encoded by a number of mutations in the genes dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps). Here, we have characterized point mutations in dhfr and dhps and microsatellite loci around dhfr on chromosome 4 and dhps on chromosome 8 as well as neutral markers on chromosomes 2 and 3 in 332 samples from Yaoundé, Cameroon...

Hancock PA, Thomas MB, Godfray HC. An age-structured model to evaluate the potential of novel malaria-control interventions: a case study of fungal biopesticide sprays. Proc Biol Sci. 2008 Sep 2. [Epub ahead of print]
It has recently been proposed that mosquito vectors of human diseases, particularly malaria, may be controlled by spraying with fungal biopesticides that increase the rate of adult mortality. Though fungal pathogens do not cause instantaneous mortality, they can kill mosquitoes before they are old enough to transmit disease. A model is developed (i) to explore the potential for fungal entomopathogens to reduce significantly infectious mosquito populations, (ii) to assess the relative value of the many different fungal strains that might be used, and (iii) to help guide the tactical design of vector-control programmes...

Sowunmi A, Balogun ST, Gbotosho GO, Happi CT. Plasmodium falciparum gametocyte sex ratios in children with acute, symptomatic, uncomplicated infections treated with amodiaquine. Malar J. 2008 Sep 2;7(1):169. [Epub ahead of print]
Amodiaquine is frequently used as a partner drug in combination therapy or in some setting as monotherapy, but little is known about its effects on gametocyte production and sex ratio and its potential influence on transmission in Africa. The effects of amodiaquine on sexual stage parasites and gametocyte sex ratio, and the factors associated with a male-biased sex ratio were evaluated in 612 children with uncomplicated Plasmodium falciparum malaria who were treated with amodiaquine during the period 2000 - 2006 in an endemic area...

Greenwood BM. Control to elimination: implications for malaria research.  Trends Parasitol. 2008 Aug 27. [Epub ahead of print]
Recent reports indicate that a high level of malaria control can be achieved with existing control tools once their use has been scaled up. This has led to renewed interest in the possibility of malaria elimination, an approach that is now supported by several influential organisations. An increasing focus on elimination requires a review of priorities within the malaria research agenda. The development of drugs and vaccines with a strong transmission-blocking potential becomes increasingly important. Novel approaches to surveillance will be necessary to ensure that once elimination has been achieved, it is not threatened by a rapid reintroduction of malaria from neighbouring areas …

Daniel Dodoo, Anastasia Aikins, Kwadwo Asamoah Kusi, Helena Lamptey, Ed Remarque, Paul Milligan, Samuel Bosomprah, Roma Chilengi, Yaa Difie Osei, Bartholomew Dicky Akanmori and Michael Theisen. Cohort study of the association of antibody levels to AMA1, MSP119, MSP3 and GLURP with protection from clinical malaria in Ghanaian children.  Malaria Journal 2008, 7:142
Antigen-specific antibody-mediated immune responses play an important role in natural protection against clinical malaria, but conflicting estimates of this association have emerged from immuno-epidemiological studies in different geographical settings. This study was aimed at assessing in a standardized manner the relationship between the antibody responses to four malaria vaccine candidate antigens and protection from clinical malaria, in a cohort of Ghanaian children…

The package, known as the President’s Emergency Plan for AIDS Relief (PEPFAR), was originally signed in 2003 and helped to buy large amounts of antiretroviral drugs to support medical care for more than 1.4 million people.

Increasingly, experts say, this kind of disease-focused model is defining the global health agenda.

Bush’s reauthorisation of the plan this year aims to provide essential treatment to three million people by 2015. The United States isn’t alone in focusing on AIDS. The Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria currently funds treatment for an estimated 1.4 million people, and the U.N. General Assembly and the Group of Eight industrialised nations support universal access to AIDS treatment.

The priority of fighting AIDS and other diseases is also one of the U.N.’s Millennium Development Goals.

However, despite the massive amounts of money driving current efforts, the global health agenda is still in its infancy. Finding the best way to fight poverty and diseases abroad is still a matter of debate.

Ruth White, an associate professor of sociology and anthropology at Seattle University who runs an aid organisation, says that a narrow focus on disease has drawbacks.

"It’s dangerous because it sucks up resources that could be spread around to have more general health impact instead of focusing efforts on people with one disease and ignoring people with others," she said.

"Basic nutrition can help provide immunity support that can prevent or ameliorate malaria, AIDS and tuberculosis. When people have poor nutrition and are generally unhealthy they are more susceptible to these illnesses," White said.

White is hardly the only voice in Seattle speaking on global health. The city is host to undoubtedly the largest private powerbroker in prioritising global health issues in the country, the Bill and Melinda Gates Foundation. The behemoth, which employs more than 620 people, has about 65 billion dollars in assets and has supplied 16.5 billion dollars in grants since its inception in 2000.

Bill Gates has stated that HIV/AIDS is the top priority of his foundation, which has provided large grants towards fighting the disease in Sub-Sahara Africa.

However, according to the Los Angeles Times, the strict disease focus carried out by the Gates foundation has created some problematic results.

The Times found that the high level of grants provided by the Gates Foundation to fight high-profile disease, notably HIV/AIDS, has led to recipients increasing their demands for specially trained clinicians, resulting in a diverting of staff from basic medical care. Such shortages have led to increased neglect of common medical conditions.

According to the article, such focus has shortchanged basic needs like nutrition and transportation. In many instances, patients actually vomit up their free AIDS medication due to malnutrition, and others lack money to travel to clinics providing such life-saving services.

An IPS request for an interview with the Gates Foundation was denied.

Part of the dilemma may be a lack of understanding of local community needs, according to Loyce Mbewa-Ong’udi, president of the Rabuor Village Project (RBV), a Seattle-based aid organisation that works on a super-local level in the rural Kenyan village of its name.

"You can’t go in with a pre-designed programme, and that needs to improve big time," she said. "Communities know what they want and what they need. They understand their priorities."

Mbewa-Ong’udi believes that a pitfall for some organisations comes from being out of touch with a majority of African communities, which are rural. As many aid organisations operate in large urban centres, they fail to see challenges faced in the countryside, and tend to undervalue local knowledge.

The RBV’s approach has been to work in partnership with community members focusing on disseminating health and development knowledge by forming a village committee, and by training 50 men and women in basic health-care knowledge.

"We identify what is going on and address what they’d like to improve," Mbewa-Ong’udi said.

RBV has also worked on solving more than just the AIDS crisis. The organisation is concentrating on developing local industries, including brick making, sunflower oil production and dairy goats, in addition to a micro-lending programme. RBV has also drilled a well and is looking to develop a large-scale water distribution system for households and agriculture.

White agrees with the approach and thinks it needs to be more prevalent.

"There is not enough humility in the willingness to be equal partners in our efforts on the ground," she said. "We may have technical knowledge, but they (locals) have the cultural and practical knowledge we need to be most effective and efficient."

However, the emphasis on diseases like AIDS remains a difficult challenge to overcome.

"AIDS and TB are diseases that scare the hell out of people in developed nations because they are global and spreading," said Charles Piller, an investigative reporter with the Los Angeles Times who has extensively covered the Gates Foundation.

And with good reason. According to the World Health Organization an estimated 33.2 million people worldwide were infected with HIV/AIDS as of 2007, 22.5 million of whom live in Sub-Saharan Africa. A total of 2.1 million died from the disease last year. But other pressing concerns exist.

"Clean water would be a much better way to improve public health in places like Africa in the long run, but it’s very costly infrastructure," Piller said.

Currently, one-fifth of the world’s population does not have access to clean drinking water and two-fifths don’t have access to basic sanitation, resulting in illness and the deaths of more than five million people each year, according to Water First International, a Seattle-based aid organisation that focuses on hygiene and water supplies in the developing world.

This issue of focusing on malaria, AIDS and tuberculosis is important, but the donor community must consider how funding is allocated, said Kirk Anderson of Water First International.

"All you have to do is look at the funding towards those things and funding on water," he said. "Are we going to allocate 100 times the amount of money towards malaria than water?"

"The message is out there and there’s a caring community that wants to take action. But we as individuals need to be better educated on how to be good philanthropists and collect good information," he said.

In the last week of July the malaria community from the East and Southern Africa regions came together in Lusaka, Zambia for their annual planning and review meeting. This important meeting provides a forum to review the malaria control programmes of each of the 22 countries in the region and this year’s specific theme was “Improving Malaria Diagnosis”.

Despite all efforts, malaria continues to be a serious public health concern throughout the world and especially in Africa. It affects over 100 countries and approximately 40 percent of the world’s population. Of the 2.5-billion people at risk between 300- and 500-million become severely sick and over one-million people die from malaria every year. In Africa, the worst affected continent, one in every five childhood deaths is due to the effects of the disease. The World Health Organisation estimates that an African child has on average between 1.6 and 5.4 episodes of malaria fever each year and every thirty seconds an African child dies of malaria.

A human and economic tragedy

Those who survive an episode of severe malaria are likely to suffer from learning impairment or brain damage. Pregnant women and their unborn children are also especially vulnerable to malaria, which is a major cause of stillbirths, low birth weight and maternal anaemia. The disease is not only a human tragedy; it is an economic one as well. The disease is estimated to cost the continent $12-billion in foregone income every year and is estimated to reduce per capita incomes by 1.3 percent per year.

All cases and deaths of malaria occur needlessly because the disease is entirely preventable and curable. Early diagnosis and prompt treatment are essential for those that fall victim to the deadly parasite. However, many primary level health care facilities in Africa lack the tools to detect the malaria parasite. Diagnosis of malaria is thus usually based on clinical symptoms such as fever, but due to the fact that many infectious diseases mimic malaria symptoms this approach leads to over-diagnosis rates of between 30–70 percent — depending on malaria transmission patterns. Over-diagnosis of malaria in turn leads to unnecessary antimalarial drug use which has the potential to lead to increased drug resistance and delays in achieving the correct diagnosis of the patient.

In the absence of a capable lab technician to conduct a microscopic analysis of a blood sample, a rapid diagnostic test (RDT), which takes approximately 15 minutes, provides a good alternative. The former is more accurate but takes time, requires a skilled lab technician and is more expensive than a RDT. However, without correct diagnoses we run the risk of losing a highly effective tool in the fight against malaria — effective antimalarial treatments.

Presently the malaria community only has one effective class of drugs (artemisinin-based combination therapies — ACTs) to treat the most severe form of malaria: plasmodium falciparum. To make matters worse due to the dishonest practices of some pharmaceutical manufacturers that are producing fake or substandard drugs there is an increased probability of resistance building up to the available ACTs. Africa Fighting Malaria recently released a report that was published in the Public Library of Science journal PLoS ONE. The report entitled Antimalarial Drug Quality in the Most Severely Malarious Parts of Africa – A Six Country Study reports on the tests AFM conducted to check the efficacy of drugs collected in six malaria endemic African countries namely: Ghana, Nigeria, Tanzania, Rwanda, Kenya and Uganda.

In the analysis, over 200 samples of antimalarial treatments were collected and tested to see if they met international standards. Overall 35 per cent of the samples were substandard and failed the test. This means that one in three patients is unlikely to be cured by the proclaimed antimalarial treatments purchased. Sub-standard drugs as opposed to outright fakes (where there is no attempt whatsoever to include the active ingredient) are of particular concern because in addition to affecting the patients’ health, they also increase the probability of the malaria parasites building up resistance to good quality drugs. This has the potential of rendering an entire class of drugs useless, which in turn has serious long-term implications for our ability to fight the disease.

Local production puzzler

Given the precarious nature of the situation it is in many instances unfortunate that large multilateral donors are actively supporting and encouraging the domestic production of antimalarial drugs. First impressions may find the local production of drugs appealing, since it has the potential to decrease transportation costs, provide local jobs, increase expertise and cut dependence on foreign suppliers. However, apart from the potential for the production of fake or substandard drugs, local manufacturers may not be as efficient in production as other established manufacturers that are already supplying the market on a no-profit and no-loss basis.

In order to support inefficient and sub-standard home industries, a government may protect local manufacturers from foreign competition by imposing high tariffs on imported pharmaceuticals. At the same time, the government may offer tax incentives and subsidies to local companies. These constrict the supply of imported drugs, which are often of superior quality, without necessarily increasing local supply appreciably.

Despite the donor community attempting to increase access to medicines in developing countries through the development of local manufacturing facilities they should be cautious in their prescriptions, particularly if the wider policy environment in these economies is not conducive to the development of local facilities. Taxes and tariffs on pharmaceutical drugs and devices must be eliminated as a matter of urgency and strict regulatory standards must be adopted in order to clamp down on the production of fake and substandard drugs. It is thus incumbent on African governments to enforce laws on malaria treatment, to work to improve diagnosis and to use only high-quality artemisinin-based combination therapies.

South Africa was one of the first countries in the world to introduce RDT’s to diagnose patients and it was also one of the first countries to change its first line treatment of uncomplicated malaria to ACT’s. South Africa was able to do this because it does not rely on international funding for its malaria control programmes — it bases its decisions on scientific evidence that has been proven to work on the ground. South Africa’s leadership in malaria control continues to be a beacon of light that other African countries strive to emulate and the South African department of health should be applauded for all of its work in malaria control

The culprit: one’s own immune system

Platelets – those tiny, unassuming cells that cause blood to clot and scabs to form when you cut yourself – play an important early role in promoting cerebral malaria, an often lethal complication that occurs mostly in children. Affecting as many as half a billion people in tropical and subtropical regions, malaria is one of the oldest recorded diseases and the parasite responsible for it, Plasmodium, among the most studied pathogens of all time. Still, cerebral malaria, which results from a combination of blood vessel and immune system dysfunction, is not well understood.

In a study described in the August 14 issue of Cell Host and Microbe, Johns Hopkins researchers reveal that when red blood cells are infected with the malaria parasite, they activate platelets to secrete the PF4 protein, which triggers the immune system to inflame blood vessels and obstruct capillaries in the brain; both are hallmarks of cerebral malaria.

In their experiments, the Hopkins team first infected human red blood cells in culture with the malaria parasite and found that this did, indeed, induce platelet activation.

The researchers then infected separate sets of live mice with the malaria parasite: one set treated so that it lacked platelets altogether and two others treated with aspirin or Plavix, platelet inhibitors that prevent the release of PF4.

The survival rate of mice without platelets as well as those treated with inhibitors was improved over that of the mice left alone, but only when the treatment began very soon after infection. When researchers started treating mice with platelet inhibitors one day after infecting them, those mice survived more often than control mice. However, when researchers waited until after three days to treat infected mice with platelet inhibitors, that group did no better in terms of survival.

"Cerebral malaria is lethal 20 percent of the time in the best of hands, and here we’ve shown that something as simple as aspirin, because of its affect on platelets, might be able to improve the outcomes of those who contract this deadly form of the disease," says David Sullivan M.D., an associate professor of molecular microbiology and immunology in the Johns Hopkins University Bloomberg School of Public Health.

To make the specific connection between PF4 and malaria, the scientists compared the responses to malaria infection by so-called "wild type" normal mice and mice genetically engineered to lack pF4. They found that the amount of parasite in the blood was the same in both sets of mice. The notable difference was in the animals’ immune responses to that same parasite burden. More than 60 percent of the mice lacking PF4 were still alive after day 10, while only 30 percent of the mice with PF4 survived that long.

"The take-home lesson is that platelets, by releasing PF4, are playing an early role in the wind-up phase of cerebral malaria," says Craig Morrell, DVM, Ph.D., an assistant professor of molecular and comparative pathobiology at the Johns Hopkins University School of Medicine. "Our mouse studies show that timing is critical; with the mice, we know when we infected them and controlled when we treated them. A big challenge in translating this to humans is that people don’t know when they get infected.

"Platelets don’t get any respect, but they’re the second most abundant cell in the blood after red blood cells and packed full of factors that rally the immune system to action. By taking what we know about platelets and their activation and applying it to malaria, we have found a driver of cerebral malaria."

###

The research was funded by the National Institutes of Health and supported by the Johns Hopkins Malaria Research Institute.

Authors on the paper are Kalyan Srivastava, Ian A. Cockburn, Anne Marie Swaim, Laura E. Thompson, Abhai Tripathi, Craig A. Fletcher, Erin M. Shirk, Henry Sun, Karen Fox-Talbot, David Sullivan, Fidel Zavala, and Morrell, all of Hopkins: also, M. Anna Kowalska of The Children’s Hospital of Philadelphia, Pa.

Vacancy Notice No: HQ/08/HQ/HTM/FT740
Title: Coordinator, Vector Control and Prevention (VCP)
Grade: P-6
Contract type: Fixed-term appointment
Duration of contract: 2 years (limited duration)
Date: 20 August 2008
Deadline for application : 3 September 2008
Duty Station: Geneva Switzerland
Organization unit: HQ/HTM HIV/AIDS, TB and
Neglected Tropical Diseases (HQ/HTM) /
HQ/GMP Global Malaria Programme (HQ/GMP)VCP

OBJECTIVES OF THE PROGRAMME:

The objectives of the Global Malaria Programme are to facilitate access of populations at risk to effective treatment of malaria; to promote the application of preventive measures against malaria for populations at risk; to build capacity for malaria control; to strengthen malaria surveillance systems, and the monitoring and evaluation of malaria control.

The mission of the Vector Control and Prevention Team is to maintain, update and promote evidence-based and consensus-based recommendations, norms and standards for malaria prevention, and to stimulate the development and testing of new technologies, tools and guidelines for malaria control.

Description of duties:

To plan, direct and coordinate the work of a highly specialized technical and scientific team focusing on Malaria Vector Control interventions and projects. The incumbent works closely with other teams within GMP as well as Malaria Units and Vector Biology and Control units in the Regional Offices to ensure coordinated action.

To liaise and coordinate with other WHO technical areas to provide authoritative expertise and participate in the development of technical strategies, programmes and projects across the Organization.

To direct and/or participate in the development and implementation of new/revised policies, standards, norms and guidelines and promote the acceptance of new malaria control vector norms by all partners based on evidence and technical consensus.

Together with the Director GMP, to coordinate fund raising efforts of GMP.

To ensure the quality of publications, documents, reports and/or databases on technical and strategic issues in malaria vector control.

To allocate and monitor the use of resources, guide, supervise and evaluate staff, promote long term staff development and develop technical and/or administrative solutions in response to new and evolving challenges in the WHO working environment.

To provide technical advice, expertise and ongoing liaison to the RBM Partnership through its Secretariat and other Partners in the development and communication of effective technical approaches to Malaria Vector Control.

To oversee the development of VCP work plans to advocate state-of-the-art and excellence in the field, critically monitoring and assessing performance and results, and demonstrated value, anticipating challenges and recommending further activities and resolving problems, including participation in the departmental strategic planning, management, guiding and motivating staff members at headquarters and in countries, spearheading and encouraging exchanges of information and common understanding within the department, team, WHO

Regional and Country offices, Roll Back Malaria Partnership, academic and research institutions to ensure close collaboration and coordination of Malaria Vector Control activities in a proactive manner.

REQUIRED QUALIFICATIONS

Education:

Essential: Medical Degree and/or postgraduate degree in entomology.

Desirable: Degree or postgraduate training in epidemiology, molecular biology, biochemistry or public health.

Skills:

Thorough knowledge of malaria, medical entomology, and integrated vector management, complemented by demonstrated knowledge of current methods for research on malaria vectors and insecticides, as well as methods for the assessment and management of insecticide resistance and vector bionomics.

Computer literacy. Excellent presentation skills.

Experience:

Essential: Extensive experience in research on malaria vector entomology and vector control in endemic control.

Extensive field experience in operational vector control in endemic countries. Extensive experience in collaboration with the industry on the development of new products, especially long-lasting insecticidal nets and transfers of technologies.

Considerable experience in WHO including leadership and managerial experience.

Desirable: Experience at national or international levels in malaria vector control. Experience in leading national projects/programmes in the field of malaria prevention and control, and assessing their impact on public health, preferably in developing countries.

Languages:

Excellent knowledge of English or French with a (good) working knowledge of the other language. Knowledge of another WHO official language an asset.

Additional Information:

Only on-line applications will be accepted. Similar posts may be filled from this vacancy notice. A written test and/or oral presentation may be used as a form of screening.

Please refer to the WHO competency model on our website: http://www.who.int/employment/competencies/en/index.html

Annual salary: (Net of tax)

89129US$ at single rate
96427US$ with primary dependants

Post Adjustment: 92 % of the above figure(s). This percentage is to be considered as indicative since variations may occur each month either upwards or downwards due to currency exchange rate fluctuations or inflation.

A written test and interviews may be used as a form of screening Online applications are strongly encouraged to enable WHO to store your profile in a permanent database.

Please visit WHO’s e-Recruitment website at: www.who.int/employment.  The system provides instructions for online application procedures.

All applicants are encouraged to apply online as soon as possible after the vacancy has been posted and well before the deadline stated in the vacancy announcement.

Applications from women and from nationals of non- and under-represented member states are particularly encouraged.

Any appointment/extension of appointment is subject to WHO Staff Regulations, Staff Rules and Manual.

Only candidates under serious consideration will be contacted.

Currently accepting applications

WHO has a smoke-free environment and does not recruit smokers or other tobacco users.

Deadline for applications: 12 September 2008

The London School of Hygiene and Tropical Medicine (LSHTM), the Medicines for Malaria Venture (MMV) and Pfizer invite letters of interest (LOI) to participate in a Phase III efficacy, and safety study of azithromycin-chloroquine fixed dose combination (AZCQ) versus sulphadoxine-pyrimethamine (SP) for the intermittent preventive treatment of P. falciparum malaria during pregnancy (IPTp). This study will be a pivotal study in the registration of AZCQ for IPTp

The target start date for the study is the beginning of the 2nd Quarter 2009, with the recruitment phase of 18 to 24 months.

Background

Important progress has been made in Africa with the introduction of a preventive strategy for malaria in pregnancy consisting of IPTp. SP is the current standard of care for this indication, but development of safe, efficacious and affordable alternatives for IPTp is one of the main priorities for the control of malaria in pregnancy.

AZCQ is being developed for intermittent preventive treatment of falciparum malaria in pregnant women. AZCQ has demonstrated efficacy, safety and tolerability in two phase III clinical studies in the treatment of symptomatic uncomplicated malaria in adults in sub-Saharan Africa. Both azithromycin and chloroquine are considered safe in pregnant women as individual agents.

The proposed study is a Phase III clinical trial comparing AZCQ with SP, for use in the IPTp.  The protective efficacy of AZCQ in pregnancy against sexually transmitted Infections (STI), and respiratory infections (RTI) will also be evaluated. 

Who should apply

LOI are expected from African research institutions, scientists, research clinics and health care facilities where pregnant women are seeking antenatal care, where capacity for follow-up and delivery of pregnant women and laboratory facilities exist.

Selection process

Responses to this call for LOI will be reviewed by a panel of Pfizer, LSHTM and MMV staff to short-list potential sites to participate. A second round of information will be requested by Pfizer from short-listed sites specifically related to the study protocol and Good Clinical Practices (GCP) compliance. Based on that information Pfizer team may visit the sites for pre-trial assessment and final site selection.     

How to apply

LOI should be 6-8-pages long, in English or French, providing all the following information:

• Name of principal investigator with telephone, fax and e-mail address
• Brief description of the research team/institution and collaborators
• Prior clinical trial experience/ ICH-GCP inspection history / on-going study commitments that may conflict with proposed studies
• Certification in ICH-GCP training, if available
• Information on regulatory / Ministry of Health / ethics committee application process & timelines
• Standard of care in the country for prophylaxis (IPTp) and treatment of uncomplicated P. falciparum malaria during pregnancy
• Level of  resistance to chloroquine in the region (if available)
• Level of resistance to SP in your region (if available)
• Description of current infrastructures:
• antenatal clinic (ANC) and bed facilities
• number of pregnant women seen in the ANC
• laboratory facilities (parasitology, haematology, biochemistry)
• laboratory technique used to routinely evaluate parasitaemia (please provide a short description of the technique(s) used
• any lab accreditation or quality control programme that the lab participates in or any previous lab audit(s) and outcome(s)
• Evidence of malaria season(s). A table needs to be provided within the number of uncomplicated P. falciparum malaria cases collected in the proposed site by month during 2 years from January 2006 to December 2007 (if not yet available from January 2005 to December 2006)
• It would also be helpful if you could confirm that your ministry of health would support the study.
• Top-line estimated cost per patient at your facility and a draft budget justification

LOI should be returned by e-mail or hardcopy no later than Friday 12 September 2008 to:

 Pfizer address:

AZCQ IPTp study
c/o Dr. Richa Chandra
Development Team Leader, Malaria Program
Senior Director, Infectious Diseases, Pfizer Global R&D
50 Pequot Avenue, MS: 6025-B3112
New London, CT 06320, USA

E-mail: richa.s.chandra@pfizer.com
Phone: 001-860-732-5532
Mobile: 001-860-501-3836

Ferguson HM, Ng’habi KR, Walder T, Kadungula D, Moore SJ, Lyimo I, Russell TL, Urassa H, Mshinda H, Killeen GF, Knols BG. Establishment of a large semi-field system for experimental study of African malaria vector ecology and control in Tanzania. Malar J. 2008 Aug 20;7(1):158. [Epub ahead of print]
Medical entomologists increasingly recognize that the ability to make inferences between laboratory experiments of vector biology and epidemiological trends observed in the field is hindered by a conceptual and methodological gap occurring between these approaches which prevents hypothesis-driven empirical research from being conducted on relatively large and environmentally realistic scales. The development of Semi-Field Systems (SFS) has been proposed as the best mechanism for bridging this gap…

van Schalkwyk DA, Priebe W, Saliba KJ. The inhibitory effect of 2-halo derivatives of D-glucose on glycolysis and on the proliferation of the human malaria parasite Plasmodium falciparum. J Pharmacol Exp Ther. 2008 Aug 19. [Epub ahead of print].
The intraerythrocytic stage of the human malaria parasite Plasmodium falciparum relies on glycolysis for ATP generation, and since it has no energy stores a constant supply of glucose is necessary in order for the parasite to grow and multiply. The 2-substituted glucose analogues 2-deoxy-D-glucose (2-DG) and 2- fluoro-2-deoxy-D-glucose (2-FG) have previously been shown to inhibit the in vitro growth of P. falciparum and have been suggested to do so by inhibiting glycosylation in the parasite...

Lines J, Schapira A, Smith T. Tackling malaria today. BMJ. 2008 Aug 19;337:a869. doi: 10.1136/bmj.a869.
Once again, after an interval of 40 years, local elimination and global eradication of malaria is a focus of international health. In 2007, the African Union called for elimination of malaria from the continent, and the Bill and Melinda Gates Foundation challenged partners to adopt the goal of eradication. In this article, we draw on lessons from the first global malaria eradication campaign to argue that in most countries, time...

Watts G. Tightening the net around malaria. BMJ. 2008 Aug 19;337:a1267. doi: 10.1136/bmj.a1267
In so far as attempts to thwart malaria have made progress in recent years, one man in particular is entitled to a share of the credit. He’s Brian Greenwood of the London School of Hygiene and Tropical Medicine—and the recent decision to make him one of the joint winners of the newly created Hideyo Noguchi Africa Prize was a well deserved public acknowledgment of his personal contribution. The citation speaks of his bold and innovative work on the disease...

Jawara M, Pinder M, Drakeley CJ, Nwakanma DC, Jallow E, Bogh C, Lindsay SW, Conway DJ. Dry season ecology of Anopheles gambiae complex mosquitoes in The Gambia.  Malar J. 2008 Aug 18;7(1):156. [Epub ahead of print]
Malaria in The Gambia is highly seasonal, with transmission occurring as Anopheles gambiae s.l. populations expand during and immediately after a single annual rainy season that lasts from June to October. There has been very limited investigation of the ecology of vectors during the dry season, when numbers are very limited and distributions may be restricted…

Uneke CJ, Ogbonna A. Malaria and HIV co-infection in pregnancy in sub-Saharan Africa: impact of treatment using antimalarial and antiretroviral agents.  Am J Trop Med Hyg. 2008 Aug;79(2):185-91
Malaria and HIV infection represent severe public health problems in sub-Saharan Africa, and pregnant women are at increased risk because the two diseases intersect in pregnancy, causing adverse perinatal outcome. As access to antiretroviral drugs is increasing in the sub-region, and new combinations of antimalarial drugs are being implemented while more are being evaluated, there is potential for interactions between these therapies …

Exxon Mobil Corporation announced today a $3.5-million grant to the Global Health Group at the University of California, San Francisco (UCSF), to expand its core support for an unprecedented malaria elimination effort in southern Africa.

"To win the fight against malaria we must attack the disease on many fronts," said Rex W. Tillerson, chairman and chief executive officer. "ExxonMobil is committed to this battle, which is why we’re doing everything we are -- from helping to develop new drugs, facilitating the delivery of insecticide treated bed nets to places where they are desperately needed and supporting programs that prevent the spread of the disease."

The UCSF Global Health Group and its partners currently provide significant support to Botswana and Swaziland in the development of strategic plans to eliminate malaria from those countries. The Group will use today’s funding from ExxonMobil to build on this support, and expand it to additional southern African countries such as Namibia and Zanzibar. This work, conducted in partnership with the Clinton Foundation, is a cornerstone of the Global Health Group’s Malaria Elimination Initiative, which seeks to eliminate the disease in several countries around the world, working inward from the natural global borders of the disease.

Funding will also allow the Global Health Group - Clinton Foundation partnership to support development and enhancement of critical cross-border initiatives between countries with low levels of malaria and their more heavily-affected neighbors, helping to control the disease and pave the way for elimination. Resources will also be used to support rigorous monitoring and evaluation, and sharing of lessons and experiences with the broader malaria elimination community. These efforts are conducted in support of the Southern African Development Community’s (SADC) goal of eliminating malaria from the region.

"ExxonMobil has been a corporate leader in the fight against malaria and we are delighted by their support for our work," said Sir Richard Feachem, KBE, DSc(Med), PhD, director of the Global Health Group. "This funding will greatly strengthen the pioneering malaria control and elimination efforts under way in southern Africa and link them more effectively to similar work in other parts of the world."

Dr. Steven Phillips, medical projects director for ExxonMobil said it is vital to take a new regional approach if the battle against malaria is to be successfully transitioned from one aimed at controlling the disease to outright elimination.

"Malaria knows no borders, it cannot be eliminated in any one country unless we tackle it together as a regional strategy," said Dr. Phillips. "Elimination of this disease requires new levels of regional and international cooperation."

The funding to UCSF will bring ExxonMobil’s commitment to organizations engaged in important community and social development projects in Africa to more than $130 million, which includes more than $50 million committed through the company’s Africa Health Initiative.

The Africa Health Initiative was established in 2000 in support of the Abuja Declaration on Roll Back Malaria in Africa and its goal to halve malaria deaths by 2010. Since then, ExxonMobil has developed on-the-ground public-private partnerships to fight malaria at the community level, progress treatment and vaccine research and raise awareness and international support.

As part of those relationships, Dr. Phillips serves on the board of Malaria No More and as an advisor to the UN Special Envoy on Malaria.

Malaria is a life-threatening disease caused by a parasite and transmitted to humans by the bite of a mosquito. With between 1 million and 3 million deaths annually and 3,000 children deaths daily, it remains one of the globe’s leading infectious killers. The majority of its victims are children under the age of five and pregnant women.

Today’s announcement brings to a total of twelve countries in Africa where anti-malaria efforts are being supported by ExxonMobil, the largest non-pharmaceutical corporate donor to malaria research and development efforts. The others are Angola, Nigeria, Equatorial Guinea, Chad, Cameroon, Kenya and Uganda.

The Integrated Malaria Control Programme embarked upon by the Anglo Gold Ashanti in 2005 which sought to reduce the incidence of malaria within its catchment area has already started yielding positive results, the manager of the Malaria Control Programme of Anglo Gold Ashanti, Samuel O Danso has announced.

This is evidenced by the fact that the programme’s objective to halve malaria cases within two years, through the adoption of a multi-pronged approach has been achieved in six months.

A monthly average of 12,000 reported cases at the two major hospitals in the municipality, has dropped to 3,120, a 74 percent decrease, and within the Anglo Gold Ashanti mine community, there is a drop from 238 cases per 1,000 employees to 29 cases.

Addressing the media, Mr Danso said that the company was able to save over $30,000 a month on malaria medication by cutting down the monthly expenditure of $55,000 on malaria treatment to $12,000.

He attributed the success story to the community’s acceptance of the programme and the diligence of the corps of well trained, motivated and disciplined spray men and added that the mine also succeeded in reducing the man hours lost to malaria from 6,983 in 2005 to 304 in 2008.

The programme, he explained, adopted measures like indoor residual spraying to control the vector (the female anopheles mosquito) and distribution of insecticide mosquito nets to orphanages, maternity homes and the children’s wards of the two main hospitals.

The indoor residual spraying involves the spraying of every item on every inch of space, including interior walls, ceiling and underside of furniture at homes, offices, churches, schools and village huts.

"We have covered the entire municipality about five times already (two rounds a year) and in every round, we covered every room within a 110-mile radius of Obuasi,” he emphasised.

He said in the first year of the programme, the mine spent $1.7 million and thereafter $1.4 million a year adding that the success story of Obuasi earned the company an award at the Global Business Coalition Award in the United States in 2007.

Mr Danso said, “Already, other mining companies in Ghana are approaching us to replicate the programme in their mining areas. Newmont, for instance, has brought 19 of its employees here to be trained.”

“At the national level, the President’s Special Malaria Initiative in the North, is using the Obuasi programme as a case study” he added.

Integrating efforts to control malaria and neglected tropical diseases (NTDs) is an inexpensive and effective solution to reduce the incidence of deadly tropical anemia in sub-Saharan Africa, according to a new analysis published in the Public Library of Science (PLoS) Neglected Tropical Diseases. In this region, many people are co-infected with malaria and NTDs such as hookworm and schistosomiasis. Malaria alone kills more than one million children every year, and NTDs afflict hundreds of millions more.

The new analysis, ’’Tropical Anemia: One of Africa’s Great Killers and a Rationale for Linking Malaria and Neglected Tropical Disease Control to Achieve a Common Goal,’’ makes a compelling case for integrating approaches to control malaria and NTDs in order to mitigate their devastating impacts in a cost-effective way. Together, malaria and the seven most common NTDs cause almost two million deaths and are responsible for the loss of nearly 100 million disability-adjusted life years (DALYs) annually - almost 20% higher than the disease burden from HIV/AIDS. Both malaria and NTDs cause immense suffering largely through anemia, a deficiency in hemoglobin often accompanied by a reduced number of red blood cells. Anemia accounts for up to half of the malaria deaths in young children, and is a major contributor to both the enormous burden of maternal deaths during pregnancy and to premature births. Chronic anemia in young children is also tied to reduction in physical growth, impaired cognition, and poor school performance.

Co-infection with malaria and one or more NTDs (especially hookworm infection or schistosomiasis, two of the most common NTDs in sub-Saharan Africa) causes a pronounced exacerbation of anemia. Severe hemoglobin deficiencies are the manifestation of co-infection of malaria and NTDs, shown to be markedly higher than in those with only a single infection. This phenomenon is commonly referred to the "perfect storm of anemia."

Malaria control and NTD control have each been found to reduce anemia in both children and pregnant women. "Combining malaria and NTD control practices in a unified anemia framework affords one of the best opportunities to reduce the perfect storm of anemia morbidity and mortality in sub-Saharan Africa," said Peter J. Hotez, MD, PhD, President of the Sabin Vaccine Institute and Walter G. Ross Professor and Chair of the Department of Microbiology, Immunology, and Tropical Medicine at The George Washington University.

The analysis also stated that, "in addition to the health improvement that would result from anemia reduction, there is also some evidence that hookworm and schistosomiasis (and possibly other NTDs) may promote increased susceptibility to malaria, so that NTD control would work in synergy with nets and other measures to reduce malaria incidence." The use of bed-nets was shown to increase substantially - in some cases nine-fold - when used alongside NTD control efforts.

"Based on this link, the public-private partnerships of the Global Network for NTDs are working to identify opportunities for integrating malaria and NTD control efforts in sub-Saharan Africa," said Kari Stoever, Managing Director of the Global Network for Neglected Tropical Diseases. "The Network’s effective system of delivering treatment through trained local community coordinators is an ideal way to enhance malaria control and NTD control efforts and, ultimately, reduce deadly cases of these diseases and anemia."

Noting that NTD control can cost as little as 50 cents per person per year, the authors stated that this inexpensive investment would be "another promising, low-cost and highly cost-effective, and complementary approach for potentially reducing the morbidity of malaria in sub-Saharan Africa."

"An integrated control program for tropical anemia in Africa represents one of our better hopes for a quick win in the fight for sustainable disease control and poverty reduction integration," Dr. Hotez and Dr. Molyneux concluded. By taking a more holistic approach to disease control and prevention, we can finally help the people of sub-Saharan Africa break out of the cycle of poverty that has been plaguing them for so long.

Tropical Anemia: One of Africa’s Great Killers and a Rationale for Linking Malaria and Neglected Tropical Disease Control to Achieve a Common Goal’’ is co-authored by Dr. Peter. J. Hotez (Executive Director of the Global Network for NTDs, President of the Sabin Vaccine Institute and Walter G. Ross Professor and Chair of the Department of Microbiology, Immunology and Tropical Medicine at George Washington University) and David H. Molyneux (Professor of Tropical Health Sciences at the Liverpool School of Tropical Medicine and Director of the Lymphatic Filariasis Support Centre).

Deadline for applications: 1 September 2008

http://www.amanet-trust.org/ext/news/jobCTC.htm  

The African Malaria Network Trust (AMANET) is a pan-African non-profit institution whose mission is to promote capacity strengthening, performance and impact of African malaria R & D institutions. The Trust was incorporated in Tanzania on 14th March 2002.

Currently AMANET undertakes short- and long-term training of African malaria researchers, infrastructure improvement, equipping research institutions, and sponsorship of clinical and field trials of candidate malaria intervention tools.

AMANET is pleased to invite applications from suitable candidates for a position of Clinical Trials Coordinator to be based at the AMANET Secretariat in Dar es Salaam, Tanzania.

Purpose of the job

The Clinical Trials Coordinator (CTC) shall be responsible for AMANET sponsored clinical trials, and therefore the principal advisor to the Managing Trustee (MT) on all matters relating to clinical trials, including their planning, execution, monitoring and evaluation.

Job description

1. Planning and coordinating clinical trials following ICH/GCP and other international regulations;
2. Overseeing the designing and preparation of trial protocols, investigators’ brochures, informed consent statements, reference manuals, etc;
3. Ensuring compliance to applicable international regulations for all clinical trials  and AMANET’s observance of sponsor responsibilities;
4. Implementation and supervision of Project Managers, Clinical Monitors to ensure  adherence to trial protocols and programme activities;
5. Supervising trials across Africa and ensure adequate capacity for clinical trials is attained;
6. Supervising several professional Secretariat staff members;
7. Preparing  and follow up of minutes of the Expert Committees;
8. Supervision of filing regulatory and ethics review documents;
9. Maintenance of AMANET’s quality assurance programme is up to standard including, but not limited to, preparing & review of SOPs, and coordination of external audits;
10. Representing AMANET interests to stakeholders;
11. Developing funding proposals;
12. Interface between AMANET and key external contacts and collaborators including product developers, contract research organizations and research associates
13. Undertaking any other duties as assigned by the Managing Trustee.

Qualifications:

1. MD or equivalent medical degree, a postgraduate degree (at least MSc or equivalent, preferably PhD in community or public health, clinical research, epidemiology, paediatrics, tropical medicine, communicable diseases, biostatistics or similar area of specialization);  
2. Postgraduate training in clinical research and / or product development is essential;
3. Computer skills are essential as is solid  knowledge and experience with ICH/GCP together with other international biomedical research guidelines;
4. Demonstrable competence as team player with good interpersonal skills;
5. Strong experience in project/programme management with a verifiable record;
6. Familiarity with health research ethics issues in African settings is desirable;
7. Previous training and experience in carrying out and monitoring clinical and field trials of interventions is required; and
8. Experience in research supervision and knowledge of French are added advantages.

Remuneration:

The successful candidate will be based in Dar es Salaam, Tanzania and offered an attractive and highly competitive international salary based on qualifications and experience.

How to apply

If you meet the above criteria, submit by e-mail an application letter with a detailed CV, which should also show your contacts (including e-mail addresses) and names and addresses of three professional /work and personal / study related referees.

Also attach copies of other essential documents e.g. certificates, testimonials, etc. Your application should be received on or before 1st September 2008 and should be sent to:

The Managing Trustee,
African Malaria Network Trust,
PO Box 33207, Dar es Salaam, Tanzania.
Website: http://www.amanet-trust.org
Email: vacancy@amanet-trust.org

Deadline for applications: 26 September 2008

http://www.jobs.ac.uk/jobs/NN198/Malaria_Epidemiologist/

3 Years extendable by mutual agreement

£34,933 - £43,182 per annum

For 60 years now, MRC in The Gambia has been carrying out internationally competitive research on Bacterial Diseases, Malaria and Viral Diseases. We’ve established ourselves as a leading research centre in sub-Saharan Africa, and our reputation is exceptional. Perhaps more importantly, we continue to push forward into new and challenging areas. Both epidemiologists will have vital impact on the future work of the Unit.

Malaria Epidemiologist

You will further develop epidemiological research within the Malaria Programme and, with the Head of Programme, will develop strategic plans to impact on the future direction of malaria control and potential elimination both in The Gambia and the sub-region.

You will have a first degree in science or medicine, a PhD in epidemiology or modelling of biological or health systems and preferably an MSc in epidemiology or statistics. You’ll have solid experience of statistical and other model-based analyses of empirical data, and it will be advantageous to have had significant malaria research experience. A working knowledge of French would be an asset.

We require you to be an excellent communicator and leader with demonstrated potential for working in a diverse team that includes academic, governmental and NGO partners.

Salary will be commensurate with qualifications and experience and will be within the range £34,933 - £43,182 per annum. The package also includes generous overseas allowances, furnished accommodation, flights and other benefits.

For further information and to apply, please visit our website: http://jobs.mrc.ac.uk. If you do not have internet access or experience technical difficulties, please call 01793 301049   quoting reference GAM08/415 (Malaria Epidemiologist). For on line applications please attach a CV and covering letter.

Closing date: 26th September 2008

For further information about MRC UK visit www.mrc.ac.uk and for MRC Gambia www.mrc.gm

Magistrado P, Salanti A, Tuikue Ndam NG, Mwakalinga SB, Resende M, Dahlbäck M, Hviid L, Lusingu J, Theander TG, Nielsen MA. VAR2CSA Expression on the Surface of Placenta-Derived Plasmodium falciparum-Infected Erythrocytes. J Infect Dis. 2008 Aug 13. [Epub ahead of print]
Malaria remains a major threat, in sub-Saharan Africa primarily, and the most deadly infections are those with Plasmodium falciparum. Pregnancy-associated malaria is a clinically important complication of infection; it results from a unique interaction between proteoglycans in the placental intervillous space and parasite antigens. Both placental and chondroitin sulphate A-selected parasites have high-level transcripts of a unique var gene named var2csa…

Efferth T, Romero MR, Wolf DG, Stamminger T, Marin JJ, Marschall M.  The Antiviral Activities of Artemisinin and Artesunate. Clin Infect Dis. 2008 Aug 12. [Epub ahead of print]
Traditional Chinese medicine commands a unique position among all traditional medicines because of its 5000 years of history. Our own interest in natural products from traditional Chinese medicine was triggered in the 1990s, by artemisinin-type sesquiterpene lactones from Artemisia annua L. As demonstrated in recent years, this class of compounds has activity against malaria, cancer cells, and schistosomiasis. Interestingly, the bioactivity of artemisinin and its semisynthetic derivative artesunate is even broader and includes the inhibition of certain viruses, such as human cytomegalovirus and other members of the Herpesviridae family (e.g., herpes simplex virus type 1 and Epstein-Barr virus), hepatitis B virus, hepatitis C virus, and bovine viral diarrhea virus...

Mullen GE, Ellis RD, Miura K, Malkin E, Nolan C, Hay M, Fay MP, Saul A, Zhu D, Rausch K, Moretz S, Zhou H, Long CA, Miller LH, Treanor J. Phase 1 trial of AMA1-C1/Alhydrogel plus CPG 7909: an asexual blood-stage vaccine for Plasmodium falciparum malaria. PLoS ONE. 2008 Aug 13;3(8):e2940.
Apical Membrane Antigen 1 (AMA1), a polymorphic merozoite surface protein, is a leading blood-stage malaria vaccine candidate. This is the first reported use in humans of an investigational vaccine, AMA1-C1/Alhydrogel, with the novel adjuvant CPG 7909. METHODS: A phase 1 trial was conducted at the University of Rochester with 75 malaria-naive volunteers to assess the safety and immunogenicity of the AMA1-C1/Alhydrogel+CPG 7909 malaria vaccine...

Smith T, Maire N, Ross A, Penny M, Chitnis N, Schapira A, Studer A, Genton B, Lengeler C, Tediosi F, DE Savigny D, Tanner M. Towards a comprehensive simulation model of malaria epidemiology and control. Parasitology. 2008 Aug 11:1-10. [Epub ahead of print]
Planning of the control of Plasmodium falciparum malaria leads to a need for models of malaria epidemiology that provide realistic quantitative prediction of likely epidemiological outcomes of a wide range of control strategies. Predictions of the effects of control often ignore medium- and long-term dynamics. The complexities of the Plasmodium life-cycle, and of within-host dynamics, limit the applicability of conventional deterministic malaria models...

Ramharter M, Kurth F, Schreier AC, Nemeth J, Glasenapp IV, Bélard S, Schlie M, Kammer J, Koumba PK, Cisse B, Mordmüller B, Lell B, Issifou S, Oeuvray C, Fleckenstein L, Kremsner PG. Fixed-Dose Pyronaridine-Artesunate Combination for Treatment of Uncomplicated Falciparum Malaria in Pediatric Patients in Gabon.  J Infect Dis. 2008 Aug 11. [Epub ahead of print]
HIV-related immune-suppression increases the risk of malaria (infection, disease and treatment failure) and probably the circulating parasite biomass, favouring the emergence of drug-resistant parasites…

O’Meara WP, Mwangi TW, Williams TN, McKenzie FE, Snow RW, Marsh K. Relationship between exposure, clinical malaria, and age in an area of changing transmission intensity.  Am J Trop Med Hyg. 2008 Aug;79(2):185-91
The relationship between malaria transmission intensity and clinical disease is important for predicting the outcome of control measures that reduce transmission. Comparisons of hospital data between areas of differing transmission intensity suggest that the mean age of hospitalized clinical malaria is higher under relatively lower transmission, but the total number of episodes is similar until transmission drops below a threshold, where the risks of hospitalized malaria decline…

According to a study published in the open-access journal PLoS Medicine, malaria control goals can only be achieved if future funding is tied more closely to level of need.

From the Kenyan Medical Research Institute-Oxford University-Wellcome Trust Collaborative Programme, Bob Snow and colleagues have been working with malaria for several years. They conducted the Malaria Atlas Project, creating a global map depicting the risk of Plasmodium falciparum (the protozoan parasite that causes malaria in humans), and they most recently studied international malaria financing between 2002 and 2007.

Groups such as The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the World Bank, the US President’s initiative, and the Gates Foundation have all committed funds to several parts of the world with the hope of reducing malaria. The researchers compared where these donors were sending fund to an objective assessment of national burdens of malaria. The study revealed that every year, about US $1billion are sent towards the 1.4 billion people exposed to stable P. falciparum malaria risk. This distribution amounts to less than a dollar per person per year at risk. The researchers also found the 40% of international malaria financing comes from the GFATM.

In general, the authors deem appropriate the distribution of malaria funds. Over 75% of GFATM funding has been committed to Africa, the continent with the highest malaria burden. However, countries in South East Asia and Western Pacific regions received a disproportionate amount of support to control malaria. These regions have 47% of the global population risk but only receive 17% of GFATM and 24% of non-GFATM support.

Additionally, the researchers noted a wide variation in spending levels. Suriname in northern South America received from GFATM US$147 per person at risk of malaria, while Myanmar (Burma) received about US$0.01 per person-at-risk. One striking finding was that the 16 countries that represent 50% of the global population risk received less than US$0.5 per person-at-risk from all sources. These countries include 7 of the poorest countries in Africa and India and Indonesia - two of the most densely populated, stable malaria endemic countries.

Snow and colleagues conclude that the goal to cut global malaria in half by 2015 is unlikely to be achieved due to the gaps between funding support and level of stable P. falciparum risk. "We estimate that there remains a 50% - 450% shortfall of funding to achieve the scaling up of malaria control required worldwide," write the authors.

Anthony Kiszewski (Bentley College, Massachusetts) wrote in a related Perspective article: "Despite the inability of the international community to mobilize resources sufficient to meet basic goals, talk of elimination and eradication has again become fashionable. But until shortfalls in funding are rectified, such plans seem quixotic at best."

"To achieve Goal 6 of the Millennium Development Goals, the gap between needs and commitments must be filled quickly. Given recent calls for malaria eradication, Snow and colleagues’ sober assessment should provide an instrument to prod the horse on before the cart disappears too far down the road," he concludes.

International funding for malaria control in relation to populations at risk of stable Plasmodium falciparum transmission
Snow RW, Guerra CA, Mutheu JJ, Hay SI
PLoS Medicine (2008). 5(7): e142.
doi:10.1371/journal.pmed.0050142
Click Here to View the Article

Divergent goals and commitments in global malaria intervention
Kiszewski AE
PLoS Medicine (2008). 5(7): e159.
doi:10.1371/journal.pmed.0050159
Click Here to View Perspective Article

East African researchers have found that most of the breeding sites of malaria-carrying mosquitoes are man-made and can be dealt with by effective environmental management.

On Tuesday, prominent Kenyan scientist Dr Onesmo ole-MoiYoi told a Cape Town audience that it was not necessary to use the deadly pesticide DDT - still used in the northern KwaZulu-Natal area of South Africa, despite being banned in most countries around the world - to control malaria.

He suggested that environmental management of the artificially created breeding sites, when used holistically in conjunction with other anti-malaria measures such as the use of bed nets, bio-pesticidal spraying and affordable prophylactics, could provide an effective control for the dreaded disease that still kills one African person every 30 seconds.

Stressing that a comprehensive intervention package against malaria was necessary and that there was no single solution, he said: "I think a campaign of environmental interventions is what is required, and we actually have that capacity now."

’I think a campaign of environmental interventions is what is required’

Malaria causes one million deaths in sub-Saharan Africa each year, and results in economic losses estimated at $12-billion annually, reducing economic growth by as much as 1,3 percent. Some 300-million to 500-million people are affected by it.

Dr ole-MoiYoi has been director of research and partnerships at the International Centre for Insect Physiology and Ecology (ICIPE), based at Kenyatta University in Nairobi, since 2001.

He was speaking on Tuesday at a three-day conference at Kirstenbosch where global climate change experts and journalists are discussing the topic: "Practising the craft: writing about climate change & global warming".

The conference, which aims to promote public understanding of climate change and its social consequences, is hosted by the newly established Fynbos Foundation, in association with the Nieman Foundation for Journalism at Harvard, and the Nieman Society of South Africa.

Dr ole-MoiYoi also revealed that researchers from the centre had made the amazing discovery that mosquitoes, the vector of the protozoan parasites that cause malaria, could rid themselves of these parasites by feeding on particular plant species.

’Mosquitoes have discovered a cure for malaria’

He explained that it had been known that mosquitoes feed on plants to obtain sugar, but when the researchers looked at what plants the insects utilised they discovered that they were "fussy feeders", choosing only some species. One of their favourites was wild quinine.

They had found a 100 percent reduction of the malaria parasites in some mosquitoes feeding on these plants, he said.

"Mosquitoes have discovered a cure for malaria."

While researching epidemics of so-called "highland malaria", the researchers had discovered that many of the breeding sites of the mosquito species involved were man-made pits associated with brick-making operations in the Kenyan highlands.

Other human-created breeding sites elsewhere in the country included abandoned swimming pools and blocked drainage infrastructure, which created sites for stagnant water.

Dr ole-MoiYoi said climate change would have far-reaching effects and would "profoundly" influence all biological and physical life-support systems on Earth necessary for human survival.

"We can’t really predict what will happen, but different regions will be affected in different ways."

Referring specifically to malaria, he said: "There may be epidemics if we don’t put interventions in place."

He said there also had to be new interventions to control Tsetse flies and locusts.

He warned: "What we’re doing at the moment is completely disastrous."

Resistance to ciprofloxacin has emerged in people without access to the antibiotic, but who have taken a related antimalarial

A new study shows that overuse of a drug used to prevent and treat malaria may be contributing to growing antibiotic resistance. Researchers report in the journal PLoS ONE that Escherichia coli bacteria resistant to the antibiotic ciprofloxacin were detected in the digestive tracts of villagers from remote rainforest communities in Guyana who had been given the drug chloroquine to prevent and treat malaria, a potentially fatal disease spread by mosquitoes. This is the first study to show that resistance can emerge in individuals never exposed to the antibiotic, which is used throughout the world to treat bacterial infections, including pneumonia, urinary tract infections and sexually transmitted diseases.

"Ten to 15 years ago, resistance to ciprofloxacin was rare. [Now], outside of remote populations, cipro resistance in hospitals and the community at large is becoming a problem," says Andrew Simor, a senior scientist at the Sunnybrook Health Sciences Center at the University of Toronto, who was not involved in the study. "E. coli is one of the most common causes of infections in humans. A decade ago it was nearly universally susceptible to ciprofloxacin." Today, he says, as many as 30 percent of hospital patients tested have E. coli that failed to respond to ciprofloxacin, which is the drug of choice for treating these bacteria.

Drug-resistant bacteria  are known to arise from the overuse of antibiotics, which is why researchers were surprised to discover that they can develop in areas that do not have access to ciprofloxacin, says study co-author Michael Silverman, an infectious disease specialist at Lakeridge Health Network in Ontario. In fact, he says, ciprofloxacin-resistant E. coli were even more widespread in remote Guyanese villages than in U.S. intensive care units "where every second person is on antibiotics."

During a three-year study, the researchers monitored the levels of antibiotic-resistant E. coli in patients at their clinics. They found that rates of resistance were over three times higher in February 2003 than they were just a year earlier, Silverman says. The jump corresponded to the increased use of chloroquine—a drug widely prescribed to prevent and control malaria —after a large outbreak of the disease (which causes high fevers, chills, nausea and headaches) in late 2002.

Chloroquine, taken daily by some villagers, is a close chemical cousin of ciprofloxacin. In the early 1960s, the creation of the antibiotic class (quinolones), which includes ciprofloxacin, was based on the by-products of chloroquine synthesis. In laboratory experiments, the team confirmed that chloroquine concentrations similar to those seen in the human intestinal tract prompted E. coli ciprofloxacin resistance.

These findings may have far-reaching implications for the escalating problem of antibiotic resistance. The worldwide use of ciprofloxacin pales in comparison with the use of drugs to counter malaria, which the U.S. Centers for Disease Control and Prevention estimates strikes 350 million to 500 million people (mostly in Africa, Asia, and Central and South America) annually. "It is very possible that the antimalarial drugs may be inducing a large amount of the antibiotic resistance that occurs in the tropics," Silverman says.

John Turnidge, chief of laboratory medicine at Women’s and Children’s Hospital in North Adelaide, Australia, called the study "fascinating," noting that he has long suspected that the overuse of antibiotics was not the only cause of bacterial resistance. This shows, he says, that certain drugs such as chloroquine (which works by targeting the parasites inside red blood cells) may drive resistance to other classes of drugs such as the antibiotic ciprofloxacin.

Traditionally, scientists have targeted viruses, bacteria and parasites in different ways and assumed that the treatments had little to do with one another. But this finding indicates that one may play off the other when it comes to encouraging resistance in human pathogens.

Christopher Plowe, an infectious disease specialist at the University of Maryland Medical Center, says more study is needed to determine whether health officials should reconsider the widespread use of chloroquine to battle malaria. Researchers plan to test the effect of antimalarials other than chloroquine to  determine if they can do as effective a job without also hobbling the power of ciprofloxacin.

Silverman stressed that the study highlights the need to continue to try to prevent malaria through the use of insecticide-treated bed nets, along with the development of an effective vaccine.

Website: http://www.who.int/globalatlas/

There is a growing need for high quality information on human resources in health systems to inform decision making for policies and programmes at the national and international levels. The WHO Department of Human Resources for Health has been collecting and compiling cross-nationally comparable data on health workers in all WHO Member States.

Estimates of the stock (absolute numbers) and density (per 1000 population) of the health workforce are available here for 193 Member States. National-level data refer to the active health workforce, that is, all persons currently participating in the health labour market. Counting health workers poses challenges, including how to define them. The World Health Report 2006 defines health workers as "all people engaged in actions whose primary intent is to enhance health." Various permutations and combinations of what constitutes the health workforce potentially exist depending of each country’s situation and the means of measurement. The information presented here reflects a framework for harmonizing the boundaries and constituency of the health workforce across contexts.

Two sets of data are contained in the Global Atlas: a main (aggregated) set and a disaggregated set. The aggregated dataset includes estimates of the stock and density of health workers for up to 9 occupational categories. This includes:

1. physicians;
2. nursing and midwifery personnel;
3. dentistry personnel;
4. pharmaceutical personnel;
5. laboratory health workers;
6. environmental and public health workers;
7. community and traditional health workers;
8. other health service providers; and
9. health management and support workers, that is, those who do not provide services directly but are critical to the performance of health systems.

In the disaggregated dataset, estimates of the stock of health workers are available for some countries for up to 18 occupational categories, reflecting greater distinction of some categories of workers according to assumed differences in skill level and skill specialization. More information on the framework for categorizing health workers can be found in the definition notes: http://www.who.int/globalatlas/docs/HRH/HTML/Dftn.htm

Following the launch of its new strategy and the biggest reconfiguration in its 30 year history, TDR is recruiting the following fixed term positions. All positions are based in Geneva, Switzerland.

TDR is organized in several functional areas:

Research for Neglected Priorities (11 posts advertised) consisting of a series of business lines addressing focused research activities with the goal of partnering with global research expertise to address research on neglected priority needs, delivering enhanced access to superior interventions addressing infectious diseases of poverty;

Empowerment (4 posts advertised), which aims to develop excellence and leadership in health research and decision-making so that institutional and national systems can identify and manage research priorities; Stewardship (2 posts advertised), which is oriented to facilitating and fostering knowledge management, needs assessment, priority setting and progress analysis on infectious diseases of poverty, providing a neutral platform for stakeholders to discuss and harmonize activities;

Portfolio Policy and Development (2 posts advertised), with the goal of leading operational policy, strategic monitoring and review of the programme portfolio, developing partnering frameworks, and incubates new ideas and research initiatives; and

Programme Related Support (5 posts advertised) which supports the Programme with optimal business processes and development, effective negotiation and communication with partners.

For more information consult the WHO/TDR website:

http://www.who.int/tdr/about/new_jobs_june08.htm

Applications must be made on-line through the WHO website http://www.who.int/employment/vacancies/en/, where the detailed job descriptions can be found. Links for each position are provided in the list below.

The deadline for receipt of applications for all positions is 1 August 2008.

Candidates from disease endemic countries and those who have worked in disease endemic countries are encouraged to apply.

Application call runs from 07/22/2008 - 09/01/2008

For more information and requirements visit: 

http://www.nimr.mrc.ac.uk/phd/intermaltraining/

The project summaries can be found on:

http://www.nimr.mrc.ac.uk/phd/intermaltraining/projects

Application Link:

https://www.w1system08.de/intermaltraining/intern/registrieren_registrieren_for.php

14 PhD Studentships to tackle Malaria

Applications are invited for 14 new PhD studentships under a new FP7-funded Marie Curie Initial Training Network (ITN) called InterMalTraining, coordinated by Mike Blackman, NIMR. Fellows will undertake collaborative research projects, each supervised by two or more principle investigators. Detailed descriptions of the projects are available. Informal enquiries on specific projects should be directed to the relevant supervisors.

Eligibility

Students should hold the necessary qualifications entitling them to undertake PhD study in their chosen country, and should possess a high standard of written and spoken English. Further information on eligibility can be found at Biomal.

How to apply

Applications are to be submitted online at InterMalTraining and are due before 1st September 2008. Candidates may apply for up to three different projects.

Short-listed candidates will be invited to the European Molecular Biology Laboratory (EMBL), Heidelberg, on 13-15 October 2008, for interviews with the Admissions Committee. Offers of admission to the PhD programmes will be made one week after the interviews.

Locations for training and study

Successful candidates will be expected to attend at the University Montpellier, France in January 2009 for the 2-week introductory PhD course. Subsequent workshops and practical courses in London, Heidelberg and Lisbon will provide additional training opportunities.

Studentships will be funded for a maximum of 3 years with the possibility of spending part of the studentship at a partner institution.

Gianotti RL, Bomblies A, Dafalla M, Issa-Arzika I, Duchemin JB, Eltahir EA. Efficacy of local neem extracts for sustainable malaria vector control in an African village. Malar J. 2008 Jul 23;7(1):138. [Epub ahead of print]
Larval control of malaria vectors has been historically successful in reducing malaria transmission, but largely fell out of favour with the introduction of synthetic insecticides and bed nets. However, an integrated approach to malaria control, including larval control methods, continues to be the best chance for success, in view of insecticide resistance, the behavioural adaptation of the vectors to changing environments and the difficulties of reaching the poorest populations most at risk…

Kiszewski AE.  Divergent Goals and Commitments in Global Malaria Intervention. Malar PLoS Med. 2008 Jul 22;5(7):e159. [Epub ahead of print]
Robert Snow and colleagues marshal the best data yet on the finances of global malaria intervention, but their work provides a basis, not an endpoint, for discussion. To achieve Goal 6 of the Millennium Development Goals, the gap between needs and commitments must be filled quickly. Given recent calls for malaria eradication [13], Snow and colleagues’ sober assessment should provide an instrument to prod the horse on before the cart disappears too far down the road...

Snow RW, Guerra CA, Mutheu JJ, Hay SI. International Funding for Malaria Control in Relation to Populations at Risk of Stable Plasmodium falciparum Transmission. PLoS Med. 2008 Jul 22;5(7):e142. [Epub ahead of print]
The international financing of malaria control has increased significantly in the last ten years in parallel with calls to halve the malaria burden by the year 2015. The allocation of funds to countries should reflect the size of the populations at risk of infection, disease, and death. To examine this relationship, we compare an audit of international commitments with an objective assessment of national need: the population at risk of stable Plasmodium falciparum malaria transmission in 2007...

Mubyazi GM, Bygbjerg IC, Magnussen P, Olsen O, Byskov J, Hansen KS, Bloch P. Prospects, achievements, challenges and opportunities for scaling-up malaria chemoprevention in pregnancy in Tanzania: the perspective of national level officers. Malar J. 2008 Jul 22;7(1):135. [Epub ahead of print]
Objectives To describe the prospects, achievements, challenges and opportunities for implementing intermittent preventive treatment for malaria in pregnancy (IPTp) in Tanzania in light of national antenatal care (ANC) guidelines and ability of service providers to comply with them...

Van Geertruyden JP, Menten J, Colebunders R, Korenromp E, D’Alessandro U. The impact of HIV-1 on the malaria parasite biomass in adults in sub-Saharan Africa contributes to the emergence of antimalarial drug resistance.  Malar J. 2008 Jul 22;7(1):134. [Epub ahead of print]
HIV-related immune-suppression increases the risk of malaria (infection, disease and treatment failure) and probably the circulating parasite biomass, favouring the emergence of drug-resistant parasites…

Silvie O, Mota MM, Matuschewski K, Prudêncio M. Interactions of the malaria parasite and its mammalian host.  Curr Opin Microbiol. 2008 Jul 15. [Epub ahead of print]
A hallmark of Plasmodium development inside its mammalian victim is the remarkable restriction to the host species. Adaptation to an intracellular life style in specific target cells is determined by multiple parasite-host interactions. The first line of crosstalk occurs during intradermal sporozoite injection by an Anopheles mosquito. The following expansion in the liver is highly efficient and leads to successful establishment of the parasite population…

Acclaimed Congolese artiste Koffi Olomidé has been named as the first Goodwill Ambassador for the Multilateral Initiative on Malaria (MIM) and the upcoming Fifth Pan-African Malaria Conference to be held in Nairobi, Kenya, from 2 to 6 November 2009.

Mr Olomidé mission will be to promote awareness of the conference and raise visibility of this forum which provides unique opportunities for malaria scientists, policy makers, funding partners and other stakeholders to meet and exchange ideas, form scientific collaborations and partnerships.

Announcing the appointment, Prof Francine Ntoumi, MIM Secretariat Coordinator, said “We are very pleased that Mr Olomidé has accepted to devote some of his time and energy to promote MIM’s work in advancing malaria research, advocate for increased utilization of research findings and, allocation of more resources by both local and international partners. It is important that African research efforts in finding lasting solution to fight this disease that continues to cost Africa so much, both socially and economically are correctly acknowledged. ”

Accepting the appointment, Mr Olomidé said “I feel very honoured to represent MIM on this mission. I have grown up in a malaria prevalent region. I have suffered several times from malaria and also I have seen children dying from this disease. I have also seen how our pregnant mothers suffer. People have suffered so many times from malaria, there has been so much death to such an extent losing a child’s life from this disease is commonplace. This is heartbreaking”

“So I felt very privileged when MIM approached me to become their ambassador and  I accepted unconditionally and with passion as I want to actively participate in advocating and promoting the work of African malaria researchers and their partners who are leading the search for appropriate and affordable solutions  to  rid African communities  of malaria” he added.

Born in 1956 in Kisangani, the Democratic Republic of Congo (DRC), Koffi Olomidé grew up in Kinshasa, the capital. He learned singing and playing guitar at a young age. Taking inspirations from local celebrities at that time, he debuted with a song called Onia which was followed by records Asso and Princesse ya Senza. These records put Olomidé in the limelight and earned him performances with such popular bands as Zaïko Langa Langa and Viva La Musica, before he decided to go solo. He produced his first album entitled “Ngounda” in 1983; three years later he formed his now famous band Quartier Latin. This marked the beginning of a successful international career for Olomidé as a famous composer and show-man.

Koffi Olomidé is one of Africa’s best selling artists; with record performances both in Africa Europe, and North America. Olomidé has won four Kora Awards, given annually for musical achievement in sub-Saharan Africa. In the 2005 Kora Awards, he was named Africa’s Best Artist of the decade.

The upcoming Pan-African Malaria Conference, jointly organised by MIM and Kenya Medical Research Institute, will bring together nearly 2000 malaria researchers and control experts from malaria-endemic countries in Africa, as well as malaria scientists, administrators, and representatives from private foundations, governments and international organizations from all corners of the world.

Under the theme “Building Knowledge for Action", the Conference will provide a unique forum for communication, exchange of ideas and information, particularly with regard to dissemination of malaria research results; formation of scientific collaborations and public private partnerships; increasing international responses towards allocation of resources for malaria research and control; translation of the research results to operational guidelines and policies; reporting of field operational problems for translation to researchable questions; and enhancing malaria awareness and status on the international political and development agendas.

The Clinton Foundation announced Thursday that it had brokered an agreement among several drug makers that it hoped would ensure a steady supply of a crucial malaria medicine at reasonable prices for the world’s poor.

The charity, created by former President Bill Clinton, is trying to control spikes in the price of artemisinin, a derivative of the sweet wormwood plant that Chinese scientists turned into the latest miracle drug against malaria.

In 2004, when international donors agreed to pay for artemisinin-based drug cocktails, the price of the raw material soared. In a year, it more than quadrupled, to about $500 per pound from about $115 per pound. (At the time, pharmaceutical executives in China blamed farmers for hoarding the supply.)

The Swiss pharmaceutical maker Novartis, then the only company with an artemisinin-based drug approved by the World Health Organization, absorbed the losses, and makers of generic drugs were scared away from the field.

But by 2006, after farmers rushed to plant more sweet wormwood and pickers gathered it in the wild, the price had plummeted to about $70 a pound. It has remained in that range since.

The complex deal announced Thursday involves two Chinese suppliers of artemisinin, two Indian companies that turn it into active ingredients and two more Indian companies, Cipla and Ipca Laboratories, that produce finished pills.

The Chinese companies have agreed to supply artemisinin at a price of no more than $136 a pound, said Dai Ellis, the foundation’s executive vice president for access programs. The drug makers have agreed to buy at that price, but are free to buy elsewhere if they can find it for less than about $125 a pound. In return, they will sell their products at agreed-upon low wholesale prices.

At the moment, with global artemisinin prices well below those levels, the ceiling is “irrelevant,” Mr. Ellis said. “Capitalism takes over.”

However, he said, donors may soon start subsidizing private-market purchases of such drugs. (In most poor countries, people buy malaria drugs at private pharmacies and shops, while AIDS and tuberculosis drugs are distributed by public hospitals.) Lower prices could create new demand, sending prices of the raw material up again.

It is unclear how much control over the market the arrangement will create. Wormwood is also farmed in Vietnam and Tanzania and grows wild around the world. When prices soared, plans were announced to grow it in South Africa and elsewhere, and to make synthetic versions.

Mr. Ellis said the Clinton Foundation hoped to sign up more suppliers.

It also announced that Cipla and Ipca would produce a new artemisinin-based combination, artesunate plus amodiaquine, for about 30 percent less than its prevailing market price.

Sanofi Aventis, the first company to market a version of this combination approved by the W.H.O., deliberately did not patent it. Novartis’s earlier product combines artemisinin with a different drug, lumefantrine.

Daniel Vasella, chairman of Novartis, said he was glad to have more competitors because, even at current artemisinin prices, his company lost 80 cents on each pill it made for public health agencies. With research and distribution expenses, he said, “It has cost us over $100 million.”

A gene found only in people of African ancestry which evolved to prevent malaria infection now increases the odds of contracting AIDS by up to 40 per cent, a new study has found.

The gene does, however, seem to protect against the progression of the disease, allowing those carrying it to live about two years longer.

Around 90 per cent of people in Africa carry this genetic variant and it may be responsible for 11 per cent of the infections there, the study published Wednesday in Cell Host and Microbe found.

"After thousands of years of adaptation, this Duffy variant rose to high frequency because it helped protect against malaria," said co-author Matthew Dolan of the Wilford Hall United States Air Force Medical Center.

"Now, with another global pandemic on the scene, this same variant renders people more susceptible to HIV."

The gene in question, the Duffy Antigen Receptor for Chemokines (DARC), encodes a protein found mainly at the surface of red blood cells.

About 68 per cent of people infected with HIV live in Sub-Saharan Africa, the United Nations says.

The US and British researchers who authored the study said sexual behavior and other social factors do not fully explain large discrepancies in HIV prevalence.

Earlier studies have shown that HIV can bind to red blood cells through this receptor. The receptor has also been found to bind a wide array of inflammatory molecules, including one which is highly effective in suppressing replication of HIV

Tanzania has started using Dichloro-diphenyl-trichloroethane (DDT) for Indoor Residual Spraying (IRS) from July this year.

It will be the first East African country to start using the insecticide which is credited with eliminating malaria in the Western world decades ago before it was outlawed in many countries in 1972. Critics said it was harmful for the environment and humans.

The Deputy Minister for Health and Social Welfare Aisha Kigoda said last week that in the first phase, the DDT will be sprayed in districts facing acute malaria threat.

Dr Kigoda said spraying of the insecticide will be supervised by the National Environment Management Council (NEMC) and the Vice President’s Office (Environmental management) to ensure there is no environmental damage.

“NEMC and the Vice President’s office will issue procedures for DDT use and analyse its environmental effects before we can start using it, according to Environmental Act of 2004,” she said.

The minister said that before the use of the insecticide, there would be a campaign to educate the public on its use.

Tanzania’s decision comes as Kenya and Uganda are reluctant to use the insecticide as a final tool to drive off the disease.

The two countries are wary of the consequences DDT use on international trade, ostensibly due to the sensitivity of their major trading partner — the European Union.

Experts say that DDT, if used correctly, poses no known risk to human health.

Malaria is a preventable disease that causes more than 1 million deaths in infants and children under age 5 in sub-Saharan Africa — one approximately every 30 seconds.

“There is no ban on DDT for vector control, rather, countries are to do their best to gradually phase it out and can apply (and receive) exemptions,” said an official of the United Nations Environment Programme’s Information Unit for Conventions (UNEP/IUC) recently.

Recently, it was agreed at a meeting of the “Conference of the Parties to the Stockholm Convention on Persistent Organic Pollutants held in Geneva that governments should adopt a reporting system under which “countries in need of using DDT for vector control can report on current uses and on future needs.

Subsequent to DDT elimination, a provision of financial and technical support for adopting alternatives such as bed nets, integrated pest management and other chemicals will be mandatory.

But key players in the horticulture sector in Kenya and Tanzania see DDT as a serious threat to flower exports. Both want their respective governments to think of  an “alternative method.”

Recent reports indicate that US officials are endorsing and funding the use of DDT in sub-Saharan Africa after years of resisting calls from scientists who said the insecticide would be the best weapon for fighting malaria, despite objections by some environmentalists.

Letters of Intent Receipt Date(s): August 15, 2008, August 17, 2009, August 16, 2010.
Application Receipt Date(s): September 15, 2008, September 15, 2009, September 15, 2010
Peer Review Date(s): February/March 2009, February/March 2010, February/March 2011
Council Review Date(s): May 2009, May 2010, May 2011
Earliest Anticipated Start Date: July 2009, July 2010, July 2011

Purpose. Planning grant applications for malaria research training programs in clinical, operational and public health services for clinical, public health and social scientists and health care professionals in the countries targeted by the President’s Malaria Initiative (PMI) (Angola, Benin, Ethiopia, Ghana, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Rwanda, Senegal, Tanzania, Uganda, Zambia) are invited. The planning grants supported in response to this announcement will enable U.S. and PMI country collaborators to assess research training resources and needs and develop comprehensive research training program proposals. Specifically, planning grants will provide support for U.S. or African applicants from PMI designated countries to:

• Plan five year programs to provide integrated clinical, operational and public health services research training related to all currently available malaria prevention and treatment interventions used in malaria vector control, rapid diagnosis, effective drug therapy, intermittent preventive treatment for pregnant women and children and health services delivery to rural endemic areas.
• Examine the gaps in knowledge and expertise in the evaluation of best practices related to currently available malaria interventions in a PMI country and plan how best to provide research training to fill these gaps.
• Design mentored research experiences, research training workshops, practicum activities and graduate school curriculum related to malaria control activities.
• Collaborate with public and private malaria control organizations in one PMI designated country to design a program structure that facilitates rapid incorporation of malaria clinical, operational and public health services research results into widespread practice in their activities.
• Identify and obtain administrative, financial management and research ethics training, faculty development, research training resource materials needed to undertake a sustainable comprehensive research training program.

Funds Available and Anticipated Number of Awards. The Fogarty International Center expects to provide a total of $50,000 to $100,000 total costs (direct and F & A) per year to fund two to four new planning grant awards each year FY 2009-FY 2011.  Budgets for direct costs of up to $23,000 per year and project duration of one year may be requested.

Eligible Institutions/Organizations. The following organizations/institutions are eligible to apply:

• Public/State Controlled Institutions of Higher Education
• Private Institutions of Higher Education
• Non-domestic (non-U.S.) Entities (Foreign Organizations):

Non-profit organizations, public or private institutions, such as universities, colleges, hospitals, and laboratories in the U.S. or PMI countries are eligible to apply. Institutions in African PMI countries (Angola, Benin, Ethiopia, Ghana, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Rwanda, Senegal, Tanzania, Uganda, Zambia) or U.S. institutions are eligible to apply. U.S. applicants must apply with a PMI country research institution with which they have a demonstrable history of research collaboration. To best support the building of sustainable research capacity, only those African PMI country institutions that can document a significant and active record of malaria research grant support should apply. African PMI country institutions should apply in collaboration with U.S. institutions that are capable of enhancing their proposed research training activities.

 Eligible Project Directors/Principal Investigators (PDs/PIs). Applicants must be the principal investigator or co-investigator on a malaria clinical, operational or public health services research grant supporting studies conducted in an African malaria-endemic country. The applicant must hold a faculty or long-term research position at a public or private non-profit research institution.  More than one PD/PI, or multiple PDs/PIs, may be designated on the application.

Number of Applications. U.S. applicant individuals may only submit one application. Only one application will be funded from any African PMI country institution.

Here is the link to the PAR-08-200: http://grants.nih.gov/grants/guide/pa-files/PAR-08-200.html

Following the launch of its new strategy and the biggest reconfiguration in its 30 year history, TDR is recruiting the following fixed term positions. All positions are based in Geneva, Switzerland.

TDR is organized in several functional areas:

Research for Neglected Priorities (11 posts advertised) consisting of a series of business lines addressing focused research activities with the goal of partnering with global research expertise to address research on neglected priority needs, delivering enhanced access to superior interventions addressing infectious diseases of poverty;

Empowerment (4 posts advertised), which aims to develop excellence and leadership in health research and decision-making so that institutional and national systems can identify and manage research priorities; Stewardship (2 posts advertised), which is oriented to facilitating and fostering knowledge management, needs assessment, priority setting and progress analysis on infectious diseases of poverty, providing a neutral platform for stakeholders to discuss and harmonize activities;

Portfolio Policy and Development (2 posts advertised), with the goal of leading operational policy, strategic monitoring and review of the programme portfolio, developing partnering frameworks, and incubates new ideas and research initiatives; and

Programme Related Support (5 posts advertised) which supports the Programme with optimal business processes and development, effective negotiation and communication with partners.

Applications must be made on-line through the WHO website http://www.who.int/employment/vacancies/en/, where the detailed job descriptions can be found. Links for each position are provided in the list below.

The deadline for receipt of applications for all positions is 1 August 2008.

Candidates from disease endemic countries and those who have worked in disease endemic countries are encouraged to apply.

Ross A, Penny M, Maire N, Studer A, Carneiro I, Schellenberg D, Greenwood B, Tanner M, Smith T. Modelling the epidemiological impact of intermittent preventive treatment against malaria in infants. PLoS ONE. 2008 Jul 16;3(7):e2661
Trials of intermittent preventive treatment against malaria in infants (IPTi) using sulphadoxine-pyrimethamine (SP) have shown a positive, albeit variable, protective efficacy against clinical malaria episodes. The impact of IPTi in different epidemiological settings and over time is unknown and predictions are hampered by the lack of knowledge about how IPTi works. We investigated mechanisms proposed for the action of IPTi and made predictions of the likely impact on morbidity and mortality…

Hastings IM, Smith TA.  MalHaploFreq: A computer programme for estimating malaria haplotype frequencies from blood samples. Malar J. 2008 Jul 15;7(1):130. [Epub ahead of print]
Molecular markers, particularly those associated with drug resistance, are important surveillance tools that can inform policy choice. People infected with falciparum malaria often contain several genetically-distinct clones of the parasite; genotyping the patients’ blood reveals whether or not the marker is present (i.e. its prevalence), but does not reveal its frequency...

Bergmann-Leitner ES, Mease RM, Duncan EH, Khan F, Waitumbi J, Angov E. Evaluation of immunoglobulin purification methods and their impact on quality and yield of antigen-specific antibodies. Malar J. 2008 Jul 14;7(1):129. [Epub ahead of print]
Antibodies are the main effectors against malaria blood-stage parasites. Evaluation of functional activities in immune sera from Phase 2a/b vaccine trials may provide invaluable information in the search for immune correlates of protection. However, the presence of anti-malarial-drugs, improper collection/storage conditions or concomitant immune responses against other pathogens can contribute to non-specific anti-parasite activities when the sera/plasma are tested in vitro...

He W, Neil S, Kulkarni H, Wright E, Agan BK, Marconi VC, Dolan MJ, Weiss RA, Ahuja SK. Duffy antigen receptor for chemokines mediates trans-infection of HIV-1 from red blood cells to target cells and affects HIV-AIDS susceptibility. Cell Host Microbe. 2008 Jul 17;4(1):52-62
Duffy antigen receptor for chemokines (DARC) expressed on red blood cells (RBCs) influences plasma levels of HIV-1-suppressive and proinflammatory chemokines such as CCL5/RANTES. DARC is also the RBC receptor for Plasmodium vivax. Africans with DARC -46C/C genotype, which confers a DARC-negative phenotype, are resistant to vivax malaria. Here, we show that HIV-1 attaches to RBCs via DARC, effecting trans-infection of target cells. In African Americans, DARC -46C/C is associated with 40% increase in the odds of acquiring HIV-1. If extrapolated to Africans, approximately 11% of the HIV-1 burden in Africa may be linked to this genotype...

Clarke SE, Jukes MC, Njagi JK, Khasakhala L, Cundill B, Otido J, Crudder C, Estambale BB, Brooker S. Effect of intermittent preventive treatment of malaria on health and education in schoolchildren: a cluster-randomised, double-blind, placebo-controlled trial.  Lancet. 2008 Jul 12;372(9633):127-38
Malaria is a major cause of morbidity and mortality in early childhood, yet its consequences for health and education during the school-age years remain poorly understood. We examined the effect of intermittent preventive treatment (IPT) in reducing anaemia and improving classroom attention and educational achievement in semi-immune schoolchildren in an area of high perennial transmission…

Adjei GO, Kurtzhals JA, Rodrigues OP, Alifrangis M, Hoegberg LC, Kitcher ED, Badoe EV, Lamptey R, Goka BQ. Amodiaquine-artesunate vs artemether-lumefantrine for uncomplicated malaria in Ghanaian children: a randomized efficacy and safety trial with one year follow-up.  Malar J. 2008 Jul 11;7(1):127. [Epub ahead of print]
Artesunate-amodiaquine (AS+AQ) and artemether-lumefantrine (AM-L) are efficacious artemisinin combination therapy (ACT) regimens that have been widely adopted in sub-Saharan Africa. However, there is little information on the efficacy of these regimens on subsequent episodes beyond 28 days, or on the safety of repeated treatments…

Gao X, Yeo KP, Aw SS, Kuss C, Iyer JK, Genesan S, Rajamanonmani R, Lescar J, Bozdech Z, Preiser PR. Antibodies targeting the PfRH1 binding domain inhibit invasion of Plasmodium falciparum merozoites.  PLoS Pathog. 2008 Jul 11;4(7):e1000104
Invasion by the malaria merozoite depends on recognition of specific erythrocyte surface receptors by parasite ligands. Plasmodium falciparum uses multiple ligands, including at least two gene families, reticulocyte binding protein homologues (RBLs) and erythrocyte binding proteins/ligands (EBLs). The combination of different RBLs and EBLs expressed in a merozoite defines the invasion pathway utilized and could also play a role in parasite virulence…

Färnert A. Plasmodium falciparum population dynamics: only snapshots in time?  Trends Parasitol. 2008 Jul 9. [Epub ahead of print]
Infections caused by the malaria parasite Plasmodium falciparum often comprise multiple genetically distinct clones. Individuals in endemic areas can have different clones detected in their peripheral blood over a few days or even hours. This reveals interesting within-host dynamics of multiclonal infections, which seem to differ in asymptomatic and symptomatic infections. As well as being an intriguing biological phenomenon that merits further understanding, the extensive dynamics of P. falciparum infections have practical implications on the design and interpretation of malaria studies. Most assessments will, indeed, only provide snapshots of the parasite population dynamics …

Preventive malaria treatment in African schools dramatically reduces rates of infection and anaemia among children and may also boost learning potential, according to a study released on Friday.

British and Kenyan researchers led by Sian Clarke of the London School of Hygiene and Tropical Medicine gave three doses of two anti-malarial drugs over eight months to nearly 5,000 children aged between five and 18 in 30 schools in rural Kenya.

The two drugs, sulfadoxine-pyrimethamine and amodiaquine, are usually prescribed as a treatment after a patient has become infected, rather than as a preventive measure. A control group received twin placebos, or a dummy treatment.

The preventive regimen sharply reduced the risk of infection and halved the rate of aneamia, one of the principal symptoms of the disease.

The authors say they were also impressed by classroom tests that showed sustained concentration among the treatment cohort, although no specific impact was seen in terms of educational achievement.

"Although it has long been suspected that malaria impairs school performance, this is the first study to provide evidence of a direct link between malaria and reduced attention in class," said co-author Matthew Jukes of Harvard University.

"These results indicate that malaria infection may hinder learning and its prevention could be important to enhance the educational potential of schoolchildren," he added.

Malaria severely sickens half-a-billion people in the world each year, and kills more than a million, according to the World Health Organisation (WHO).

Ninety percent of victims live in sub-Saharan Africa, and the vast majority of those are infants and children.

Each day, some 3,000 young lives -- one every 30 seconds -- are snuffed out by the disease, which also saps more than a full percentage point from the annual economic growth of the most affected nations.

A new study--done on a scale an order of magnitude greater than anything previously attempted in the field of malaria--has uncovered an arsenal of proteins produced by the malaria parasite that allows it to hijack and remodel human red blood cells, leaving the oxygen-carrying cells stiff and sticky. Those effects on the blood cells play a major role in the development of malaria, a disease responsible for millions of deaths every year, the researchers report in the July 11th issue of the journal Cell.

"It’s a nice piece of biology revealing how the parasite survives in and totally changes red blood cells," said Alan Cowman of The Walter and Eliza Hall Institute of Medical Research in Australia. Now that those players have been found, "there may be some way of inhibiting these processes by drugs or possibly a live vaccine."

Plasmodium falciparum causes the most severe form of malaria in humans with one to three million deaths annually, the researchers said. Once in the blood, multiplication of the parasite inside red blood cells (also known as erythrocytes) is responsible for its severity and mortality associated with the disease. After the parasite invades, the red cells undergo profound structural and morphological changes, dramatically altering their physical properties and impairing circulation. In contrast to normal red blood cells, parasitized cells are rigid and adhere to the lining of the blood vessels and other cell types.

Those changes are known to be caused by proteins the parasite produces inside the cells of its host and exports across several membranes out to the red cell itself. Earlier studies showed two important ingredients: P. falciparum erythrocyte membrane protein (PfEMP1), which allows infected cells to stick to blood vessels, and knobs made up of a second protein (knob associated histidine-rich protein or KAHRP) that anchor PfEMP1 at the red cell surface.

In the new study, the researchers were particularly interested in finding proteins required for "trafficking" PfEMP1 to the infected erythrocyte surface, correct assembly of the anchoring knobs, and those involved in making infected red cells rigid, all processes associated with virulence in malaria infection, they said. In search of those players, the researchers developed mutant strains of P. falciparum each lacking one of 83 genes known or predicted to play a role in the red cell remodeling process.

Their screen turned up eight genes encoding proteins required for export of the PfEMP1 and assembly of knobs. Additionally, they show that multiple proteins play a role in generating increased rigidity of infected erythrocytes.

"In summary," the researchers wrote, "we have used a gene knockout approach on a scale not previously attempted in this organism to address the role of P. falciparum proteins that are exported into the parasite-infected erythrocyte. Collectively these proteins act like the secretion systems seen in bacteria in which pathogenicity arises from secreted proteins that interact with host cells by direct injection or by their presence in the extracellular milieu. ...It may be valuable to adopt approaches being tested in bacteria in which these systems are the target of new therapeutic approaches aimed at minimizing pathogen virulence."

However, Cowman added, while they now know the identity of the several proteins involved, they still don’t know what those proteins actually do. Those are questions Cowman’s team now plans to pursue in greater detail.

Children like playing but if malaria constantly attacks them, the joy that playing yields is replaced by despair.

In the recent years, soccer has generated millions of dollars. The youth have proved to be an invaluable asset, at least based on the current international players developed by the football academies.

PlaySoccer Malawi might not be a fully fledged academy to compete with institutions of similar intent in Europe but it has already developed young footballers with the calibre of competing on the international level.

But statistics of malaria deaths in the world is threatening PlaySoccer Malawi’s ambitions. Globally, Malaria kills one child every minute.

Established with the primary aim of providing community-based health programmes, social development and soccer skills to children aged between five and 15, the organisation has developed a programme that is aimed at preventing the spread of malaria among children.

PlaySoccer Country programme Director Patrick Kulemeka says it is unacceptable that children should continue suffering and dying of a preventable disease like malaria.

“If necessary precautions are put in place, we can protect the children from Malaria. More resources, which could be used in other pressing issues, are wasted to treat the children,” he says.

“It is our belief at PlaySoccer that Malaria can be eradicated if the society takes care of the surroundings.”

Kulemeka says PlaySoccer, which has sites in Bangwe, Ndirande and Chigumula townships, will among other things enlighten children on symptoms of Malaria and the role they can play to stop the breeding of mosquitoes in their homes.

“We believe that children are agents of social change. By equipping them with the right information, we can register some success,” says Kulemeka adding that there are about 10,000 children in the three sites.

“Firstly children are taught what causes malaria. We then advise children who have the privilege of treated mosquito nets to sleep under those nets,” he says.

Kulemeka says they ask the children to make certain that they clear all places that are breeding grounds for mosquitoes.

“We encourage them to fill swamps to get rid of stagnant water. We also ask them to fill unused pit latrines which are conducive for mosquitoes.

“We also encourage children that they should introduce fish to the ponds or dams. This is a very productive method because the fish gets rid of mosquito larvae and this disturbs the life cycle of mosquitoes,” Kulemeka says.

Kulemeka said PlaySoccer was challenged to use some orthodox means of getting rid of mosquitoes because not all people have access to mosquito nets.

“Just imagine if our surroundings were all clear and all of us were sleeping inside treated mosquito nets. This means that most mosquitoes will die and then the society will be free from malaria attack,” he says.

He also disclosed that through their programme, future players would be protected.

“This programme will benefit the nation as whole. Of course for a start children that are in our sites are the ones that will benefit first. With the availability of resources the programme will be extended to other surrounding areas,” he says.

Kulemeka says it is unfortunate that most children are failing to access treated nets which are cheaper.

“A net costs about K700. But most children in our community do not have the privilege to sleep under a treated net because they can’t afford it. However, if organisations join hands to buy nets for the less privileged, then more lives that are in danger would be safe,” he says.

Kulemeka says PlaySoccer has already donated 500 nets to children, pregnant women and maternity ward at Ndirande, Namatapa and Makhetha Health centres.

Kulemeka says PlaySoccer would soon embark on a drive code named ‘End Malaria Blue Campaign’ to raise money to be used for the purchasing of nets that would be donated to children around the populous township in Blantyre.

“Areas such as Ndirande and Bangwe harbour a lot of children. Once we raise enough money we will buy nets that would be donated to children living in those areas. We hope through that exercise we will save lives as well as resources that are spent when children suffer from Malaria,” he says.

Kulemeka says the campaign will see PlaySoccer partnering interested organisations and well-wishers in their quest to raise funds.

“We have blue ribbons and pins. Those that have cars are encouraged to buy the magnetic blue pins to be stuck on their cars while others without cars can buy the ribbons to be tagged on their clothes. The cost of each ribbon and pin is K700 and this means for every pin or ribbon bought, a net will be purchased,” he says.

“We urge companies to join this mission by buying a lot of pins for their employees that means they will be buying nets for the disadvantaged children,” he says.

He says those that purchase the pins and ribbons will show that they want to help save lives in the country.

Derrick Chithambo, an accountant at PlaySoccer assured the corporate world that Malaria Blue Campaign system is transparent.

“If a company buys 500 pins that means 500 nets have been bought. To ensure that exercise is carried in a transparent manner, a representative of that company will be called to be responsible of handing over the nets to the less privileged children,” Chithambo says.

“We hope that this exercise will receive support from the corporate world. It is better for the less privileged children to sleep under the nets because when they fall sick, they struggle to access treatment,” he says.

Call for Letters of Intent

Integrated Community based interventions

More details on business line 11:

Integrated Community based interventions

Deadline: 30 July 2008

Background

Infectious diseases remain a major cause of morbidity and mortality in developing countries, especially in Africa where they are responsible for 60% of all deaths. Effective and simple interventions exist to prevent or treat such infectious diseases, however, the delivery of these simple interventions to the affected populations has proven very difficult due to the weak public health systems in many developing countries, especially in Africa. Some of these promising new interventions which may not require trained health professionals to deliver have only limited impact because of the failure to have them delivered in an efficient and sustainable manner to poor populations. They can be administered at the community level by community members who have received basic training in their use. Disease control programs are therefore increasingly opting for community-based delivery strategies for these interventions which have been developed for different diseases.

Recent studies have indicated that the community directed intervention (CDI) model can greatly increase access to integrated health intervention among poor populations. This is in line with the WHO goals to promote integrated approaches that strengthen health systems. The CDI process, however, builds on established traditional structures and processes in rural African communities. The same structures do not exist in urban areas where infectious diseases are also endemic and where the health systems face equal challenges in delivering public health interventions to those who need them. Other formal and informal structures, however, do exist in urban areas and in the rural/urban interface and it has been postulated that these can be used for alternative intervention delivery models that are built on the principle of community empowerment.

The current interest in community based interventions in general, together with the momentum in global support for infectious disease control in developing countries provide a significant opportunity to develop efficient strategies for delivery of community -based health interventions not only for the rural areas but also for other special situations. New simple health intervention strategies are needed to improve access to other under-served populations in the urban and rural -urban interface.

The business line on " Integrated Community based interventions" (BL11) within the Business plan of the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) fits clearly into the TDR’s New 10 year vision which is, "To foster an effective global research effort on infectious diseases of poverty, in which disease endemic countries play a pivotal role". The overall strategic objective for the research under BL11 on "Integrated Community -based Interventions" is to develop innovative, effective and efficient strategies for implementing community-based interventions in poor populations.

TDR invites letters of intent on implementation research to develop and test community level health intervention strategies for urban populations.

Requirements

Ability to link up with control programmes in disease endemic countries in the design, implementation and evaluation of the research will be required

A research team that includes expertise in the Social Sciences Health Economics and Anthropology, Community health and Health Systems Research as well as Communications will be needed.

Funded studies are expected to deliver results within a time frame of 24-30 months from initial funding.

Letters of intent (LoIs) will be evaluated based on the relevance to the Call, feasibility and scientific merit. Selected LoIs will further be developed into full proposals for multicountry studies through a proposal development workshop in October, 2008 after which 4- 5 research proposals will be submitted for funding.

In the letter of intent, interested research groups should provide information on the following:

Links with a community or to a research site where the study will be conducted

Evidence of collaboration with national control programmes

Availability of the expertise required for this kind of research and institutional and logistic support.

How to apply

Interested groups are invited to submit a letter of intent of no more than 4 pages (size A4, font 12pt) outlining the following:

Project title

Background and statement of the research question

Overall and specific objectives

Overall study design

Relationship with any ongoing programme, research project, any previous research experience with CDI and network,

Proposed principal investigator, research institution and study team.

Letters of intent can be submitted in English or French. A Curriculum Vitae of the principal investigator should be attached.

Letters of intent must be submitted no later than 30 July 2008

Letters of intent should be submitted as an e-mail MS-Word file attachment (*.doc) addressed to : boatinb@who.int with copy to appiahagboglad@who.int

For additional information, please contact Dr Boakye Boatin boatinb@who.int

Rational Management of Medicines - A focus on HIV/AIDS, TB and Malaria

3 November to 14 November 2008

Ifakara, Tanzania

Deadline for Applications: 31 August 2008

CONTENTS OVERVIEW

Health is an intrinsic human right as well as a central input to poverty reduction and socioeconomic development. Cost-effective interventions including medicines for controlling major diseases exist, but a lack of money for health and a range of system constraints hamper efforts to expand health services to the poor. >From penicillin to insulin, antiseptics to antiretrovirals, science has led to dramatic improvements in health worldwide. Medicines are an essential and cost-effective tool of health care and an important element of health systems. Yet the main diseases of poverty such as HIV/AIDS, malaria and tuberculosis continue to claim innumerable lives in low income countries. Today, for millions of people worldwide essential medicines remain unavailable and unaffordable. Irrational medicine use is a global public health problem. Counterfeit and poor quality medicines are an additional barrier to equitable access to medicines. Millions of adults and children die each year from treatable and preventable diseases. There is an urgent need to develop adequate strategies that ensure better access to medicines. It is about getting evidence-based and effective medicines to the people who need them, whether by reducing their costs, promoting research and development, improving their distribution, increasing their efficacy and acceptability, or slowing down the development of antimicrobial resistance.

Rational medicine policy and management is critically important in view of constrained health budgets to achieve efficiency, equity and quality of health care in pluralistic health systems.

OBJECTIVES

To enable health professionals to understand and apply the concepts and principles of essential medicines and rational medicine management with a focus on the diseases of poverty HIV/AIDS, malaria and tuberculosis, to recognise the need for a national and international medicine policy environment, to improve knowledge and skills and to gain practical field experience for rational medicine management within different health system contexts.

 COURSE TOPICS

Historic milestones and current global medicine situation Concept of essential medicines and its relevance in primary health care Concept and principles of rational medicine management in pluralistic and reforming health systems Roles of different stakeholders including health workers, traditional healers, research organisations and the pharmaceutical industry The international context, global treaties and national medicine policy Treatment guidelines, essential medicine lists and personal medicine lists

Patterns of medicine use, strategies for the promotion of rational medicine use, community medicine use Antimicrobial resistance and approaches for containment Medicine quality and quality assurance Rational management of HIV/Aids, malaria and tuberculosis related Framework and components of a medicine supply system including procurement and distribution Elements of medicine costs, affordability and financing options Critical medicine information management

TARGET GROUP

Health professionals and managers with experience (at least two years) in international health and the pharmaceutical sector.

DURATION

2 weeks (90 hours student investment time). Equivalent to 3 ECTS points towards the TropEd European Master in International Health. A certificate will be awarded after successful completion.

COURSE FORMAT

The course language is English. The course combines lectures, in-depth discussions of case studies, short presentations, small group exercises and field visits. The course is highly participatory and participants will be exposed to a wide range of international experiences and materials.

APPLICATION PROCEDURE

Please contact the course secretariat for an application form.

Application deadline: 31 August 2008

COURSE FEE

The total course fee is CHF 2300.- (Swiss Francs) including tuition, accommodation/full board and must be paid 8 weeks before the start of the course. This sum includes the registration fee (CHF 100.-) which is due at the moment of acceptance. If a participant does not attend the course, the registration fee cannot be reimbursed. If cancellation is less than 4 weeks before beginning of the course an additional fee of CHF 500.- will be charged. Cost for international flights must be added. Travel to Tanzania has to be organized by the participant.

There are only very limited scholarships available for this course.

LOCATION

Tanzania Training Centre for International Health in Ifakara, Tanzania.

Next to a successful research institution (IHC) and the renovated St.

Francis Designated District Hospital with 370 beds, a modern and well equipped campus for teaching and training is available in a remote rural region of Tanzania about 420 km South West of Dar es Salaam that is reached by train or road. The many interfaces between theoretical and practical training make Ifakara a focal point for teaching and research in beautiful Tanzania.

COURSE FACULTY

The course is facilitated by international and national experts. The academic panel will include a number of highly experienced professionals from WHO, MEDUNSA (Limpopo), Phasuma, Nuffield (Leeds), STI, Tanzanian MOH, MSH and IHC.

COURSE COORDINATOR

Dr. Karin Wiedenmayer (STI)

CONTACT ADDRESS

Swiss Tropical Institute
Course Secretariat
Socinstrasse 57
P.O Box
CH - 4002 Basel / Switzerland
Tel.: + 41 61 284 82 80
Fax: + 41 61 284 81 06
E-mail: courses-sti@unibas.ch

Internet: www.sti.ch 

THE SWISS TROPICAL INSTITUTE

The Swiss Tropical Institute (STI) was founded in 1943. The STI offers an interdisciplinary approach to research, teaching and services in the field of International Health.

The aim of the STI is to contribute to the improvement of the health of populations internationally and nationally through excellence in research, services and teaching and training. Activities of the Institute in the framework of national and international mandates have led to its world-wide recognition in the field of International Health.

The STI has significant expertise in the pharmaceutical sector with teaching and training, research, clinical trials, assessments and implementation verification and international development cooperation. STI offers postgraduate courses in various topics for health staff.

TROPED

A collaborative network of 27 Tropical Institutes and related institutions in 13 different countries in Europe offers a joint modular Masters Curriculum in International Health (MIH). The modular structure allows the studies to be spread over 5 years.

For further information: www.troped.org

Karin Wiedenmayer, MSc, PharmD
Swiss Tropical Institute
Swiss Centre for International Health
Socinstrasse 57
4002 Basel
Switzerland
T+41 61 284 81 26
F+41 61 284 81 03

http://www.sti.ch

Medicines for Malaria Venture - MMV seeks to hire

A Director Clinical Science - Geneva

Medicines for Malaria Venture (MMV) was established in 1999 as a partnership between the public and private sector to discover, develop and deliver new antimalarial drugs at prices affordable to developing countries with a view to ultimately eradicate this terrible disease.

MMV is based in Geneva as an independent not-for-profit Swiss Foundation. It has an entrepreneurial modus operandi and has established a new business model through which it selects and manages its R&D portfolio.

We are looking for a talented Director Clinical Science to join our scientific staff and contribute to the impact of our scientific programmes.

Primary Duties and responsibilities:

• Understand the regulatory environment: Know and respect the regulations surrounding the primary activities of the clinical development projects.
• Management of Drug Safety: Insure that the clinical teams handling of all AE’s and SAE’s is according to ICH standards.
• Medical and Scientific: Provide medical input to ensure the scientific quality of the clinical programs.
• Resource Utilization: Operate within time and budget constraints of the clinical program.
• People Development: Work in collaboration with the Medical Director to assist the clinical development team to enhance skills of all members of the team.
• Effective communication: Communicate project related information including the planning and execution of meetings and presentations.
• Coordination and completion of scientific documents to include protocols, clinical study reports, other regulatory documents, ESAC reports and the MMV Annual Report.

Qualifications and Experience:

• MD, or MD/PhD with at least 3 to 5 years of experience directly related to the duties and responsibilities specified.
• Knowledge of patient care charts and patient histories.
• Knowledge of randomized controlled clinical trials principles, methodology, and procedures.
• Knowledge of adverse medical event investigation, analysis, and reporting procedures and standards.
• Knowledge of FDA and EMEA regulatory requirements and ICH/GCP guidelines is preferred.
• Knowledge of federal and state regulations and guidelines pertaining to the conduct of clinical trials on human subjects.
• Knowledge of statistical data collection, editing, validation, and analysis techniques.
• Ability to supervise Clinical Research Organizations, to include organizing, prioritizing, and scheduling work assignments.
• Knowledge of current and developing trends and standards in clinical trials monitoring.
• Knowledge of industrial standards as applied to good clinical practices and good laboratory practices.
• Knowledge of the infrastructure and operational characteristics of contract research organizations and centralized clinical laboratories
• Ability to independently develop novel concepts and techniques in clinical research monitoring.
• Ability to develop and implement clinical research monitoring plans and standard operating procedures.
• Ability to establish data collection and management guidelines.
• Ability to provide technical advice, guidance, and support to professional staff in area of specialty.
• Ability to communicate and interact competently and professionally at all levels within a broad, complex clinical research environment.

Specific skills required:

• Clear and concise verbal and written communication skills and strong organizational skills.
• Must be detail oriented, have the ability to prioritize and handle multiple tasks simultaneously and the ability to work independently and in a matrix team environment.
• Must be dedicated to quality and reliability in all work tasks.
• Must have self-motivation, eagerness to grow professionally and commitment to self-development.
• Must be fluent in English, other languages used in Africa as French and/or Portuguese are welcome.
• Proficiency with computers (PC-Windows preferred).
• Willingness to travel (up to 50%) as necessary, consistent with the project needs.

Candidates fulfilling the above requirements should send their application dossier with a recent photograph to:

Human Resources Department
MMV, case postale 1826
1215 Geneva 15

            or by email to: jobs@mmv.org.

Deadline for applications: July 31st 2008

Wu Y, Ellis RD, Shaffer D, Fontes E, Malkin EM, Mahanty S, Fay MP, Narum D, Rausch K, Miles AP, Aebig J, Orcutt A, Muratova O, Song G, Lambert L, Zhu D, Miura K, Long C, Saul A, Miller LH, Durbin AP. Phase 1 trial of malaria transmission blocking vaccine candidates Pfs25 and Pvs25 formulated with montanide ISA 51. PLoS ONE. 2008 Jul 9;3(7):e2636
Pfs25 and Pvs25, surface proteins of mosquito stage of the malaria parasites P. falciparum and P. vivax, respectively, are leading candidates for vaccines preventing malaria transmission by mosquitoes. This single blinded, dose escalating, controlled Phase 1 study assessed the safety and immunogenicity of recombinant Pfs25 and Pvs25 formulated with Montanide ISA 51, a water-in-oil emulsion…

Gardella F, Assi S, Simon F, Bogreau H, Eggelte T, Ba F, Foumane V, Henry MC, Traore Kientaga P, Basco L, Trape JF, Lalou R, Martelloni M, Desbordes M, Baragatti M, Briolant S, Almeras L, Pradines B, Fusai T, Rogier C.  Antimalarial drug use in general populations of tropical Africa. Malar J. 2008 Jul 8;7(1):124
The burden of Plasmodium falciparum malaria has worsened because of the emergence of chloroquine resistance. Antimalarial drug use and drug pressure are critical factors contributing to the selection and spread of resistance. The present study explores the geographical, socio-economic and behavioural factors associated with the use of antimalarial drugs in Africa...

Dicko A, Sagara I, Sissoko MS, Guindo O, Diallo AI, Kone M, Toure OB, Sacko M, Doumbo OK. Impact of intermittent preventive treatment with sulphadoxine-pyrimethamine targeting the transmission season on the incidence of clinical malaria in children in Mali. Malar J. 2008 Jul 8;7(1):123. [Epub ahead of print]
Recent studies have shown that intermittent preventive malaria treatment (IPT) in infants in areas of stable malaria transmission reduces malaria and severe anaemia incidence. However in most areas malaria morbidity and mortality remain high in older children...

Steketee RW, Sipilanyambe N, Chimumbwa J, Banda JJ, Mohamed A, Miller J, Basu S, Miti SK, Campbell CC. National malaria control and scaling up for impact: the Zambia experience through 2006. Am J Trop Med Hyg. 2008 Jul;79(1):45-52
With its 2006-2011 National Malaria Strategic Plan, Zambia committed to control malaria at a national scale. This scale-up for impact approach was facilitated by sound business planning and financing in 2006 of approximately US$35 million. Compared with surveys in 2001 and 2004, a 2006 national survey of 14,681 persons in 2,999 households at the end of the transmission season showed substantial coverage increases for preventive interventions. Ownership and use rates of insecticide-treated mosquito nets (ITNs) among vulnerable groups doubled, with 44% of households owning ITNs and 23% of children less than five years of age and 24% of pregnant women using them...

Protopopoff N, Van Bortel W, Marcotty T, Van Herp M, Maes P, Baza D, D’Alessandro U, Coosemans M. Spatial targeted vector control is able to reduce malaria prevalence in the highlands of Burundi.  Am J Trop Med Hyg. 2008 Jul;79(1):12-8
In a highland province of Burundi, indoor residual spraying and long-lasting insecticidal net distribution were targeted in the valley, aiming also to protect the population living on the hilltops. The impact on malaria indicators was assessed, and the potential additional effect of nets evaluated. After the intervention--and compared with the control valleys--children 1-9 years old in the treated valleys had lower risks of malaria infection (odds ratio, OR: 0.55), high parasite density (OR: 0.48), and clinical malaria (OR: 0.57)…

Smith AD, Bradley DJ, Smith V, Blaze M, Behrens RH, Chiodini PL, Whitty CJ. Imported malaria and high risk groups: observational study using UK surveillance data 1987-2006.  BMJ. 2008 Jul 3;337:a120. doi: 10.1136/bmj.a120.
To examine temporal, geographic, and sociodemographic trends in case reporting and case fatality of malaria in the United Kingdom. SETTING: National malaria reference laboratory surveillance data in the UK. DESIGN: Observational study using prospectively gathered surveillance data and data on destinations from the international passenger survey. PARTICIPANTS: 39 300 cases of proved malaria in the UK between 1987 and 2006…

Dinglasan RR, Jacobs-Lorena M. Flipping the paradigm on malaria transmission-blocking vaccines.  Trends Parasitol. 2008 Jul 1. [Epub ahead of print]
The idea of malaria transmission-blocking vaccines (TBVs) surfaced more than two decades ago. Since then, the research paradigm focused on developing TBVs that target surface antigens of parasite sexual stages. Only recently has an effort emerged that flipped this paradigm, targeting antigens of the parasite’s obligate invertebrate vector, the Anopheles mosquito. Here, we review the current state of knowledge of mosquito-based TBVs and discuss the utility of this approach for future vaccine development…

Minakawa N, Sonye G, Dida GO, Futami K, Kaneko S. Recent reduction in the water level of Lake Victoria has created more habitats for Anopheles funestus.  Malar J. 2008 Jul 3;7(1):119. [Epub ahead of print]
The water level of Lake Victoria has fallen more than 1.5 m since 1998, revealing a narrow strip of land along the shore. This study determined whether the recent drop in the water level has created additional breeding grounds for malaria vectors…

Pinzon CG, Curtidor H, Reyes C, Mendez D, Patarroyo ME. Identification of Plasmodium falciparum RhopH3 protein peptides that specifically bind to erythrocytes and inhibit merozoite invasion.  Protein Sci. 2008 Jul 1. [Epub ahead of print]
The identification of sequences involved in binding to erythrocytes is an important step for understanding the molecular basis of merozoite-erythrocyte interactions that take place during invasion of the Plasmodium falciparum malaria parasite into host cells. Several molecules located in the apical organelles (micronemes, rhoptry, dense granules) of the invasive-stage parasite are essential for erythrocyte recognition, invasion and establishment of the nascent parasitophorous vacuole. Particularly, it has been demonstrated that rhoptry proteins play an important role in binding to erythrocyte surface receptors, amongst which is the PfRhopH3 protein, which triggers important immune responses in patients from endemic regions…

Improving access to good quality drugs is a crucial element of malaria control. Ensuring high standards for medicines as well as medical treatment will be essential in preserving the efficacy of the current first line treatment, Artemisinin-based combination therapy (ACT). Although public funding for malaria control has increased markedly in recent years to approximately $1.3 billion in 2007[1], the majority of Africans in high malaria burden countries access treatment through the private sector.

With some exceptions, publicly financed treatment programs have had limited penetration into rural areas of sub-Saharan Africa, where the malaria burden is greatest. General shops, pharmacies and hawkers are ubiquitous resources. Because these outlets are poorly regulated, the quality, price and administration of anti-malarials vary significantly. Drug resistance to artemisinin has already been established in South East Asia and could spread to Africa. The use and misuse of substandard drugs could accelerate parasite resistance to artemisinin, which would be devastating for malaria control.

Much media and advocacy attention has been directed toward new discoveries of antimalarial treatment, and relatively little toward the mechanisms for delivering treatments to those in need. A major exception is the proposed Affordable Medicines Facility--malaria, which has the potential to increase access to medicines and should be commended for targeting the private sector. However, for mechanisms such as this to effectively deliver medicines to those most in need, more targeted research is needed on the market for antimalarials and the business models of general stores and traders in remote rural areas...

Full story available: http://www.aei.org/docLib/20080703_AFMBulletin1.pdf

DOZENS of market women in Lagos recently benefitted from the advocacy drive spearheaded by Vestergaard Frandsen, the makers of PermaNet, the Long Lasting Insecticide Treated Nets (LLITN), recently partnered MTN, in line with the vision to kick malaria out of Nigeria.

The drive, organised in partnership with MTN in her "Total Care" campaign to create awareness for malaria and distribute free PermaNets to the less priviledged, held ine select communities within the metropolis.

The awareness campaign kicked off at Alayabiagba modern market, Ajegunle where market women and traders were educated on the benefits of using the specially treated Mosquito Nets.

Long Lasting Insecticide-Treated bed Nets (ITNs) are amongst the most efficient means of protection from mosquitoes and malaria infection. ITN coverage has risen substantially in Nigeria in recent times. The progress was achieved through social marketing and greater subsidies for children and pregnant women.

There was practical demonstration about the use of the treated mosquito nets while free PermaNets were distributed afterwards. Amongst places visited included Ajah Market Adeniji Adele, Daleko Market, Isolo, Mile 12 Oworonsoki Market, Alagbole Market, Alagbole-Akute, Ojota Motor Park amongst others.

Speaking during the malaria awareness campaign held at the popular Mile 12 market, the Trade Channel Manager of Vestergaard Frandsen, Mr. Akeem Segun Akinpelu sensitised the market women on the need to fight malaria by protecting themselves and their families always. He emphasised the use of LLITNs recommended by the World Health Organization as an ideal guard against malaria.

Akinpelu reiterated Vestergaard’s commitment to promoting good health through continued production of top quality insecticide treated mosquito nets and as part of her corporate social responsibility, will continue to make the nets available to all Nigerians especially the less privileged, pregnant women and children - the most susceptible to the disease.

On the joint partnership, he noted:"Vestergaard and MTN share the same passion in caring and supporting the less priviledged by engaging in community upliftment activities and that is why we have gone into strong partnership to render voluntary services to the various communities visited."

In a dramatic call to action in April, U.N. Secretary-General Ban Ki-moon—backed by the African Union, the World Health Organization, UNICEF, the Gates Foundation, ExxonMobil, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, among other key international organizations and businesses—set a timetable for comprehensive malaria control in Africa by the end of 2010. Ki-moon has listened to the best science, weighed the recent evidence, and thrown down the gauntlet: there is no reason why a million or more children should die every year of a largely preventable and wholly treatable disease. Now we have a global timetable and a coalition to end the scourge.

The operational objective is to ensure that crucial interventions to control malaria are taken widely and at the appropriate scale within the next two and a half years. As I described in this space in September 2007, the package of technical control measures is now settled. There should be restriction of the mosquito vector (especially through the use of insecticide-treated bed nets and indoor spraying of insecticides); timely treatment of every clinical case with effective medicines; preventative treatment for pregnant women; and trained community health workers who will link clinics and communities in rural areas. In view of the lives to be saved and the economic benefits of reining in the disease, the total cost of around $3 billion a year is one of the world’s great bargains.

The main challenge of the next two-and-one-half years will therefore be organizational rather than conceptual or scientific. It is now up to a number of key international agencies to get the job done in Africa’s 49 countries, many of which are among the poorest in the world.  Many skeptics doubt that this kind of program can work, much less on an accelerated timetable. The international system is a congeries of overlapping public and private institutions without clear mandates, ease of coordination or a single “conductor” to harmonize activities. Many of the key institutions are sporadically funded. The recipient governments are not always noted for their transparency, efficiency and accountability, to say the least.

Yet the chances for success are also strong. Many African leaders have long been committed to this fight. The U.N. secretary-general and the office of his special envoy on malaria represent a clear point of leadership. The Global Fund to Fight AIDS, Tuberculosis and Malaria serves as a dominant funding organization, and though its own budget depends in a complex way on the contributions from many governments, at least this single agency can channel most of the money that will be needed for success. Happily, the U.S. government is committed to its own sizable contribution, which will likely grow in view of robust congressional support. Finally, the Roll Back Malaria Partnership has had years of experience in bringing the multitude of “partner institutions” under one roof.

The needed technologies are relatively straightforward and much easier to use than those, for example, for controlling the HIV/AIDS pandemic. Bed nets and antimalaria medicines could be deployed rapidly to good effect. We may also take heart in the success of an immunization campaign in reducing measles deaths in Africa by more than 90 percent since the year 2000. Other recent triumphs, based on the up-scaling of powerful and easily deliverable technologies, include the control of polio, leprosy and guinea worm.

Still, the timing will be very tight and will require an unprecedented coordination of financing, training, monitoring and logistics. Each sub-Saharan country will need very quickly to adopt, vet, fund and monitor a scaled-up antimalaria plan. The major global commodity manufacturers of bed nets, antimalaria drugs and diagnostics will have to raise production to hundreds of millions of units. Tens or hundreds of thousands of community health workers will need weeks of training on malaria control, including both prevention (such as the proper use of bed nets) and treatment.

The stakes are exceedingly high. Not just millions of lives but also the very capacity of the world to take on big and crucial goals is at stake. In the case of malaria, we have a low-cost and highly effective package of interventions that can restore health and unleash massive economic gain, but only if countless agencies, dozens of countries and hundreds of millions of individuals can effectively take a shared action. Success in this bold venture will enable us to consider similarly urgent challenges in food production, water management, biodiversity conservation and climate control, to name but four crucial areas. The consequences of organizational failure, on the other hand, would be almost too painful to behold.

The countdown to 2010 has begun.

GUIDELINES ON INCENTIVES FOR HEALTH PROFESSIONALS

International Council of Nurses, International Hospital Federation, International Pharmaceutical Federation, World Confederation for Physical Therapy, World Dental Federation, World Medical Association

May 2008

Commissioned by the Global Health Workforce Alliance (GHWA)

English PDF (44p.) [1.2 Mb] at:

http://www.who.int/workforcealliance/documents/Incentives_Guidelines%20EN.pdf

"….The world’s leading health and hospital professional associations have joined to produce the first-ever joint guidelines on incentives for the retention and recruitment of health professionals. Commissioned by GHWA as part of its work to identify and implement solutions to the health workforce crisis, the Guidelines on Incentives for Health Professionals is the combined result of collaboration.

"…..The report underlines how incentives are important levers that organizations can use to attract, retain, motivate and improve the performance of their staff in all professions and walks of life, This is especially and urgently needed in the health care sector, it states, where the growing gap between the supply of health care professionals and the demand for their services is reaching crisis levels in many countries. The ’Incentives’ guidelines offer practical solutions that can make a difference. Professional associations will implement the guidelines by using the research to support claims and raise awareness of all stakeholders including patients.

The serious shortage of health workers across the world has been identified as one of the most critical constraints to the achievement of health and development goals. The 2006 World Health Report estimated a global shortage of 4.3 million health workers, including 2.4 million physicians, nurses and midwives. Translated into access to care, the shortage means that over a billion people have no access to heath care professionals. …"

TABLE OF CONTENTS

Executive summary
Introduction
A typology of incentives in health care
Financial incentives
Wages and conditions
Performance-linked payments
Other financial incentives
Non-financial incentives
Career and professional development
Workload management
Flexible working arrangements
Positive working environments
Access to benefits and supports
What does an effective incentive scheme look like?
Developing an incentive package
Conclusion
Appendix
References

HealthConnect International has just published a new issue of the E-Health in Practice Bulletin. The current issue of the bulletin, which seeks to highlight a select number of e-health tools, resources, and opportunities that are specifically applicable for users in low-resource settings, includes the following featured items:

• International Network for the Availability of Scientific Publications (INASP) – Resources provided through this nonprofit UK-based organization include a country-by-country directory of full-text journals and other online resources that have been made available as well as training materials that are downloadable through their website. INASP also provides hands-on training at locations all over the world.

• Healthcare Information For All by 2015 [HIFA2015] Campaign / Community / E-mail Forum – For those interested in keeping up-to-date with initiatives related to improving access to health information, HIFA2015 provides an active discussion forum through an Internet mailing list.

• Health IT Bibliography – Maintained by the U.S. Agency for Healthcare Research and Quality, this peer-reviewed collection of articles and web-based resources provides case studies and practical advice on the development of health information systems.

• Swinfen Charitable Trust Telemedicine Links – Clinics and hospitals in developing countries are encouraged to join Swinfen’s telemedicine network, which currently provides free consultations from over 380 medical specialists to members of 132 hospitals in 35 countries.

• Latin American Health Care Network – MEDNET – This project, funded in part by the European Union, provides a model for supporting remote teleconsultations in rural settings as well as supporting the development of health information systems.

• Understanding Evidence-based Healthcare: A Foundation for Action – This free online course provides an overview of evidence-based healthcare.

• Calendar of Upcoming E-health-related Events

The full issue can be accessed from the HealthConnect International website (in HTML or PDF) at: http://www.healthconnect-intl.org/resources.html 

Interested individuals may also directly subscribe to the E-Health in Practice Bulletin at http://groups.google.com/group/healthconnect-international

or by contacting bulletin@healthconnect-intl.org.

Best regards,

Mark Storey
Managing Director
HealthConnect International
"Bridging the health information divide"

http://www.healthconnect-intl.org

mstorey@healthconnect-intl.org

Pinzon CG, Curtidor H, Reyes C, Mendez D, Patarroyo ME. Identification of Plasmodium falciparum RhopH3 protein peptides that specifically bind to erythrocytes and inhibit merozoite invasion. Protein Sci. 2008 Jul 1.[Epub ahead of print]
The identification of sequences involved in binding to erythrocytes is an important step for understanding the molecular basis of merozoite-erythrocyte interactions that take place during invasion of the Plasmodium falciparum malaria parasite into host cells. Several molecules located in the apical organelles (micronemes, rhoptry, dense granules) of the invasive-stage parasite are essential for erythrocyte recognition, invasion and establishment of the nascent parasitophorous vacuole…

Helinski ME, Hood RC, Gludovacz D, Mayr L, Knols BG.  A 15N stable isotope semen label to detect mating in the malaria mosquito Anopheles arabiensis Patton. Parasit Vectors. 2008 Jul 1;1(1):19. [Epub ahead of print]
In previous studies it was determined that the stable isotope 13-carbon can be used as a semen label to detect mating events in the malaria mosquito Anopheles arabiensis. In this paper we describe the use of an additional stable isotope, 15-nitrogen (15N), for that same purpose. Both stable isotopes can be analysed simultaneously in a mass spectrometer, offering the possibility to detect both labels in one sample in order to study complex and difficult-to-detect mating events, such as multiple mating. 15N-glycine was added to larval rearing water and the target enrichment was 5 atom% 15N...

Fairlie WD, Spurck TP, McCoubrie JE, Gilson PR, Miller SK, McFadden GI, Malby R, Crabb BS, Hodder AN.  Inhibition of malaria parasite development by a cyclic peptide that targets the vital parasite protein, SERA5. Infect Immun. 2008 Jun 30. [Epub ahead of print]
The serine repeat antigen (SERA) proteins of the malaria parasite Plasmodium spp. contain a putative enzyme domain similar to Papain family cysteine proteases. In P. falciparum parasites, more than half of the SERA family including the most abundantly expressed form, SERA5, have a cysteine to serine substitution within the putative catalytic triad of the active site. Although SERA5 is required for blood-stage parasite survival, the occurrence of a non-canonical catalytic triad casts doubt on the importance of the enzyme domain in this function. We used phage display to identify a small (14 residue) disulfide-bonded, cyclic peptide (SBP1) that targets the enzyme domain of SERA5...

Enosse S, Magnussen P, Abacassamo F, Gomez-Olive X, Ronn AM, Thompson R, Alifrangis M. Rapid increase of Plasmodium falciparum dhfr/dhps resistant haplotypes, after the adoption of sulphadoxine-pyrimethamine as first line treatment in 2002, in southern Mozambique. Malar J. 2008 Jul 1;7(1):115. [Epub ahead of print]
In late 2002, the health authorities of Mozambique implemented sulphadoxine-pyrimethamine (SP)/amodiaquine (AQ) as first-line treatment against uncomplicated falciparum malaria. In 2004, this has been altered to SP/artesunate in line with WHO recommendations of using Artemisinin Combination Therapies (ACTs), despite the fact that all the neighbouring countries have abandoned SP-drug combinations due to high levels of SP drug resistance. In the study area, one year prior to the change to SP/AQ, SP alone was used to treat uncomplicated malaria cases. The study described here investigated the immediate impact of the change to SP on the frequency of SP and CQ resistance-related haplotypes in the Plasmodium falciparum genes Pfdhfr, Pfdhps and Pfcrt before and a year after the introduction of SP...

Landis SH, Lokomba V, Ananth CV, Atibu J, Ryder RW, Hartmann KE, Thorp JM, Tshefu A, Meshnick SR. Impact of maternal malaria and under-nutrition on intrauterine growth restriction: a prospective ultrasound study in Democratic Republic of Congo.  Epidemiol Infect. 2008 Jun 30:1-11[Epub ahead of print]
Maternal malaria and under-nutrition are established risk factors for small-for-gestational-age (SGA) births; however, whether malaria is associated with intrauterine growth restriction (IUGR) is unknown. We investigated IUGR risk among 177 HIV-negative pregnant women enrolled in a longitudinal ultrasound study conducted in Democratic Republic of Congo from May 2005 to May 2006. Malaria infection, maternal anthropometrics, and ultrasound estimated fetal weight were measured monthly…

Bell D, Perkins MD. Making malaria testing relevant: beyond test purchase.  Trans R Soc Trop Med Hyg. 2008 Jun 27. [Epub ahead of print]
Malaria rapid diagnostic tests (RDT) are being procured and used in increasing numbers. However, the resultant effect of RDT-based diagnosis on fever management has been limited by lack of confidence in RDT results or the inability to act on results appropriately. If the utilisation of malaria RDTs is going to achieve the significant public health and financial benefits anticipated, they must be introduced in a carefully structured way and viewed as a tool for the management of febrile illness, not just malaria. If this is to occur, a re-think is required of the way many malaria programmes are funded and run…

Stratton L, O’Neill MS, Kruk ME, Bell ML. The persistent problem of malaria: Addressing the fundamental causes of a global killer.  Soc Sci Med. 2008 Jun 24. [Epub ahead of print]
Despite decades of global eradication and control efforts and explosive global economic development, malaria is the most important vector-borne disease of our day, killing more people today than 40 years ago and affecting millions worldwide, particularly poor residents of tropical regions. Global eradication efforts from the 1950s through the 1980s largely failed, leaving vector and parasite resistance in their wake. The persistence of malaria and the magnitude of its effects call for an action paradigm that links the traditional proximal arenas of intervention with malaria’s fundamental causes by addressing the environmental, economic, and political dimensions of risk…

Skovmand O, Bonnet J, Pigeon O, Corbel V. Median knock-down time as a new method for evaluating insecticide-treated textiles for mosquito control.  Malar J. 2008 Jun 27;7(1):114. [Epub ahead of print]
Insecticide treated bed nets are major tools for the Roll Back Malaria campaign. There are two types of Long-Lasting Insecticide-treated Nets (LNs) on the market: coated nets and insecticide-incorporated nets. Nets provided to this market need a recommendation from the World Health Organization to be purchased by donors and NGOs. During laboratory study (phase I), the first step consists in evaluating the wash resistance of a new LN product. When insecticide-incorporated nets are washed, it takes time to regenerate the insecticidal activity, i.e. insecticide must migrate to the net surface to be accessible to mosquitoes. The interval of time required for regeneration must be carefully determined to ensure the accuracy of further results. WHOPES procedures currently recommend the determination of the regeneration time by using mortality data…

Boraschi D, Abebe Alemayehu M, Aseffa A, Chiodi F, Chisi J, Del Prete G, Doherty TM, Elhassan I, Engers H, Gyan B, Harandi AM, Kariuki T, Kironde F, Kouriba B, Langhorne J, Laskay T, Medaglini D, Olesen O, Onyebujoh P, Palma C, Sauerwein R, Sibanda E, Steinhoff U, Tagliabue A, Thiel A, Vahedi M, Troye-Blomberg M. Immunity against HIV/AIDS, Malaria, and Tuberculosis during Co-Infections with Neglected Infectious Diseases: Recommendations for the European Union Research Priorities.  PLoS Negl Trop Dis. 2008 Jun 25;2(6):e255
Infectious diseases remain a major health and socioeconomic problem in many low-income countries, particularly in sub-Saharan Africa. For many years, the three most devastating diseases, HIV/AIDS, malaria, and tuberculosis (TB) have received most of the world’s attention. However, in rural and impoverished urban areas, a number of infectious diseases remain neglected and cause massive suffering. It has been calculated that a group of 13 neglected infectious diseases affects over one billion people, corresponding to a sixth of the world’s population. These diseases include infections with different types of worms and parasites, cholera, and sleeping sickness, and can cause significant mortality and severe disabilities in low-income countries. For most of these diseases, vaccines are either not available, poorly effective, or too expensive

The African Malaria Network Trust (AMANET) and researchers at the Malaria Research Training Center (MRTC), University of Bamako in Mali have launched a large scale study to evaluate the candidate malaria vaccine merozoite surface protein-3 long synthetic peptide (MSP3-LSP). 

MSP3 has been shown to be safe for human use in earlier studies done in Switzerland, Burkina Faso and Tanzania, both in adults as in young children. The trial launched in Mali becomes the most advanced for this product and the first ever large scale MSP3-LSP study in Africa. The study is being implemented by a well qualified and highly experienced team of researchers at MRTC, led by Professor Ogobara Doumbo, Director of MRTC. The Principal Investigator for this trial is Dr Mahamadou Soumana Sissoko.

Malaria caused by the parasite Plasmodium falciparum is a major health threat to Mali, one of the principal, if not the most important, causes of ill health and deaths in the country.  Malaria alone accounts for over a third of all doctor-patient consultations in Mali. The disease affects mostly pregnant women and children under five. Responding to the burden, the government of Mali is working hard to counter malaria using insecticide treated nets, the newly introduced Arthemisinin combination therapy and intermittent preventive treatment for pregnant women. In Mali as it is all over the malaria endemic region in Sub-Saharan Africa; increased parasite and vector resistance to drugs and insecticides continue to frustrate the war against malaria, bolstering the need for search of a new, affordable and efficacious intervention; a malaria vaccine.

“This MSP3-LSP malaria vaccine trial will address several scientific issues including confirmation of the vaccine’s preventive effect against episodes of clinical malaria and assessment of the quantity and function of the immunological responses, all of which are considered to be important parameters for an efficacious vaccine,” said Dr Sissoko.

“We have accepted to conduct this trial because MSP3-LSP has a novel and promising mechanism of action and has potential for efficacy as a malaria vaccine” said Professor Doumbo, MRTC Director.

The study which was approved by the Institutional Ethics Review Committee of the Faculty of Medicine, Pharmacy and Dentistry at Bamako University, the Malian Ministry of Health and the AMANET Scientific Committee, involves 414 healthy children. The children, aged between 12-48 months, are randomly selected from the peri-urban village of Sotuba in the outskirts of Bamako. The MRTC has collected base-line malaria data and established a good working relationship with the community in this area since 1990.

Trial participants are divided into two groups (test and control) each comprising 207 children. The test group will receive the candidate MSP3-LSP vaccine while the control group will receive a rabies vaccine. Each child is scheduled to receive a total of three immunizations delivered a month apart and will be followed up for minimum period of two years. These schedules of vaccinations comply with the current expanded programme on immunization (EPI) for newborns.

The trial is sponsored by the African Malaria Network Trust (AMANET); a Dar es Salaam based pan-African NGO leading Africa in malaria Research and Development. The malaria vaccine programme at AMANET receives funding from the European Commission’s Aid Cooperation Office (AIDCO).

Commenting on the launch, the AMANET Managing Trustee Professor Wen Kilama said, “The launch of this study marks a significant step in the search for an effective affordable intervention to provide Africa with the necessary tools to win the battle against malaria and rid Africa of a deadly scourge”

MSP3 discovery is based on converging evidence from many immuno-epidemiological studies and pre-clinical studies in animals. It has been shown that induced antibodies to MSP3 promote the function of a group of white blood cells (monocytes) which attacks and kills the malaria parasite. For this reason, the trial will also provide the first proof of concept for this mode of action of antibodies, the second main paradigm underlying immunity to malaria (the first one being the inhibition of parasite invasion into red blood cells).

Moreover, the MSP3 target is said to be highly “conserved”, meaning that it is identical in all parasites infecting humans, a major advantage as compared to other malaria vaccine candidates. Aluminium hydroxide, the adjuvant used this vaccine, has the widest clinical experience. An adjuvant is a substance added to a vaccine to potentate its immune responses.

MSP3 was invented by Dr Pierre Druilhe and colleagues at the Biomedical Parasitological Unit of the Institute Pasteur in Paris, France. The vaccine batch currently under trial is produced by Synprosis, a Biotechnology company based in Marseille, France and clinical lots are released by Henogen of Belgium.

# # #

For further information contact:

Dr Charles L. Wanga
Communications Officer
African Malaria Network Trust [AMANET]
Third Floor, Commission for Science and Technology Building
Ali Hassan Mwinyi Rd
PO Box 33207, Dar es Salaam, TANZANIA.
Email : clwanga@amanet-trust.org  
www.amanet-trust.org 
Tel: +255 22 2700018
Fax: +255 22 2700380

This past October, at a scientific conference in Seattle, Bill and Melinda Gates issued a challenge that rocked the international health community. The leaders of the world’s richest charitable foundation called on scientists and health officials to join in a global effort to eradicate malaria, an infection that kills more than a million people each year, most of them infants and children.

Mention of the big "E word" has sparked a spirited debate about whether eradication will ever be possible, even as enthusiasm and funding build for a global drive to end malaria deaths in sub-Saharan Africa by focusing on prevention and treatment — an ambitious first step that would have an enormous impact on public health. That multibillion-dollar initiative, announced in April by United Nations Secretary-General Ban Ki-Moon, was inspired by recent gains against malaria in countries such as Rwanda and Ethiopia, where national programs, funded largely by international donors, have reduced illness and deaths by about 60% over a period of 2 to 3 years with the use of insecticide-treated bed nets, rapid diagnosis, and combination-drug treatment. Yet Plasmodium falciparum, the parasite species that causes most malaria deaths, is a far more formidable foe than variola (smallpox) virus and poliovirus, which were targets of previous global eradication campaigns.

The World Health Organization (WHO) defines eradication as permanent reduction to zero of the worldwide incidence of an infection by a specific agent, resulting from time-bound, deliberate efforts. Elimination is defined as reduction of the incidence of infection to zero within a defined geographic area. Since anopheles mosquito species with the potential to transmit malaria invariably remain present after the parasite has been eliminated in human hosts, countries must still use measures such as aggressive surveillance for cases in immigrants or arriving travelers, as well as provision of rapid diagnosis and treatment, to prevent reestablishment of the infection.1 The malaria community is sharply divided over whether money and effort should be spent on shrinking the world malaria map by trying to eliminate infection in areas where transmission is low or whether such projects will distract from reducing suffering in African countries where intense transmission renders elimination infeasible but where regional dissemination of prevention and treatment could reduce the incidence of clinical illness by 90% or more.

Global eradication is judged to be impossible with the current tools. Yet "unless you think and worry" now about long-term eradication "and about what tools you would need, you can’t engage the scientific community about what those tools would look like," said Regina Rabinovich, director of Infectious Disease Initiatives at the Bill and Melinda Gates Foundation.

A synthetic organism could be producing enough of a key malaria drug to treat the world within three years.

A species of yeast has been fitted with synthetic genes that make a compound called artemisinin, which is used to treat multi-drug resistant strains of malaria. The chemical is currently extracted from a Chinese wormwood shrub called Artemisia annua, but this is a relatively expensive process.

Jay Keasling, of the University of California, Berkeley, and colleagues announced 2 years ago that they had engineered artimisinic acid-producing yeast by inserting around 12 synthetic genes which had been copied from A. annua and several other species.

They have now optimised the process and are scaling it up for industrial production in partnership with drugs giant Sanofi-Aventis.

Single reactor

Artemisinic acid is a precursor to artemisinin which can be converted in several chemical steps. Using yeast to produce it could be cheaper and ensure a steady supply of the drug.

If scale-up is successful, the yeast may become the first "blockbuster" synthetic organism – one with strong commercial applications.

"With the yields that we are getting now, within 2 to 3 years one 50,000-litre chemical reactor could produce all the drug that is needed in the world," says Keasling, who presented his results at a synthetic biology meeting at London’s Royal Society on Tuesday. "That’s enough drug to treat over 500 million people."

The goal will be to launch the drug at market price, but reduce it as the production process becomes more efficient.

Useful brew

Keasling’s approach differs from traditional genetic engineering approaches in that the genes which are inserted into the yeast have been synthesised from scratch in order to make them easier for the cell to read.

"We recode the genes so that they no longer look like plant genes or E. coli [bacteria] genes, but look like yeast genes," says Keasling. "This means the organism has less chance of rejecting them."

The genes encode enzymes which enable sugar molecules to be converted into the artemisinin precursor.

"The process is very similar to producing beer," Keasling says. "We put in some sugar and minimal nutrients, and out comes artemisinic acid at the other end."

SADC countries presented their joint proposal for malaria funding to a team of international experts in Nairobi, Kenya last week for recommendations before submitting it to the Global Fund to Fight HIV and Aids, Tuberculosis and Malaria, Round 8.

The deadline for GFATM proposals is July 1.

Regional co-ordinator for malaria programmes in the military Lieutenant-Colonel Kaka Mudambo said the "mock trial" presentation was meant to get advice from other international health experts on how best to come up with a concrete proposal.

"We are now finalising the proposal and currently, we are in the process of incoporating submissions made by the experts into our proposal," Lt-Col Mudambo said.

Lt-Col Mudambo said the costing on how much the region is intending to apply for from the GFATM, which is being done in Durban, South Africa, is expected to be available by Friday. He said the proposal, which seeks to eliminate malaria within the region, will focus on intensification of existing malaria programmes.

These programmes include vector control, use of insecticides treated mosquito nets, distribution of information and education campaign material.

The Sadc project will also focus on reaching to inaccessible areas by boat such as those that lie along the Zambezi escarpment.

Lt-Col Mudambo said through the proposal, Sadc will also strengthen the linkage between patients and clinics at border countries.

"This will make it possible for patients in one country to receive malaria treatment at a nearby clinic in another country within the region," Lt-Col Mudambo said.

Currently people who live along the borders find it difficult to seek medical treatment from a nearest health institution in the neighbouring country because of inadequate or improper travel documentation.

Lt-Col Mudambo said Sadc countries have also agreed to incorporate the tourism sector in particular areas like Hwange where malaria is the major cause of illness and death.

The joint application by Sadc countries to GFATM is the first of its kind for malaria projects and goes in line with this year&rsquos World Malaria Day theme: Malaria A Disease Without Borders and the slogan United to Combat Malaria.

Location: Dar es salaam, Tanzania

Deadline for applications: 11 July 2008

www.amanet-trust.org

The African Malaria Network Trust (AMANET) is a pan-African non-profit institution whose   Mission is to promote capacity strengthening, performance and impact of African malaria R & D institutions. The Trust was incorporated in Tanzania on 14th March 2002. Currently AMANET undertakes short- and long-term training of African malaria researchers, infrastructure improvement, equipping research institutions, and sponsorship of clinical and field trials of candidate malaria intervention tools.

AMANET is pleased to invite applications from suitable candidates for a vacant position of GMZ2Project Manager to be based at the AMANET Secretariat in Dar es Salaam, Tanzania.

Purpose of the Job

The Project Manager will be responsible for the day to day management of the seven partner consortium project - Integrated projects on clinical trials, capacity building, and networking.  He / She will report directly to the Consortium Project Coordinator at AMANET. He / She will among other activities, be expected to be in charge of the following:

Job Description:

• Together with the Work Package Leaders, develop and implement innovative and up to date information sharing mechanisms within the network
• To ensure that monthly updates of the project activities are posted into the Project Workspace in the Website in a timely manner
• To facilitate trainees / fellows placements within networked institutions both in the South and the North
• Responsible for timely development and publication of mid-year and annual reports and brochures and their distribution to stakeholders and networked partners
• To coordinate with Work package Leaders, within the network to ensure smooth and timely implementation of the project.
• To regularly follow-up and update stakeholders on capacity development and site development timelines, achievements and defaults.
• To facilitate mid-term and end-period evaluations 
• Actively participate in the general management activities
• To organise the Project Steering Committee  meetings
• To carry out any other duties as assigned by the Consortium

Qualifications:

• Must possess at least a good basic university degree in biological sciences, a postgraduate degree in life sciences will be an added advantage;
• Proven research experience in malaria is desirable;
• Experience in malaria vaccine development work and good clinical practices (GCP) is an added advantage
• Good command of written and oral English is required; Knowledge of French will be an added advantage
• Must be computer competent in office application software, including but not limited to word processing, spreadsheets, desktop publishing, power point, database and mainly project management;
• Prior intercultural exposure desirable;
• Candidate should be dynamic, multitasked, a team player with strong interpersonal skills.
• Female candidates are strongly encouraged to apply for this position.

Remuneration:

The successful candidate will be based in Dar es Salaam, Tanzania and offered an attractive and highly competitive international salary based on qualifications and experience.

How to apply

If you meet the above criteria, submit by e-mail an application letter with a detailed CV, which should also show your contacts (including e-mail address) and names and addresses of three professional /work and personal / study related referees.

Also attach copies of other essential documents e.g. certificates, testimonials, etc. Your application should be received on or before 11 July 2008 and should be sent to:
 

The Managing Trustee,
African Malaria Network Trust,
Tanzania Commission for Science and Technology Building,
P.O. Box 33207,
Dar es Salaam, Tanzania.

Email: vacancy@amanet-trust.org, copy to: clwanga@amanet-trust.org
Website: www.amanet-trust.org

ICGEB Malaria Research Program announces to the malaria community a position on an EC-funded project for a period of 1-3 years for young African Scientists  who are either  senior doctoral students close to completion or recent graduates (post-docs) in the Biosciences  with an interest in malaria. Specialization in any of the areas such as molecular biology, biochemistry, biophysics, microbiology or parasitology will be an asset.

Topic : Placental malaria

Duration : 2008 onwards

Location : ICGEB, New Delhi, India

Placement Supervisors: Drs. Chetan Chitnis and Amit Sharma

Qualification : PhD (in biosciences with an interest in parasitology)

Other requirements: Candidate must be able to read/write English.

Grant: Appointment will be for up to 3 years on a European Commission funded grant. Salary will be competitive and tax-free.

Health/Travel Insurance: Provided for.

Deadline for applications:  July 31, 2008.

Selection Process: Candidates must provide a detailed CV, at least two letters of recommendation from their current or previous supervisors, and a 2 page letter of interest describing their research interests and career goals. Applications will be screened at ICGEB by a panel of scientists followed by telephonic interview.

Complete application files should be sent to cchitnis@icgeb.res.in  or asharma@icgeb.res.in

Deadline for applications: 15 July 2008

The Johns Hopkins University Bloomberg School of Public Health and Phoebe R. Berman Institute of Bioethics, with support from the Fogarty International Center of the U.S. National Institutes of Health (NIH), are pleased to announce the availability of a one year training program in research ethics for scientists and professionals from sub-Saharan Africa. The program is directed by Dr. Nancy Kass and Dr. Adnan Hyder.

The JHU-Fogarty African Bioethics Training Program is currently accepting applications for the 2009 training cycle that starts in January 2009. The deadline for applications is July 15, 2008.

The training program will provide funding for African scientists, professionals, and senior scholars to study research ethics, and also to do an independent project in their home country related to research ethics.

Appropriate candidates include researchers who are working at universities, government ministries, private organizations and other relevant health research institutions, as well as professionals working with institutional review boards or ethics boards.

Pre- and post-doctoral trainees from a country in sub-Saharan Africa and with a strong interest in international health research ethics should apply. Pre-doctoral trainees must have a bachelor degree in any relevant field. Post-doctoral trainees must have a Ph.D., M.D., or the equivalent.

Trainees should develop a clear plan of how they will integrate the training into their current work/research responsibilities, should have a clear statement of support from a division head or other relevant supervisor, and preferably should have some previous experience in research ethics.

Further information about the training program, including application materials and instructions, can be found at the following website:

http://www.bioethicsinstitute.org/web/page/440/sectionid/378/pagelevel/2/interior.asp 

Specific inquiries may be sent to jali@jhsph.edu

Sarr O, Ahouidi AD, Ly O, Daily JP, Ndiaye D, Ndir O, Mboup S, Wirth DF. Mutations in PFCRT K76T do not correlate with sulfadoxine-pyrimethamine-amodiaquine failure in Pikine, Senegal. Parasitol Res. 2008 Jun 5. [Epub ahead of print]
In 2003, the high level of chloroquine (CQ) treatment failure for uncomplicated Plasmodium falciparum malaria cases has led Senegal to adopt a new combination therapy with sulfadoxine-pyrimethamine and amodiaquine (SP-AQ). From September through November 2004, we used the 14-day World Health Organization follow-up protocol to assess the therapeutic response in patients with uncomplicated P. falciparum malaria in an area of high prevalence of pfcrt T76 mutant allele and SP resistance mutations. Of the 82 patients who were recruited, 68 (82.9%) completed follow-up…

Prudhomme J, McDaniel E, Ponts N, Bertani S, Fenical W, Jensen P, Le Roch K.  Marine actinomycetes: a new source of compounds against the human malaria parasite. PLoS ONE. 2008 Jun 4;3(6):e2335.
Malaria continues to be a devastating parasitic disease that causes the death of 2 million individuals annually. The increase in multi-drug resistance together with the absence of an efficient vaccine hastens the need for speedy and comprehensive antimalarial drug discovery and development. Throughout history, traditional herbal remedies or natural products have been a reliable source of antimalarial agents, e.g. quinine and artemisinin...

Armstrong Schellenberg JR, Mrisho M, Manzi F, Shirima K, Mbuya C, Mushi AK, Charles Ketende S, Alonso PL, Mshinda H, Tanner M, Schellenberg D.  Health and survival of young children in southern Tanzania. BMC Public Health. 2008 Jun 3;8(1):194. [Epub ahead of print]
With a view to developing health systems strategies to improve reach to high-risk groups, we present information on health and survival from household and health facility perspectives in five districts of southern Tanzania. METHODS: We documented availability of health workers, vaccines, drugs, supplies and services essential for child health through a survey of all health facilities in the area. We did a representative cluster sample survey of 21,600 households using a modular questionnaire including household assets, birth histories, and antenatal care in currently pregnant women...

Clark TD, Greenhouse B, Njama-Meya D, Nzarubara B, Maiteki-Sebuguzi C, Staedke SG, Seto E, Kamya MR, Rosenthal PJ, Dorsey G. Factors Determining the Heterogeneity of Malaria Incidence in Children in Kampala, Uganda. J Infect Dis. 2008 Jun 3. [Epub ahead of print]
Malaria risk may be heterogeneous in urban areas of Africa. Identifying those at highest risk for malaria may lead to more targeted approaches to malaria control. Methods. @nbsp; A representative sample of 558 children aged 1-10 years were recruited from a census population in a single parish of Kampala and followed up for 2 years...

Chaves LF, Kaneko A, Taleo G, Pascual M, Wilson ML. Malaria transmission pattern resilience to climatic variability is mediated by insecticide-treated nets.  Malar J. 2008 Jun 2;7(1):100. [Epub ahead of print]
Malaria is an important public-health problem in the archipelago of Vanuatu and climate has been hypothesized as important influence on transmission risk. Beginning in 1988, a major intervention using insecticide-treated bed nets (ITNs) was implemented in the country in an attempt to reduce Plasmodium transmission. To date, no study has addressed the impact of ITN intervention in Vanuatu, how it may have modified the burden of disease, and whether there were any changes in malaria incidence that might be related to climatic drivers…

Duan J, Mu J, Thera MA, Joy D, Kosakovsky Pond SL, Diemert D, Long C, Zhou H, Miura K, Ouattara A, Dolo A, Doumbo O, Su XZ, Miller L. Population structure of the genes encoding the polymorphic Plasmodium falciparum apical membrane antigen 1: Implications for vaccine design.  Proc Natl Acad Sci U S A. 2008 Jun 3;105(22):7857-62. Epub 2008 May 30
Immunization with the highly polymorphic Plasmodium falciparum apical membrane antigen 1 (PfAMA1) induces protection in animals but primarily against parasites that express the same or similar alleles. One strategy to overcome the obstacle of polymorphism is to combine PfAMA1 proteins representing major haplotypes into one vaccine. To determine the minimum number of haplotypes that would confer broad protection, we sequenced the coding region of PfAMA1 from 97 clones from around the world and 61 isolates from Mali, identifying 150 haplotypes for domains 1 to 3 that included previous sequences…

A Swiss biotechnology company said Wednesday that it has successfully tested a malaria vaccine which could be marketed as early as 2014, according to a statement from directors.

Mymetics, who acquired the trial vaccine from Swiss research and development company Pevion Biotech, said it had carried out clinical trials on humans in Britain and Switzerland.

Studies on Tanzanian children and teenagers in areas where malaria is prevalent are also underway, Mymetics said.

It added that further experiments on substances which create antibodies that resist the infection were also in the pipeline.

It could take up to three years to complete clinical trials, which would set a timetable of roughly six years for the vaccination to obtain full approval, Mymetics chief executive Christain Rochet added.

"There is a pressing need for a vaccine against malaria," he said. "Up to 500 million people a year are infected, with a mortality rate of approximately two million each year."

Malaria is a deadly parastic infection passed on from infected mosquitos to humans, and strikes mainly in tropical and sub-tropical environments.

Mymetics said it is also testing a possible vaccine against the HIV-AIDS virus and tests will start later this year on 33 women in Belgium.

It said it would not market the vaccines but would seek to sell them to a major pharmaceutical group.

How easy is it to diagnose malaria? Prof Dave Newman of the University of Exeter has created a portable magneto-optical instrument to do the job in a minute. And, when his new method is fully refined, it may not even need a blood sample.

Newman’s expertise as a physicist involves materials for magneto-optical recordable discs. Used since the late 1980s, these rely on measuring a change in laser light reflected from magnetic media in different magnetic states.

There’s also a link between malaria, magnetism and light. Red blood cells are infected by the malarial parasite (Plasmodium) from female Anopheles mosquitoes. The oxygen-carrying haemoglobin is then digested by the parasite, forming haemozoin which exhibits properties of being attracted to magnetic fields.

Some years ago, Newman had considered researching malaria diagnosis but was prevented by blood safety restrictions. Then he moved to the University of Exeter. "I went back to this idea and, by talking to a biologist friend of mine, I came to the conclusion that maybe it was possible to detect malaria by detecting the haemozoin by magneto-optics."

Thanks to European Union funding, Newman and colleagues from Exeter and Coventry universities have now tested a prototype instrument at the Royal Tropical Institute in Amsterdam. Clinical trials are also planned in Kenya.

It works like this. The parasite produces haemozoin in the form of rectangular rod-like crystals and, normally, the long axes point in random directions. "When you apply a [magnetic] field to them, they become magnetised and all orientate in the field direction," says Newman.

The crystals also absorb polarised red laser light more strongly along their length than the width (optical dichroism). Put a blood sample into the instrument, apply a directional magnetic field, then a laser and photodetector take optical measurements proportional to the haemozoin concentration. "The intention is to produce something about the size of a shoe box which will be rugged enough to go out into the field," says Newman.

Colin Sutherland is a senior lecturer at the London School of Tropical Medicine & Hygiene and a clinical scientist at the Hospital for Tropical Diseases. He says that malaria is usually identified with a microscope or by antigen diagnostic kits which may not be too reliable. "This particular test looks very exciting," he says. "The fact that it’s rapid is great but it will, of course, need to be emphasised for a test to be usable by a malaria control programme in Africa, it must be affordable and portable."

Newman is researching a prototype which doesn’t use a blood sample. Instead, he envisages putting a finger inside a box within a magnetic field, shining a laser beam onto a fingernail, and taking an optical reading from the blood beneath.

Health authorities have started countrywide investigations of all pharmacies over reported fake malaria drugs on the market. The aim is to establish authenticity of media reports in Uganda that a recent study by U.S. scientists indicated that fake malaria medication was on sale in Rwanda.

The Director of Pharmacies in the Ministry of Health, Viateur Mutanguha, confirmed Monday that extensive inspection of all malaria drugs was underway.

"We want to identify the credibility of the research," Mutanguha underscored.

The New Vision paper recently said that researchers wrote in the online journal Public Library of Science that 33% of substandard malaria drugs are on Rwandan market.

Similar study was reportedly done in Kenya appeared to have the highest (38%) followed by Uganda and Ghana (35%), Tanzania and Nigeria (32%).

The drugs allegedly tested by researchers in these countries were Amodiaqine known as Camaquin, Artesunate; but Mutanguha said such drugs are no longer on the market here.

Others sampled in the study include sulfadoxine-pyromethamine usually known as Fansidar, Artemether-Lumefantrine also known as Coartem and Mefloquine.

Except for Fansidar which is soon to be banned, the health official said that the other two drugs (Coartem and Mefloquine) are imported under our quality assurance guidelines.

"All imported medications pass through our control procedures. Dealers first provide us with proforma invoices listing the kind of drugs they propose to import" he said.

"They also to present us with copies of certificates of standard analysis, and about the firm producing the drug," he explained.

However, Mutanguha expressed lack of a high-tech laboratory for thorough verification (quality control) of drug quality which manufacturers propose.

He called for the boosting of Rwanda Bureau of Standards (RBS) laboratory equipment to ensure that the drug quality which producers indicate is easily detected.

Regardless of fake malaria drug claims, Rwanda was ranked first by the World Health Organization (WHO) this year among African countries doing well in the fight against Malaria.

Spain’s 2008 Prince of Asturias prize for international cooperation was shared between four malaria research centres in Africa on Wednesday, its jury president said.

The panel wanted to reward "the merit and the work of these research centres which are fighting to break the link between the disease and poverty," said Antonio Garrigues Walker.

The Manhica Health Research Centre in Mozambique, the Ifakara Health Research and Development Centre in Tanzania, the Malaria Research and Training Centre in Mali and the Kintampo Health Research Centre in Ghana will share the 50,000 euros (80,000 dollars) award.

Last year’s prize was handed out to former US vice-president Al Gore for his work on climate change.

The four African malaria centres were selected among candidates including the International Criminal Court in The Hague and the Oxfam International branch of Intermon Oxfam.

Since 1981, the Prince of Asturias Foundation -- under the patronage of the heir apparent to the Spanish throne, King Juan Carlos’s son, Felipe -- selects eight recipients every year for prizes in eight categories: communication and humanities; social sciences; arts; letters; scientific and technical research; international cooperation; concord; and sports.

According to the foundation, malaria is a threat to almost 40 per cent of the world’s population, with the majority of deaths occurring in sub-Saharan Africa.

The protein MAEBL is critical for completing the life cycle of malaria parasites in mosquitoes, allowing the insects to transmit the potentially deadly infection to humans, a University of South Florida study has shown. The research may ultimately help provide a way to better control malaria by blocking development of the malaria parasite in the mosquito.

Researchers with the USF Global Health Infectious Diseases Research team found that the transmembrane protein MAEBL is required for the infective stage of the malaria parasite Plasmodium falciparum to invade the mosquitos salivary glands. Their findings were published May 28 in the online journal PLoS ONE.

The mosquito is the messenger of death, said the studys principal investigator John Adams, PhD, professor of global health at the USF College of Public Health. If we could eliminate the parasite from the mosquito, people wouldnt become infected.

Plasmodium falciparum causes three-quarters of all malaria cases in Africa, and 95 percent of malaria deaths worldwide. It is transmitted to humans by the bite of an infected mosquito, which injects the worm-like, one-celled malaria parasites from its salivary glands into the persons bloodstream.

The study was done by genetically modifying the malaria parasites and feeding them in a blood meal to uninfected mosquitoes. Parasites in which MAEBL was deleted were not harbored in the salivary glands of mosquitoes, even though an earlier form of these parasites was observed in the gut of the mosquitoes. The researchers concluded that the transmembrane form of MAEBL is essential for the parasite to enter the mosquitos salivary glands.

While more studies are needed, lead author Fabian Saenz, PhD, said the finding suggests that silencing the receptor for MAEBL in the mosquito salivary gland might block passage of the parasite through the mosquito, thereby preventing human infection through mosquito bites.

Our study shows that MAEBL is a weak link in the parasites biology, Dr. Adams said. This could provide a potential way to block transmission in the mosquito, before the parasite ever has a chance to infect a new person. It is better to prevent the malaria infection from occurring in the first place than having to kill the parasite already inside humans with vaccines or drugs.

In anticipation of the upcoming G8 meeting to be held in Japan in July, health leaders and malaria awareness ambassadors will join together at TICAD in an effort to urge the G8 leaders to fulfill their pledges made at the 2007 Heiligendamm Summit for $60 billion in new funding to fight malaria, HIV/AIDS, tuberculosis, Health System Strengthening, MDGs 4, 5 and 6 

We hope African leaders will address the burden of malaria within the human security segment at the 4th Tokyo International Conference on African Development (TICAD). The disease together with HIV continues to hamper Africa’s economic development. Up to 40% of household budget is spent on malaria medication. The economic cost of malaria to Africa is $12 billion resulting in a much lower GDP

“With united voices from Africa, from the Americas, from Europe, and from Asia: We’re asking the G8 leaders in particular Japan, to fulfill the pledges made at previous G8 summits to fight malaria. Millions of lives depend on it’.”  said Yvonne Chaka Chaka, international music icon and Roll Back Malaria and UNICEF Ambassador.

Youssou N’dour led the panel, including Dr. Greenwood, to sign up to the call by the “Me Too” campaign, a joint public campaign organized by Japanese civil society organization to push for more and better aid for health to be agreed at the G8 Hokkaido Toya-ko Summit.

Masaki Inaba of Africa Japan Forum, spokesperson of the Me Too campaign said “My wish for ‘Me Too’:  stop millions of women and children dying from malaria and other diseases”

Youssou N’dour echoed Masaki, and stressed “There can be no breakthrough in Africa’s development and prosperity without first addressing malaria. Last time the G8 met in Japan, the Global Fund was created.   This year’s G8 is the place for another visionary commitment: a G8 call for the elimination of malaria.   African leaders, please insist on universal coverage in the fight against malaria.   We only have 947 days to achieve the universal coverage targets.”    N’dour, the grammy-winning Senegalese artist, is a Goodwill Ambassador to the Roll Back Malaria Partnership and Unicef.

Research Assistant 

Closing date for applications: 22 June 2008

Interviews will be held during 1 – 11 July 2008

www.kit.nl

The Royal Tropical Institute, Department of Biomedical Research, section Parasitology wants to expand its research programme in the field of protozoan parasites, in particular in the field of trypanosomiasis, leishmaniasis and malaria. The Parasitology Research Group is looking for a Research Assistant/Technician. The primary objective of the group is to conduct research towards the development, evaluation and implementation of new diagnostic tools, improved treatment and understanding the basis of drug resistance of protozoan parasites.

This post will assume primary responsibility for culturing protozoan parasites, to perform RNA/DNA extractions and amplifications, to set-up genetic characterizations of parasites and to assist in test development, including serology.  More information can obtained by contacting Dr. Henk Schallig, research coordinator parasitology: h.schallig@kit.nl

Scientist (Post-doc)

Closing date for applications: 22 June 2008

Interviews will be held during 1 – 11 July 2008

www.kit.nl

The Royal Tropical Institute, Department of Biomedical Research, section Parasitology wants to expand its research programme in the field of protozoan parasites, in particular in the field of trypanosomiasis, leishmaniasis and malaria. The Parasitology Research Group is looking for a Scientist (Post-doc). The primary objective of the group is to conduct research towards the development, evaluation and implementation of new diagnostic tools, improved treatment and understanding the basis of drug resistance of protozoan parasites.

The primary responsibility of the applicant is initiating research towards novel assays, technology and reagents for improving diagnosis of protozoan infections and studying mechanisms underlying drug resistance. The candidate is capable of developing its own research line within the targets of the research group and will actively seek funding for the research activities. The applicant will assist the research coordinator in his management duties and will also play a key part in the smooth running of research team. This role could progress to include supervisory responsibilities as the team expands. More information can be obtained by contacting Dr. Henk Schallig, research coordinator parasitology: h.schallig@kit.nl

Sanofi-Aventis Impact Malaria program announces to the  malaria community a short placement  for  6 months  in France for young African Scientists  who are either  senior doctoral students close to completion or recent graduates (post-docs) in the Biosciences  with an interest in malaria

Topic : Meta Analysis of Cross Resistance Studies between Amodiaquine and Chloroquine 

Duration : 6 months,  September 2008 - February 2009

Location : Institut de Médecine Tropicale du Service de Santé des Armées (IMTSSA) in Marseille (France)

Placement Supervisors: Pr.  Christophe ROGIER + Candidate’s, Home Country Professor

Qualification : PhD or post doc (biosciences with interest in parasitology)

Other requirements: Candidate must be able to read English and French to be able to use data in both languages

Grant: 15000 Euros to cover travel to and from France, as well as lodging and local travel expenses

Health/Travel Insurance: Provided by Sanofi-Aventis

Deadline for applications:  June 27, 2008

Selection Process: Candidates expressing interest should write a 2 page letter of interest, demonstrating what value that will add to the scientists’ or his home laboratory profile. Candidate must provide a detailed CV and a letter recommendation from their Home country supervisor.  Applications will be screened by an international panel of scientists followed by an interview of the shortlisted candidates by July 15, 2008.  Candidates will be notified shortly thereafter. 

Complete application files should be sent as a zipped folder containing all three documents to:  Dr. Jean-Marc Bouchez, Sanofi-Aventis, France. Email address : Malariainternship.marseille@sanofi-aventis.com

Scholz M, Fraunholz MJ. A computational model of gene expression reveals early transcriptional events at the subtelomeric regions of the malaria parasite, Plasmodium falciparum. Genome Biol. 2008 May 27;9(5):R88. [Epub ahead of print]
The malaria parasite, Plasmodium falciparum, replicates asexually in a well-defined infection cycle within human erythrocytes (red blood cells, RBC). The intraerythrocytic developmental cycle (IDC) proceeds with a 48 hour periodicity…

Radhakrishnan ML, Tidor B.  Optimal Drug Cocktail Design: Methods for Targeting Molecular Ensembles and Insights from Theoretical Model Systems. J Chem Inf Model. 2008 May 27;48(5):1055-1073.
Drug resistance is a significant obstacle in the effective treatment of diseases with rapidly mutating targets, such as AIDS, malaria, and certain forms of cancer. Such targets are remarkably efficient at exploring the space of functional mutants and at evolving to evade drug binding while still maintaining their biological role. To overcome this challenge, drug regimens must be active against potential target variants. Such a goal may be accomplished by one drug molecule that recognizes multiple variants or by a drug "cocktail"a small collection of drug molecules that collectively binds all desired variants...

John R, Ephraim T, Andrew A.  Reduced susceptibility to pyrethroid insecticide-treated nets by the malaria vector Anopheles gambiae s.l. in western Uganda. Malar J. 2008 May 26;7(1):92. [Epub ahead of print]
yrethroid insecticide-treated mosquito nets are massively being scaled-up for malaria prevention particularly in children under five years of age and pregnant mothers in sub-Saharan Africa. However, there is serious concern of the likely evolution of widespread pyrethroid resistance in the malaria vector Anopheles gambiae s.l. due to the extensive use of pyrethroid insecticide-treated mosquito nets. The purpose of this study was to ascertain the status of pyrethroid resistance in An. gambiae s.l. in western Uganda...

Matsiegui PB, Missinou MA, Necek M, Mavoungou E, Saadou I, Lell B, Kremsner PG. Antipyretic effect of ibuprofen in Gabonese children with uncomplicated falciparum malaria: a randomized, double-blind, placebo-controlled trial. Malar J. 2008 May 26;7(1):91. [Epub ahead of print]
ntipyretic drugs are widely used in children with fever, though there is a controversy about the benefit of reducing fever in children with malaria. In order to assess the effect of ibuprofen on fever compared to placebo in children with uncomplicated Plasmodium falciparum malaria in Gabon, a randomized double blind placebo controlled trial, was designed...

Blackman MJ. Malarial proteases and host cell egress: an ’emerging’ cascade. Cell Microbiol. 2008 May 22. [Epub ahead of print]
Malaria is a scourge of large swathes of the globe, stressing the need for a continuing effort to better understand the biology of its aetiological agent. Like all pathogens of the phylum Apicomplexa, the malaria parasite spends part of its life inside a host cell or cyst. It eventually needs to escape (egress) from this protective environment to progress through its life cycle. Egress of Plasmodium blood-stage merozoites, liver-stage merozoites and mosquito midgut sporozoites relies on protease activity, so the enzymes involved have potential as antimalarial drug targets…

We received with deep sympathy the sad news of the passing of Professor Chris Curtis, who was a Medical Entomologist at the London School of Hygiene and Tropical Medicine.  A longstanding pioneer and advocate of Insecticide Treated  Nets (ITNs) and other appropriate technologies for mosquito vector control in Africa, Professor Curtis is particularly remembered for his tireless dedication not only to research but also to supervising tens of postgraduate students and mentoring many who are leading the anti-vector battle across the continent.

On behalf of the MIM Secretariat and the MIM Malaria Community, we express our deepest condolences to his family. The war against malaria has indeed lost one of its strongest generals.

A page has been set up at the LSHTM website to collect messages of goodwill and expressions of appreciation. These messages will be conveyed to his wife Jill Curtis, and will also be shared:

http://palin.lshtm.ac.uk/news/curtis/

----------

From LSHTM’s Director, Professor Sir Andrew Haines:

Chris was one of the world’s leading medical entomologists. He made enormous contributions to the science and application of vector control and his pioneering studies have laid the foundation for many of the current approaches to controlling malaria. Equally importantly, he was a tireless educator who has inspired generations of students all over the world.

During Chris’s short illness, messages of goodwill have been flooding in from colleagues and students all over the world. The huge volume of these messages, and the depth of feeling that they express, shows that there is a remarkably large community of people, scattered over the world, whose work and lives have been given lasting inspiration by Chris’s gentleness, integrity, generosity and commitment.

Our thoughts are with Jill and his family at this time.

Andy Haines

Director

Japan announced Friday it will give 560 million dollars to help fight AIDS, tuberculosis and malaria as it seeks to make aid for Africa a major theme of its chairmanship of the G8 group.

Prime Minister Yasuo Fukuda said the fresh aid would be channelled through the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria.

He said the financial assistance would be given "in the coming years" from 2009, but did not specify how many years it would extend over.

Japan last pledged aid worth 500 million dollars to the fund in 2005. The money was disbursed over the three years to February 2008, according to a foreign ministry official.

The new aid aims to "demonstrate Japan’s diplomatic efforts to help Africa" as it prepares to host an international conference on African aid next week and the Group of Eight summit of world leaders in July, the official said.

The money comes on top of Japan’s pledge earlier this week to double its financial assistance to Africa by 2012 as part of efforts to help the continent combat poverty and civil conflicts, he said.

Mymetics, a vaccine development company, has acquired a preventive malaria vaccine from Switzerland-based Pevion Biotech.

The Pevion vaccine has successfully completed human clinical trial Phases I and II in Switzerland and in the UK, respectively, with only two of four contemplated antigens. The clinical trials are being conducted in connection with the application for approval of this vaccine under the EU regulations.

A Phase Ib clinical trial has been launched in Tanzania to extend the protocol to children and teenagers in a naturally endemic area. A new cycle of Phase I and II clinical trials with all four antigens is scheduled thereafter.

Christian Rochet, CEO and president of Mymetics, said: "We are pleased with this acquisition which allows us to start feeding a pipeline of products for the future, in addition to our preventive HIV/AIDS vaccine."

The global burden of disease is shifting from infectious diseases to non-communicable diseases, with chronic conditions such as heart disease and stroke now being the chief killers globally, according to a new World Health Organisation report.

The shifting health trends indicate that leading infectious diseases - diarrhoea, HIV, tuberculosis, neonatal infections and malaria - will become less important causes of death globally over the next 20 years.

The World Health Statistics 2008 released on Monday is based on data collected from WHO’s 193 member states. The annual report is the most authoritative reference for a set of 73 health indicators in countries around the world, according to the UN health agency.

"We are definitely seeing a trend towards fewer people dying of infectious diseases across the world," said Dr Ties Boerma, Director of the WHO Department of Health Statistics and Informatics. "We tend to associate developing countries with infectious diseases, such as HIV/AIDS, tuberculosis and malaria. But in more and more countries the chief causes of death are non-communicable diseases, such as heart disease and stroke."

The statistical report documents in detail the levels of mortality in children and adults, patterns of morbidity and burden of disease, prevalence of risk factors such as smoking and alcohol consumption, use of health care, availability of health care workers, and health care financing. It also draws attention to important issues in global health, such as maternal mortality.

In developed countries, nine mothers die for every 100 000 live births, while in developing countries the death rate is 450 and in sub-Saharan Africa it is 950.

The report says high health costs are worsening poverty levels, with some 100 million people impoverished every year by paying out of pocket for health care.

Coverage of key maternal, neonatal and child health interventions is still low. Four out of 10 women and children do not receive basic preventive and curative interventions and at current rates of progress it will take several decades before this gap is closed.

See full report

Roughly one-third of the malaria drugs sold at chemists in East Africa’s capital cities are ineffective, a new study has found Tests on a total of 195 packs of malaria medicines bought in Dar es Salaam, Kampala, Kigali, Nairobi and two West African cities showed that 35 per cent either lacked sufficient amounts of active ingredients or did not dissolve quickly enough to work.

The incidence of ineffective drugs was highest in Kenya, with 38 per cent of the 42 packets purchased in Nairobi found to be sub-standard.

Tanzania’s rate was lowest, at 32 per cent, followed by Rwanda, a 33 per cent and Uganda, at 35 per cent. The malaria drugs most likely to fail quality tests were those manufactured in Africa, researchers said.

Nearly half of those medicines were found to be deficient, compared with 24 per cent of drugs of European origin.

The comparative weakness of regulatory systems in Africa may account for the difference, researchers suggest. They also report that 33 per cent of the tested packets contained only artemisinin, an anti-malarial agent produced in China and regarded as an especially promising treatment.

In order to prevent the malaria virus from developing resistance to this new drug, the World Health Organisation last year asked pharmaceutical companies to sell artemisinin only when it has been combined with other anti-malaria drugs.

“The high persistence of sub-standard drugs and clinically inappropriate artemisinin mono-therapies in the private sector risks patient safety and, through drug resistance, places the future of malaria treatment at risk globally,” the researchers write.

Their findings are published in The Public Library of Science. Thousands of East Africans could die as a result of the bogus drugs.

The authors of the new study do not attempt to quantify the impact of what they say is a public health crisis “but,” they add, “it must be staggering.”Malaria annually takes the lives of at least 500,000 Africans.

And Africans account for about 90 per cent of the half-billion people in the world who contract the disease, according to WHO.

The study’s authors — Roger Bate of the Africa Fighting Malaria group in Washington; Richard Tren, a researcher with a US-based think tank; and Amir Attaran of the University of Ottawa in Canada — urge other international agencies to join WHO in applying pressure on behalf of governments for more responsible production of anti-malaria drugs.

Specifically, they ask major multilateral donors such as the World Bank to make their anti-malaria aid conditional on the removal of artemisinin-only therapies from national formularies.

The researchers also call on the World Trade Organisation to enact rules prohibiting trade in artemisinin-only therapies and reducing tariffs on proper malaria medicines to zero.

A post-doctoral position is available in the Pennsylvania State University College of Medicine, Division of Infectious Diseases and Epidemiology to work at a newly established malaria molecular biology laboratory to study mechanisms of parasite red cell invasion. 

The ideal candidate should have a Ph.D. and/or M.D., be highly motivated, and have a strong background in molecular biology techniques to include PCR, RT-PCR, cloning, northern and southern blot hybridization procedures, and experience with cell culture work.

Experience in flow cytometry and in vitro culture of malaria are also very desirable. Interested persons should send their CVs and three letters of reference to José A. Stoute, M.D., by e-mail at jose.stoute@us.army.mil.

Penn State is committed to affirmative action, equal opportunity and the diversity of its workforce.

José A. Stoute, M.D.
Division of Malaria Vaccine Development
Walter Reed Army Institute of Research
503 Robert Grant Ave.
Silver Spring, MD 20910
e-mail: jose.stoute@us.army.mil
Tel 301-319-9652
Fax 301-319-7358
E-fax: 630-214-2008

Karunamoorthi K, Mulelam A, Wassie F. Laboratory evaluation of traditional insect/mosquito repellent plants against Anopheles arabiensis, the predominant malaria vector in Ethiopia. Parasitol Res. 2008 May 21. [Epub ahead of print]
Laboratory study was carried out to evaluate the repellent efficiency of most commonly known four traditional insect/mosquito repellent plants Wogert [vernacular name (local native language, Amharic); Silene macroserene], Kebercho [vernacular name (local native language, Amharic); Echinops sp.], Tinjut [vernacular name (local native language, Amharic); Ostostegia integrifolia], and Woira[vernacular name (local native language, Amharic); Olea europaea] against Anopheles arabiensis under the laboratory conditions…

Cairns M, Carneiro I, Milligan P, Owusu-Agyei S, Awine T, Gosling R, Greenwood B, Chandramohan D.  Duration of protection against malaria and anaemia provided by intermittent preventive treatment in infants in Navrongo, Ghana.  PLoS ONE.2008 May 21;3(5):e2227.
Intermittent preventive treatment for malaria in Infants (IPTi) has been shown to give effective and safe protection against malaria. It has been suggested that IPTi might have long-lasting beneficial effects but, in most settings, the protection provided by IPTi appears to be short-lived. Knowledge of the duration of protection given by IPTi would help interpret the results of existing trials and suggest optimal delivery schedules for IPTi. This study investigated how the protective efficacy of IPTi against malaria and anaemia changes over time...

Mwangi TW, Fegan G, Williams TN, Kinyanjui SM, Snow RW, Marsh K.  Evidence for over-dispersion in the distribution of clinical malaria episodes in children.  PLoS ONE. 2008 May 21;3(5):e2196.
It may be assumed that patterns of clinical malaria in children of similar age under the same level of exposure would follow a Poisson distribution with no over-dispersion. Longitudinal studies that have been conducted over many years suggest that some children may experience more episodes of clinical malaria than would be expected. The aim of this study was to identify this group of children and investigate possible causes for this increased susceptibility...

Hassan SE, Malik EM, Okoued SI, Eltayeb EM. Retention and efficacy of long-lasting insecticide-treated nets distributed in eastern Sudan: A two-step community-based study. Malar J. 2008 May 20;7(1):85. [Epub ahead of print]
In order to assess the effectiveness of long-lasting insecticide-treated nets (LLINs) as a method for malaria control, there is a need to determine how high is the retention of bed nets, how they are utilized, and how efficacious they are against the mosquitoes that transmit the disease. This is especially important in case of Sudan after emergence of resistance to pyrethroids in use...

Robert V, Bourgouin C, Depoix D, Thouvenot C, Lombard MN, Grellier P. Malaria and obesity: obese mice are resistant to cerebral malaria. Malar J. 2008 May 19;7(1):81. [Epub ahead of print]
The relationship between malaria and obesity are largely unknown. This is partly due to the fact that malaria occurs mainly in tropical areas where, until recently, obesity was not prevalent. It now appears, however, that obesity is emerging as a problem in developing countries. To investigate the possible role of obesity on the host-parasite response to malarial infection, this study applied a murine model, which uses the existence of genetically well characterized obese mice…

Mendes AM, Schlegelmilch T, Cohuet A, Awono-Ambene P, De Iorio M, Fontenille D, Morlais I, Christophides GK, Kafatos FC, Vlachou D. Conserved mosquito/parasite interactions affect development of Plasmodium falciparum in Africa. PLoS Pathog. 2008 May 16;4(5):e1000069.
In much of sub-Saharan Africa, the mosquito Anopheles gambiae is the main vector of the major human malaria parasite, Plasmodium falciparum. Convenient laboratory studies have identified mosquito genes that affect positively or negatively the developmental cycle of the model rodent parasite, P. berghei. Here, we use transcription profiling and reverse genetics to explore whether five disparate mosquito gene regulators of P. berghei development are also pertinent to A. gambiae/P. falciparum interactions in semi-natural conditions, using field isolates of this parasite and geographically related mosquitoes. We detected broadly similar albeit not identical transcriptional responses of these genes to the two parasite species...

Lovegrove FE, Gharib SA, Peña-Castillo L, Patel SN, Ruzinski JT, Hughes TR, Liles WC, Kain KC. Parasite burden and CD36-mediated sequestration are determinants of acute lung injury in an experimental malaria model.  PLoS Pathog. 2008 May 16;4(5):e1000068
Although acute lung injury (ALI) is a common complication of severe malaria, little is known about the underlying molecular basis of lung dysfunction. Animal models have provided powerful insights into the pathogenesis of severe malaria syndromes such as cerebral malaria (CM); however, no model of malaria-induced lung injury has been definitively established. This study used bronchoalveolar lavage (BAL), histopathology and gene expression analysis to examine the development of ALI in mice infected with Plasmodium berghei ANKA (PbA)...

Click here to view this paper as an Adobe Acrobat PDF.

Drug resistance due to parasite mutation was a key driver of malaria’s resurgence in sub-

Saharan Africa in the 1990s. Southeast Asian countries demonstrated the efficacy of a new but expensive treatment and, together with a Swiss pharmaceutical company, developed the first fixed-dose artemisinin-based combination therapy (ACT) for malaria. Few countries claimed they could afford to adopt this drug as a first line treatment. Advocates, malaria scientists and United States Congress ultimately exposed the folly of continuing to fund outdated drugs like chloroquine and sulfadoxine-pyrimethamine (SP), and donor agencies moved to meet the huge need for ACTs.

The results have been a mixture of success and systemic failure. The United States Government, World Bank and the Global Fund to Fight AIDS, TB and Malaria have substantially increased malaria control funding and through the World Health Organisation (WHO) and Roll Back Malaria Partnership (RBM) provided technical assistance to help countries change treatment guidelines to ACTs and devise strategies to finance them. As of September 2007, ACTs are listed as first-line treatments for uncomplicated malaria in every national treatment policy in sub-Saharan Africa where they are needed. The Global Fund is helping to deliver 264 million ACTs, backed by an unprecedented $471 million allocation for malaria control (42% of total allocations) in its most recent round of grants (Round 7). Largely as a result of these efforts, some African countries are reporting localized declines in malaria cases and deaths.

Yet the rising demand for artemisinin has increased incentives for producers to market

artemisinin as a monotherapy. The WHO has explicitly recommended against this practice, as widespread exposure could accelerate parasite resistance to artemisinin. No new class of antimalarial treatment is expected to enter the market for at least a decade, so all foreseeable malaria treatment strategies depend on the integrity of this drug. Recent evidence from Southeast Asia suggests that artemisinin may be losing effectiveness against malaria. If this is attributable to parasite resistance, Africa may not be far behind.

Unfortunately, public health systems on the African continent remain weak and underdeveloped. Most people still seek treatment from the private sector, where substandard and artemisinin monotherapy drugs abound. Africa Fighting Malaria (AFM) has confirmed this in a recent study of private sector antimalarial drug quality in six African countries: Ghana, Kenya, Nigeria, Rwanda, Tanzania and Uganda. Antimalarial monotherapy tablets, including artemisinin, were widely available in urban and peri-urban pharmacies, with 35 percent of all treatments failing basic content testing.

This comes as no surprise. Only 20 percent of the WHO’s 191 member states currently have well-developed drug regulation. Post-market surveillance of the private sector in low-income countries is practically non-existent, and national drug registries are infrequently updated or publicized. Africa has only six WHO-registered national pharmacovigilance systems to detect substandard drugs. Though the agency has made efforts to scale these up and develop new sites, resistance monitoring networks remain severely limited.

In the absence of strong national regulatory and pharmacovigilance systems, consistent leadership among donor agencies providing ACTs is critical and sorely lacking. The Global

Fund has adopted a stand-alone policy of procuring drugs not tested by competent agencies. This is intended to increase competition and spur price reductions, but it may result in the distribution of unsafe drugs. Such practice is forbidden in developed countries. The Executive Director of RBM has voiced concerns about the quality of these drugs, but the Global Fund is reticent to leave nascent copy drug companies in the lurch.

An outgrowth of the trend toward generics and copy drugs is local production of pharmaceuticals. Some donors aggressively advocate this concept even as they acknowledge safety risks and substantial opportunity costs. Tremendous investment of limited resources will be required to turn African factories into viable, internationally-accredited production facilities.

Further, localized producers have an inclination and incentive to protect their output by lobbying for tariffs and other protective measures, which threaten to increase costs and impede access to quality drugs. Ideological support for local production destructively conflates industrial and public health policy, and provides copy drug companies little incentive to improve quality. The latter point is most concerning as donor agencies roll out new treatment solutions like the Affordable Medicines Facility malaria (AMFm). If approved, this initiative will adopt the commendable goal of subsidizing ACTs for private and public sector distribution.

Unfortunately it plans to compromise on drug quality standards in line with the Global Fund. Without a commensurate strengthening of national regulation, postmarket surveillance and

pharmacovigilance to pace the inevitable development of artemisinin resistance, such policies could result in setbacks for malaria control and public health.

Substandard drugs continue to circulate in Africa, causing an estimated 200,000 avoidable deaths from malaria alone each year. Structural reforms are elusive. Malaria endemic countries remain hugely dependent on donors, who too often reward policy failures with new aid initiatives. Eight years ago, African governments pledged to remove taxes and tariffs on malaria control technologies, and devote at least 15 percent of their national budgets to improving health care. Most are failing to live up to these commitments. Unless Africa takes its own health care more seriously, the present gains against malaria should not be expected to last.

The solution to the malaria problem in Africa lies in engaging local people to find out what they know about malaria and what they are capable of doing in order to control the disease.

Kenya is one of the countries that have the best knowledge about malaria in the world today. Paradoxically, it is also one of the countries with the highest number of people who succumb to the disease.

This shows that African countries have not laid out proper strategies on how to fight the disease, and they have not fully participated in the control of the disease. First, the solution to the malaria problem in Africa lies in engaging local people to find out what they know about the disease and what they are capable of doing in order to control it.  This information can then be used to develop products and services that are relevant to the needs of African people.

The global health agencies concerned with malaria control must focus on understanding how people control, treat and the beliefs on malaria locally, instead of bringing solutions imposed from the West. The problem is that the West has owned the malaria problem, and continues to leave Africans out when seeking solutions.

Malaria is a major killer disease in Africa. The World Health Organisation (WHO) reported that about 1.3 million people died from the disease in 2005. Children and pregnant women are more susceptible to malaria. About 90 per cent of malaria deaths occur in children under five years of age.

The health body recommends widespread use of treated mosquito nets, and spraying of insecticides around houses, arguing that sleeping under the mosquito nets reduces the likelihood of catching malaria by about 25 per cent.

This was the argument that was used to create the Roll Back Malaria Programme in 1998, with an aim of reducing malaria prevalence by 50 per cent every five years.  In 1998, malaria killed only about 250,000 people each year worldwide. The plan by WHO was a massive distribution of millions of insecticide treated mosquito nets throughout the continent and other areas in of the world where malaria is endemic. These were good intentions. 

The programme  only worked on one front. The organisation managed to distribute millions of insecticide treated nets in many African countries. But malaria cases did not reduce. In fact, since 1998, the number of deaths due to malaria have steadily risen from 250,000 to 1.3 million deaths by 2005.

Analysts have offered explanations to this increase in the face of increased investment to fight the disease. One of the explanations was that the people living in malaria endemic zones did not use the mosquito nets as advised.

Other said people living in malaria endemic areas used the mosquito nets exactly as WHO recommended, but the mosquitoes bit them before they went to bed. Thus, the people are likely to have contracted malaria already before using the treated nets.

According to the recommendation WHO, the nets are only used when sleeping. This hinders the purpose of use of nets as a way to eradicating malaria because people do not carry the net everywhere.

The mosquitoes come out in the evenings and these are times when women are preparing food in open places, young children are winding up the play time before dinner. At this time, the mosquitoes are busy buzzing around, looking for candidates to bite.

They bite unsuspecting pregnant women sitting at the fireplace and the children playing outside. By the time they go to bed under the care of treated nets the bite from the mosquito has already transmitted the malaria parasites. In these circumstances, bed nets do not offer any protection. 

The bed nets recommended by WHO are treated with pyrethroids. A pyrethroid is a synthetic version of natural pyrethrin. The WHO imports pyrethroids from a Japanese manufacturer, to treat mosquito nets imported from China. The pyrethroids are also used for indoor residual spraying.

Why does WHO import pyrethroids to Kenya instead of buying pyrethrum from Kenyan farmers? Why do they have to import the nets when they can buy them from a local manufacturer?

 The fundamental problem is that this leads to flooding of synthetic pyrethroid in the local market. This story is not unique to Kenya. The same thing is happening in Tanzania, Uganda, Rwanda and Burundi. 

It is time for Kenyan pyrethrum producers to get involved in malaria control. First they will contribute to eradicating a disease that is killing millions of Africans, and second, they will generate new and sustainable sources of income. Kenyans have grown pyrethrum for many years. However, Kenyans do not grow pyrethrum for malaria control. Pyrethrum Board of Kenya (PBK) exports most of the pyrethrum produced in Kenyan.

It is time that PBK markets the produce instead of the aggressive Japanese business reaping all the benefits.

If the PBK sold pyrethrum to WHO, pyrethrum farmers would benefit. This will also reduce the cost of the insecticides as they will be locally produced.  Kenyans should seize this opportunity and help fight malaria.

The business people can create a pyrethrum extraction plant and encourage increased production of pyrethrum in the Kenyan highlands.  Kenyan pyrethrum still has a very big demand internationally.

What about the nets? Kenyan business people should invest in mosquito net manufacturing . The local people should own the malaria business if we are to bring malaria under control. The protection of PBK to solely extract and market pyrethrum is unethical because the body does not invest in malaria control business.

The government must remove any remaining restrictions in the Pyrethrum Act impeding local people to engage freely in malaria control business. Foreign companies such as the Sumitomo of Japan and East African Botanicals, and Kenya Private Sector Alliance and similar business associations can work together to lobby the government to remove all clauses that restrict local people from participating in the entire value chain of pyrethrum products.

With appropriate government response and revisions of the Act , the next step is to build the system for increasing pyrethrum production.

Pyrethrum management is a low technology business and easily affordable. Traditionally, people used to harvest pyrethrum flowers and dry the flowers hanging upside down to increase pyrethrin concentration. Modern commercial production plants have high tech driers in aerated buildings. The aerated buildings are not necessary in Kenya where there is abundance of sunshine. The flowers dry well on drying racks under the sun.

The idea is to dry them until the moisture content reduces to about 10 per cent. The next step involves crushing the dry flowers into a fine powder. The fineness of the powder influences the pyrethrum efficiency and the longevity. Finer powder is more efficient in killing insects, but it loses the pyrethrin content much faster. A coarse powder is less efficient but lasts longer.

Crushing the stems with the flowers does not reduce the pyrethrin concentration.

The problem with pyrethrum extract is that it is very sensitive to light. When exposed to light, the extract can last up 10 days in a sealed container at room temperature. Dried extract can however last for up to six months when kept in the dark without refrigeration. Because of this sensitivity to light, it is wise to store the pyrethrum extract in amber coloured bottles.

The two ways of using pyrethrum are dusting or spraying. Cool temperatures enhance the insecticide effect of pyrethrum. Therefore, it is better to spray or dust in late afternoon. The sun also accelerates degradation.

Farmers use pyrethrum to protect their crops from parasites, by applying the crushed powder leaves of plants requiring protection. People burn the uncrushed dried flowers to repel and kill mosquitoes. Some people mix the crushed flowers with sawdust and burn them to chase mosquitoes.

This is the idea behind mosquito coils. Pyrethrin extract is also packaged as a spray. Though this is a more high tech end of production. Pyrethrin production  does not require a huge starting capital. Yet investment in pyrethrum business, or malaria control business is very lucrative with very huge returns. Other crops that Kenyans  can benefit from include Artemesia and neen.

They are many investment opportunities in other products discovered by our scientists at the universities, research institutions such as KEMRI, KARI, and ICIPE that Kenyans need to embrace. 

The writers are members of Knowledge Development Network

www.kdnc.org

Some 35% of antimalarial drugs sold in six major African cities failed basic quality tests according to a study published today in PLoS ONE, a peer-reviewed open-access journal.

The cities were in Ghana, Kenya, Nigeria Rwanda, Tanzania and Uganda. The study further found that artemisinin monotherapies, which the World Health Organisation explicitly rejects as substandard, remain common in Africa. Substandard antimalarial drugs cause an estimated 200,000 avoidable deaths each year.

"Our study shows that efforts to increase access to quality antimalarial drugs in Africa are increasingly important," said Dr. Roger Bate, Resident Fellow at the American Enterprise Institute and lead author on the study. "Substandard drugs not only endanger lives today, but also jeopardize future malaria treatment strategies by accelerating parasite resistance."

Artemisinin combination therapies, or ACTs, lower the chances of developing parasite resistance and reducing treatment efficacy. Yet a third of the drugs collected in the study were artemisinin monotherapies. 42% of them failed and 78% were manufactured after the World Health Organisation proscribed them in January 2006.

"Malaria surged through Africa in the 1990s, fueled by resistance to chloroquine and other historically effective drugs," said Richard Tren, Director of Africa Fighting Malaria, a non-profit advocacy group. "Because regulation and post-market surveillance of drugs is so poor in most malarial countries, ACTs now risk the same fate."

The World Health Assembly resolved in May 2007 to stop the production and marketing of artemisinin monotherapies. But according to the World Health Organisation, only 40 of 74 global manufacturers have agreed in principle to stop production, and 42 countries - 18 of them in sub-Saharan Africa - still allow companies to market these drugs.

Africa Fighting Malaria also released a report on malaria treatment policy in Africa today, available at: . The report examines the challenges of pharmaceutical regulation and production in Africa, and calls for stronger global leadership from donors on drug procurement standards.

"Under the Global Fund’s ’Option C’, poor countries can use taxpayer funds to buy untested drugs of uncertain quality," said Richard Tren. "Option C was intended to increase incentives for nascent ACT producers to enter the market and foster competition. It has accomplished this, but it has not provided any incentives for these companies to go the extra step and submit to bioequivalence testing by a stringent regulatory authority."

Post-market surveillance and pharmacovigilance are severely limited in Africa, yet crucial to detecting bad drugs and the inevitable development of parasite resistance for an at-risk population of 700 million. As the PLoS ONE study argues, a fraction of the current global budget for malaria control could support a decentralized network for basic drug quality testing in Africa using Minilabs, portable chemistry sets, or equivalent technologies.

A health warning: counterfeit medicines can do even greater damage than heroin and cocaine

Heroin and cocaine are not the only illegal drugs with a terrible impact on global health. Counterfeit medicines can do much greater damage.

Some of these fakes contain potentially toxic chemicals. Others are like homoeopathic remedies - while harmless in themselves, as they contain no active ingredients, they do not work as advertised. When taken to treat a potentially lethal disease, they can kill.

They are certainly killing in South-East Asia. Artesunate is one of the most effective drugs for treating malaria, and up to half the tablets on sale in the region are counterfeit. Most contain no artesunate at all. The acutely ill patients who use them, many of them children, are taking nothing stronger than a placebo, and thousands are dying as a result. Some fake antimalarials carry a secondary threat. They contain traces of artesunate too small to be clinically useful, but significant enough to encourage resistance to one of the few antimalarials that is still widely effective.

Traffic in counterfeits has traditionally been treated as minor fraud, but there have recently been welcome signs of change. An outstanding piece of scientific detective work, led by the Wellcome Trust and Interpol, has cracked one of the world’s worst counterfeiting rings. By analysing traces of pollen and environmental contaminants in fake artesunate, Operation Jupiter has tracked the origin of many batches to one region of China. Six arrests followed, along with the seizure of thousands of fake packets.

This was an important breakthrough, and there is already evidence that it has helped to stanch the flow. Targeting manufacturers, however, can be only part of the solution to this lethal trade. It exists for a simple reason: antimalarials are too expensive, which leaves a market niche for cheap knock-offs that criminal gangs will always find a way to exploit.

A project called the Affordable Medicines Facility for Malaria is seeking funding to subsidise accredited factories to produce effective drugs for developing countries. The Global Fund to Fight Aids, Tuberculosis and Malaria will soon decide whether to provide the $1.9 billion it needs over five years.

The provision of cheaper antimalarials, of course, would be a social good in itself. A positive ruling would also do far more to undermine counterfeiting than forensic science can hope to achieve.

The £80 million funding crisis in British physics - the subject of a damning select committee report last week - may be just the start of the field’s problems. One of the biggest slices of the physics budget is the UK’s subscriptions to international partnerships such as Cern, the European Space Agency and the European Southern Observatory, and these are all priced in euros. Unless the Government moves to guarantee these against the fluctuating value of the pound, further belt-tightening may soon be necessary.

London School of Hygiene & Tropical Medicine (University of London)
Department of Infectious and Tropical Diseases
Disease Control and Vector Biology Unit

Post of MIP Trial Coordinator, West Africa
Application deadline: 23 May 2008

Website: http://www.lshtm.ac.uk

An exciting and challenging opening is available for an epidemiologist, clinician or public health specialist to coordinate a large trial of intermittent preventive malaria treatment in the prevention of malaria in pregnancy (IPTp) that will be conducted in three to four countries in West Africa with support from a grant from the Malaria in Pregnancy Consortium. The objective of this trial is to determine whether in areas where malaria transmission is highly seasonal, a reduction can be made in the number of doses of intermittent preventative treatment needed or in the duration for which intermittent preventive treatment is given.

The primary responsibility of the coordinator will be to ensure that activities at the sites where the trial will be conducted are well integrated and conducted to a high standard. Each site will have its own project leader with responsibility for activities at that site.

Applicants, who may be clinically or non-clinically qualified, should have a post-graduate qualification in epidemiology or public health and experience of conducting clinical trials in a developing country.

Applicants must have excellent communication and management skills and some knowledge of French.

An appointment will be made as soon as possible. A contract of 36 months will be offered. The appointment will be made on the Clinical or Non-Clinical Lecturer scale with a starting salary between £35,858 and £41,377. The successful candidate will be placed on the scales according to skills and experience. For successful candidates based in West Africa, additional overseas benefits may be applicable.

For further particulars and an application form, please contact:

The Personnel Office, LSHTM,

Telephone 020 7927 2203 (24 hour answer phone) or e-mail personnel@lshtm.ac.uk quoting reference BG_IPTp. Only applications in the format outlined in the recruitment pack will be considered.

Closing date for applications is 23 May 2008.

Shortlisted candidates will be interviewed the week commencing 30th June 2008. For more information about the School, please visit www.lshtm.ac.uk.

The London School of Hygiene & Tropical Medicine is committed to being an equal opportunities employer.

Submission Deadline – May 28

Other Conference Application Deadlines:
Young Investigator Award – Due May 28
ASTMH Travel Award – Due May 28
ACME Travel Award – Due June 11
Elsevier Student Book Award – Due September 15

We look forward to seeing you at the ASTMH 57th Annual Meeting, to be held December 7-11, 2008 at the Sheraton New Orleans in New Orleans, Louisiana.

Call for Abstracts
Submission Deadline – May 28
Click here to view abstract submission information: http://www.astmh.org/meetings/education.cfm

Young Investigator Award
Application Deadline – May 28
This award recognizes developing young scientists who are pursuing careers in various aspects of tropical disease research.
Click here to download an application.

ASTMH Travel Awards
Application Deadline – May 28
Limited funding is available to support annual meeting travel of selected students and young investigators from developing countries and the United States. 
Click here to download an application.

American Committee of Medical Entomology (ACME) Travel Awards
Application Deadline – June 11
Limited funding is available to support annual meeting travel for graduate students who plan to submit an abstract(s) pertaining to arthropods of medical importance.
Visit to download an application.

Elsevier Student Book Award
Application Deadline – September 15
This award recognizes excellence in clinically-oriented research presented by a student or person in graduate medical training at the annual meeting.
Click here to download an application.

Pre-Meeting Courses
Clinical Pre-Meeting Course:
Malaria Eradication: Are We Ready to Try Again?
December 6-7, 2008
With the maturation of the debate on malaria eradication strategy, this course will focus on the progress and challenges of sustaining and expanding global support of malaria control.

Parasitology Pre-Meeting Course:
Whole Genome Association Studies: 
Understanding the Genetic Basis of Susceptibility to Infectious Diseases
December 6, 2008
This course will target scientists, physicians, clinicians, graduate students and educators with interests in the rapidly evolving field of whole genome association studies and how these approaches can be used to understand the basis for susceptibility or resistance to infectious diseases.  Topics will include an overview of whole genome association, a review of the state of the art in technology development, an overview of computational analyses and biostatistics and a discussion of some of the bioethical considerations associated with these studies.

Conference Updates
Visit http://www.astmh.org/meetings/index.cfm for annual meeting updates.
Contact info@astmh.org with questions.  Thanks for your support of the ASTMH annual meeting.
American Society of Tropical Medicine and Hygiene
111 Deer Lake Road, Suite 100
Deerfield, IL  60015
847.480.9592
Fax 847.480.9282
info@astmh.org
http://www.astmh.org

Noor AM, Moloney G, Borle M, Fegan GW, Shewchuk T, Snow RW.
The use of mosquito nets and the prevalence of Plasmodium falciparum infection in rural South Central Somalia. PLoS ONE. 2008 May 7;3(5):e2081.
There have been resurgent efforts in Africa to estimate the public health impact of malaria control interventions such as insecticide treated nets (ITNs) following substantial investments in scaling-up coverage in the last five years. Little is known, however, on the effectiveness of ITN in areas of Africa that support low transmission. This hinders the accurate estimation of impact of ITN use on disease burden and its cost-effectiveness in low transmission settings…

Doherty CP, Cox SE, Fulford AJ, Austin S, Hilmers DC, Abrams SA, Prentice AM.  Iron incorporation and post-malaria anaemia.  PLoS ONE. 2008 May 7;3(5):e2133.
Iron supplementation is employed to treat post-malarial anaemia in environments where iron deficiency is common. Malaria induces an intense inflammatory reaction that stalls reticulo-endothelial macrophagal iron recycling from haemolysed red blood cells and inhibits oral iron absorption, but the magnitude and duration of these effects are unclear...

Bate R, Coticelli P, Tren R, Attaran A.  Antimalarial drug quality in the most severely malarious parts of Africa - a six country study.  PLoS ONE. 2008 May 7;3(5):e2132.
A range of antimalarial drugs were procured from private pharmacies in urban and peri-urban areas in the major cities of six African countries, situated in the part of that continent and the world that is most highly endemic for malaria. Semi-quantitative thin-layer chromatography (TLC) and dissolution testing were used to measure active pharmaceutical ingredient content against internationally acceptable standards...

Wilson NO, Adjei AA, Anderson W, Baidoo S, Stiles JK. Detection of Plasmodium falciparum histidine-rich protein II in saliva of malaria patients. Am J Trop Med Hyg. 2008 May;78(5):733-5
Detection of Plasmodium falciparum parasites in patients with malaria necessitates drawing blood, which increases the risk of accidental infections and is poorly accepted in communities with blood taboos. Thus, non-invasive, cost-effective malaria tests that minimize the need for blood collection are needed. Plasmodium falciparum histidine-rich protein II (PfHRP II) levels in plasma and saliva were compared in malaria-positive and -negative patients in Ghana...

Enevold A, Lusingu JP, Mmbando B, Alifrangis M, Lemnge MM, Bygbjerg IC, Theander TG, Vestergaard LS. Reduced risk of uncomplicated malaria episodes in children with alpha+-thalassemia in northeastern Tanzania. Am J Trop Med Hyg. 2008 May;78(5):714-20
The prevalence of human red blood cell (RBC) polymorphisms is high in areas of intense Plasmodium falciparum transmission, and individuals carrying these genetic traits are believed to be partially protected against severe malaria. However, it remains uncertain how RBC polymorphisms affect the susceptibility to uncomplicated malaria …

Okech BA, Meleshkevitch EA, Miller MM, Popova LB, Harvey WR, Boudko DY. Synergy and specificity of two Na+-aromatic amino acid symporters in the model alimentary canal of mosquito larvae. J Exp Biol. 2008 May;211(Pt 10):1594-602.
The nutrient amino acid transporter (NAT) subfamily is the largest subdivision of the sodium neurotransmitter symporter family (SNF; also known as SLC6; HUGO). There are seven members of the NAT population in the African malaria mosquito Anopheles gambiae, two of which, AgNAT6 and AgNAT8, preferably transport indole- and phenyl-branched substrates, respectively...

Skinner-Adams TS, McCarthy JS, Gardiner DL, Andrews KT. HIV and malaria co-infection: interactions and consequences of chemotherapy.  Trends Parasitol. 2008 May 2 [Epub ahead of print]
The global epidemiology of HIV/AIDS and malaria overlap because a significant number of HIV-infected individuals live in regions with different levels of malaria transmission. Although the consequences of co-infection with HIV and malaria parasites are not fully understood, available evidence suggests that the infections act synergistically and together result in worse outcomes...

ZAMBIA and Russia yesterday signed a US$7 million grant for the malaria national support programme.

Health Minister, Brian Chituwo, said yesterday that the fund, to be administered through the World Bank, would help scale up malaria interventions in the country.

Dr Chituwo said the grant would greatly contribute to regional efforts in controlling the killer disease.

The minister was speaking during the signing ceremony in Lusaka.

He said part of the money would be invested in human resource development to equip health personnel with skills in the provision of quality healthcare.

Dr Chituwo said the focus of the Zambian Government was on boosting the malaria control measures and working towards the elimination of malaria in the region and the world over.

“I have no doubt that the Russian trust fund will not only assist the Zambian Government in scaling up interventions but will contribute towards our regional efforts to control malaria,” he said.

He said the national malaria control programme, which was established to deal with malaria issues, was committed to facilitating equal access to quality and cost-effective malaria control and prevention interventions.

Dr Chituwo said he was happy that many health facilities now had a regular supply of anti-malarial drugs and increased coverage of insecticide treated nets.

Russian Ambassador to Zambia, Anvar Azimov, said the Russian government was happy with the achievements Zambia had made in the fight against malaria.

Dr Azimov said Russia was committed to supporting health and education sectors, which greatly benefitted the Zambian people.

The envoy said next year, Russia would set aside about US$5 billion to go towards the education, health and energy support projects in developing countries such as Zambia.

He said the funds under the Russian Development Agency Aid had been introduced to improve the lives of people in developing countries.

Speaking at the same function, World Bank country manager, Kapil Kapoor, said the bank estimated the economic impact of malaria on the Zambian economy at approximately 1.5 per cent of the Gross Domestic Product every year.

He said the bank, which had been tasked to spearhead the malaria fund, was happy with the determination the Zambian Government had shown in dealing with malaria cases.

Canadian scientists working with Ugandans at Makerere University have reported that their novel drug candidates to treat malaria have demonstrated good safety in their first toxicity tests in animals.

This was announced on Monday in a press release by the Canada-based Upstream Biosciences Inc. The institute was founded in 2004 in the Canadian province of British Colombia.

“Researchers reported that Upstream’s anti-malarial candidates were well tolerated, with no signs of serious toxicity at likely healing dosages,” the release reads in part.

According to the researchers, activity in this range in a new class of anti-malarial drugs has the potential to represent an important advance in the treatment of a resistant form of the disease.

The release said the new data represents the third set of positive toxicity results in animals obtained by researchers at Makerere University for Upstream’s drug candidates for malaria, trypanosomiasis and leishmaniasis, all diseases caused by related parasites.

“These first positive toxicity results in animals for our anti-malarial candidates mark an important step in our programme to develop safe and effective drugs to fight this pervasive condition,” Mr Joel Bellenson, CEO Upstream was quoted as saying.

However, in a follow-up interview with Daily Monitor, Mr Bellenson said researchers can now move on to testing the drugs in sick animals, “and we know how high a dosage ceiling we can use for this testing.”

Asked how soon human trials would begin, he said it was hard to make precise predictions about the timing of trials.

He added: “Drug development has several stages and sometimes requires taking one step back to make two steps forward. When we get the animal efficacy data, it will tell us whether we need to use our artificial intelligence software to make the drugs more potent or less toxic.”

Mr Bellenson explained that the current malaria drugs have a similar mode of action and the parasites become resistant to chemicals related to these older drugs quite easily.

“Our compounds are a completely different chemical structure and are therefore likely to work by blocking different proteins activities,” he added.

“In addition, our compounds may have another advantage to work against sleeping sickness, Nagana and kala azar as well as malaria.

 This would simplify drug stocking logistics and administration to sick patients.” Malaria is the leading cause of illness and death in Uganda, accounting for 25-40 per cent of all outpatient visits at healthcare facilities.

Up to 20 per cent of all hospital admissions and 15 per cent of in-patient deaths are due to malaria.

Researchers from the Universities of Exeter and Coventry have developed the first new technique for diagnosing malaria able to challenge the rapid diagnostic tests (RDTs) currently used in the field. Early results, now published in the Biophysical Journal, suggest that the technique could be as effective as RDTs but far faster and cheaper, making it a potentially viable alternative. The team is now working on a non-invasive version of the device, which with the assistance of a team from the Royal Tropical Institute (KIT), Department of Biomedical Research in Amsterdam, it is planning to trial in Kenya later this year.

Two years in the making and funded by the European Union, this technique uses magneto-optic technology (MOT) to detect haemozoin, a waste product of the malarial parasite, in the blood. Haemozoin crystals are weakly magnetic and have a distinct rectangular form. They also exhibit optical dichroism, which means that they absorb light more strongly along their length than across their width. When aligned by a magnetic field they behave like a weak Polaroid© sheet such as used in sunglasses. This new technology takes advantage of these properties to give a precise reading of the presence of haemozoin in a small blood sample. The team has created a device, which gives a positive or negative reading for malaria in less than a minute.

The new device has a totally different approach from RDTs, which use a chemical agent to detect antigens associated with the malarial parasite. One of the problems with RDTs is that they need to be kept within a given temperature range, which is difficult in hot climates. These disposable kits cost between $1.50 and $4.50 each and take around 15 minutes to deliver a reading.

High-power microscopy is still the best method available for malaria diagnosis and has been used for more than a century. Unfortunately it is time-consuming and requires expensive equipment and specialist medical skills, which are rarely available in villages in rural areas in malaria endemic countries. Over the last decade RDTs have been developed, which allow for faster diagnosis in the field, but these are too costly to be viable for developing countries. Furthermore, RDTs are often not stable at relatively high temperatures and sometimes remain positive even after successful treatment. In many communities where malaria is having a severe impact on health, there is no testing for malaria and young children who have a fever are given anti-malaria drugs as a matter of course. This has contributed to the malarial parasite becoming increasingly resistant to the common anti-malaria drugs. Malaria is a disease for which there is still no vaccine.

Professor Dave Newman of the University of Exeter’s School of Engineering, Computing and Mathematics, said: "There is an urgent need for a new diagnostic technique for malaria, particularly in the light of global warming, which threatens to spread the disease into new parts of the world, including southern Europe. The early results from our device are very promising and hugely exciting. We expect to ultimately produce a sensitive non-invasive device that will be cost effective and easy to use, making it suitable for developing countries, where the need is greatest."

This research was carried out by the University of Exeter, University of Coventry and KIT Biomedical Research, Amsterdam and was funded under the European Commission Framework 6 Program.

A generation after the first attempt failed, people are once more talking seriously about eradicating malaria.

The fight against the ancient, mosquito-borne disease has newfound support almost everywhere, including in the National Basketball Association. The world’s richest charity, the Bill and Melinda Gates Foundation, is leading the charge. There’s an effective drug -- artemisinin -- that wasn’t around 30 years ago, and a consumer product -- insecticide-treated bed nets -- that together are saving tens of thousands of lives.

But whether that will lead one day to the last case of malaria is an open question -- and one that will take another generation to answer.

Yesterday, on the first World Malaria Day, the prospect hovered somewhere between useful fantasy and distant hope.

"Why can’t we set our dream high?" Margaret Chan, the World Health Organization’s director-general, asked soon after arriving in Washington for events here and in New York. "I don’t think we can deny the countries of Africa that possibility, even though we realistically know it will take a long time."

About 500 million people get malaria each year and about 1 million die, the vast majority African children younger than 5. Worldwide, about 2.37 billion people in 87 countries are at risk of the disease, which is caused by a parasite called plasmodium that is passed from person to person by mosquitoes.

The first call for eradication came in 1955 from the World Health Assembly, which consists of the health ministers of U.N. member countries. It was confident that DDT, an insecticide whose use during World War II had dramatically reduced malaria, coupled with postwar economic development could stop the disease.

(Only one eradication effort has succeeded. Smallpox was officially declared gone in 1980 after a campaign that began in 1966.)

The malaria effort lasted 14 years, cost about $1.4 billion and in some places eclipsed other efforts to improve health. By the time the World Health Assembly lowered its goal to malaria "control," 18 countries had become malaria-free, including Spain, Cuba, Taiwan and most of Eastern Europe.

But no countries in Africa, where transmission often occurs year-round, got rid of the disease. Some came close only to see malaria roar back. Sri Lanka recorded only 18 cases in its best year; it now has about 10,000 a year.

The failure greatly disheartened the public-health community. Malaria rejoined malnutrition, diarrhea and pneumonia as seemingly inevitable threats to poor people in the developing world.

This fatalism at least partly set the scene for a resurgence of the disease in recent decades. However, money is pouring again into malaria control -- about $1 billion a year, 10 times the amount of a decade ago.

The big funders include the Global Fund to Fight AIDS, Tuberculosis and Malaria, which since 2002 has given $2.5 billion to fight the disease, and President Bush’s Malaria Initiative, launched in 2005 with a goal of spending $1.2 billion over five years.

Much of the money is going for drugs and mosquito nets permanently impregnated with insecticide. Widespread use of nets has helped Rwanda and Ethiopia reduce child malaria deaths by more than 50 percent in the past three years. A charity called Nothing but Nets has raised enough money to buy nearly 2 million $10 nets, with help from the NBA and many schoolchildren.

Bush marked the occasion yesterday at a Boys & Girls Club in Hartford, Conn. About 150 clubs around the country raised $25,000 for nets.

"I know the boys and girls will probably never meet any of the lives who are being saved. I had the honor of traveling to Africa, and I can assure all who’ve been helping, the people of Africa are most grateful to the American citizens for their help," he said.

The strategy of spraying indoor walls of houses with insecticides, including DDT, once or twice a year is also making a comeback.

The cost of scaling up prevention, treatment and surveillance to fully cover malaria-afflicted areas is $3.8 billion to $7 billion a year, according to two recent estimates.

That huge amount did not deter Bill and Melinda Gates. At a malaria summit they held in Seattle last October, the Gateses called for the eradication of malaria. WHO’s Chan did not know the announcement was coming but gave it what many took as an unofficial endorsement when she told the audience, "I dare you to come along with us."

Most malaria experts, however, say the goal is currently unfeasible.

That’s because transmission rates in "hyper-endemic" parts of Africa are 100 times higher than in any place where the disease has been eliminated. There is no vaccine; without one, eradication is hard to imagine. One candidate tested in Africa reduced infections by 35 percent over two years; a much more effective one is not expected for more than a decade.

In a paper prepared for the British government in December, three malaria experts wrote that "it is not unthinkable that global eradication can be achieved, but it is not possible with current methods."

That doesn’t bother Richard Feachem, former head of the Global Fund and now at the University of California at San Francisco.

He and others espouse a two-pronged strategy -- aggressive control in the high-transmission parts of Africa, while simultaneously "shrinking the malaria map" by eliminating the disease from places where it is less intense. The latter includes islands in Oceania, parts of southern Africa and China. He believes that by the time eradication becomes a possibility in Africa, there will be new tools.

"The overall effort is measured in decades," he said recently.

Dates: 23 - 27 June 2008

Location: Dar es Salaam, Tanzania

Deadline for Applications: 30 May 2008

http://www.amanet-trust.org/ext/news/AHRECall2008.html

Background/Rationale

The high disease burden of African countries, the emergence of new diseases, and efforts to address the10/90 gap, have led to an unprecedented increase in health research activities in Africa. In light of the generally poor health delivery systems, the lower levels of education, and poverty of communities and governments, it has become imperative that HRE in Africa be strengthened in order to minimise the risk of unethical research being conducted on the poor populations.

Historically, research participants and research institutions have been exposed to abuse and are inadequately prepared to handle complexities that characterize justice and beneficence desirable for research involving human participants and communities.  This is ever so important in the less developed world where regulatory systems are either very weak or non existent in majority of cases.

Over the next three years, and through a grant from The Bill and Melinda Gates Foundation, AMANET will organize a series of 5 workshops on Advanced Health Research Ethics (HRE) primarily for health investigators and secondarily for Ethics Committee members and policy makers. Since the workshops will be at an advanced level, basic HRE training will be a pre-requisite. The first workshop will be held in Dar es Salaam from 23 to 27 June 2008.

Precedence:

AMANET continues to champion the need for training in biomedical research ethics to various stakeholders of research in Africa. With regard to health research ethics for ethics review committees, the following workshops have been organized by AMANET:

1. Workshops on Ethics in Health Research in Africa,  in Kenya (Kisumu, 2001), Ethiopia (Addis Ababa,   2001), South Africa (2002, Pretoria), Gabon, (Libreville, 2002), Sudan (Khartoum, 2003), Cameroon (Yaoundé, 2003), Ethiopia (2007), Ghana (2008) Senegal (in French, 2008) and Tanzania (Dar es Salaam, 2005, 2006 and 2007)
2. Workshop on Standard Operating Procedures for Ethics Review of Health Research in Africa, 17-21 February 2003, Entebbe, Uganda;
3. Workshop on Advanced Ethics in Biomedical Research that Involves Human Subjects, 1-3 December 2004, Zanzibar, Tanzania; and
4. Workshop on Protection of Human Research Participants: Writing of Standard Operating Procedures for Ethics Review Committees in Eastern Africa: 29-31 August 2005, Dar es salaam, Tanzania.

Reports on the above activities are available in the various issues of the AMANET Newsletter available online at: www.amanet-trust.org.   

Workshop Pedagogical Methods

The workshop will apply participatory approaches including overviews, case studies, discussion groups, panellists, and participants presentations and other interactive and adult teaching/learning methods. To broaden discussions special panels for some of the topics will be convened. Lecture type presentations will be followed by question and answer sessions. Experienced facilitators have been carefully selected from within Africa.  

Workshop Participants (Selection)

Basic HRE training and participation in the AMANET online HRE Discussion Forum will be considered in the selection process. The online Discussion Forum can be accessed via the AMANET website; some of the case studies discussed online will be used during the workshop. The target candidates are health researchers, but few places may be available for applicants outside these criteria. Interested candidates who meet the selection criteria should submit their applications by the 30th of May 2008.

Workshop Objectives

This workshop aims firstly to flag topical ethical issues that are relevant to health research in developing country settings, and secondly to explore various schools of thought with the aim of coming up with well thought out positions and/or recommendations. Examples and case studies pertinent to Africa will be used. The following are the highlights of the topics to be covered:

1. Applying Ethical principles in Health Research and Ethical review process
2. Responsibilities in Health Research
3. Ethical issues in research design and recruitment of research participants.
4. Research with vulnerable persons and groups
5. Legal and social issues in Health Research Ethics
6. Ethical Issues in international collaborative health research 
7. Models and practicalities of community consultation
8. Ethical issues surrounding the 10/90 gap
9. Ethical issues in traditional medical practice and “research”
10. Professional Ethics
11. Animal Research Ethics

Workshop Outcomes

By the end of the five day workshop, it is further hoped that:

1. Participants will be brought up to date with topical ethical issues around current research   practices;
2. Participants will be able to address ethical issues at the design stage of health research and be able to enhance the protection of the welfare of research participants when implementing health research protocols.  

Language:

The workshop will be conducted in English; there will be no translations to other languages.

Workshop Reports:

Three participants will be nominated to be rapporteurs for the workshop. Proceedings will be recorded for publication in the AMANET newsletter and will be available for participants. 

AMANET Scholarship:

Selected participants will be awarded scholarships by AMANET, which will cover costs for economy class airfares (where needed), visas, tuition and accommodation and meals. Participants should meet all their home country transit costs.

Timelines:

1. This call sent out on or before 30 April 2008
2. Applications should reach AMANET secretariat no later than 30 May 2008
3. Please note that only short-listed candidates will be contacted, a list of selected candidates will be made available on the AMANET web site.
4. Selected participants will be informed by 15 June 2008

Applications (with brief CVs and one-half page justification) should be submitted by email to: 

The Managing Trustee,
African Malaria Network Trust,
Tanzania Commission for Science and Technology Building,
PO Box 33207,
Dar es Salaam, Tanzania.
E-mail: info@amanet-trust.org
Fax: +255 22 2700380
www.amanet-trust.org

Acknowledgements

The workshop is supported by a grant to AMANET from the Bill and Melinda Gates Foundation on strengthening institutional health research ethics in Africa.

Location: Abuja, Nigeria

Deadline for Applications: 12 May 2008

Background

Malaria Consortium is a leading international organisation working in Africa and Asia as well as at global level on communicable disease control. Malaria Consortium manages a large number of communicable disease projects in a number of countries. These projects range from technical support at central government level to direct implementation of projects for the control of malaria, tuberculosis, diarrhoeal diseases and neglected tropical diseases at district and community levels.

Malaria Consortium recently won a large-scale, £50 million DFID-funded five year, comprehensive malaria control programme in Nigeria. Malaria Consortium is seeking a dynamic individual with extensive experience of malaria control to be the lead technical person in this exciting, innovative and influential new public-private partnership programme in Nigeria.

Key roles and responsibilities

1. Be responsible for all technical inputs on malaria, particularly treatment, to the project
2. Work with Malaria Consortium technical team to refine project strategies, develop plans, and coordinate technical monitoring, evaluation and operational research
3. Technically support FMoH in the development of malaria policies, strategies, implementation plans and training materials, particularly on treatment
4. Ensure project, NMCP and states link malaria control activities within a health systems strengthening approach
5. Design and oversee the implementation of malaria case management training programmes for the public and private sectors, including for patent medicine vendors
6. Put in place quality assurance procedures and monitoring systems for case management strengthening
7. Provide technical inputs to the commercial sector pharmaceutical partnership on malaria treatment issues
8. Support NMCP and states implement and monitor intermittent preventive therapy for pregnant women
9. Oversee routine and campaign distributions of long-lasting insecticide treated nets
10. Represent Malaria Consortium and the project on malaria technical working groups

Line manager: Programme Director

Location: Abuja, Nigeria and frequent in-country travel and occasional international travel

Skills and experience:

1. Medical degree and postgraduate qualification in international health or related discipline
2. Minimum of ten years experience in malaria control in Africa, including some at international level
3. Proven technical skills in malaria, including malaria case management
4. Experience and understanding of working with Ministries of Health in policy and strategy formulation
5. Experience of training health workers, preferably both public and private sector (formal and informal)
6. Experience and understanding of Nigerian context (desirable)
7. Significant experience in project management
8. Excellent writing and presentation skills

A competitive package and long term contract will be provided to the successful candidate.

For more details please see www.malariaconsortium.org 

A CV with a 2 side covering letter should be submitted by email to Ian Gavin at i.gavin@malariaconsortium.org  by Monday 12th May 2008.

Samarasekera U.  Drug subsidy could help Tanzania tackle malaria.  Lancet. 2008 Apr 26;371(9622):1403-6
No Abstract...

Shetty P.  Fred Binka: fighting malaria in Africa.  Lancet. 2008 Apr 26;371(9622):1409
No Abstract...

Chambers RG, Gupta RK, Ghebreyesus TA.  Responding to the challenge to end malaria deaths in Africa.  Lancet. 2008 Apr 26;371(9622):1399-401
No Abstract...

Todryk SM, Bejon P, Mwangi T, Plebanski M, Urban B, Marsh K, Hill AV, Flanagan KL. Correlation of memory T cell responses against TRAP with protection from clinical malaria, and CD4 CD25 T cells with susceptibility in Kenyans. PLoS ONE. 2008 Apr 30;3(4):e2027
Immunity to malaria develops naturally in endemic regions, but the protective immune mechanisms are poorly understood. Many vaccination strategies aim to induce T cells against diverse pre-erythrocytic antigens, but correlates of protection in the field have been limited. The objective of this study was to investigate cell-mediated immune correlates of protection in natural malaria...

Santolamazza F, Calzetta M, Etang J, Barrese E, Dia I, Caccone A, Donnelly MJ, Petrarca V, Simard F, Pinto J, Della Torre A. Distribution of knock-down resistance mutations in Anopheles gambiae molecular forms in west and west-central Africa. Malar J. 2008 Apr 29;7(1):74 [Epub ahead of print]
Knock-down resistance (kdr) to DDT and pyrethroids in the major Afrotropical vector species, Anopheles gambiae sensu stricto, is associated with two alternative point mutations at amino acid position 1014 of the voltage-gated sodium channel gene, resulting in either a leucine-phenylalanine (L1014F), or a leucine-serine (L1014S) substitution…

Mueller DH, Wiseman V, Bakusa D, Morgah K, Dare A, Tchamdja P. Cost-effectiveness analysis of insecticide-treated net distribution as part of the Togo Integrated Child Health Campaign. Malar J. 2008 Apr 29;7(1):73 [Epub ahead of print]
...To evaluate the cost-effectiveness of the first nationwide delivery of long-lasting insecticide-treated nets (LLITNs) as part of the 2004 measles vaccination campaign in Togo to all children between nine months and five years...

Cohen ER, O’Neill JM, Joffres M, Upshur RE, Mills E. Reporting of informed consent, standard of care and post-trial obligations in global randomized intervention trials: A systematic survey of registered trials.  Dev World Bioeth. 2008 Apr 28 [Epub ahead of print]
Ethical guidelines are designed to ensure benefits, protection and respect of participants in clinical research. Clinical trials must now be registered on open-access databases and provide details on ethical considerations. This systematic survey aimed to determine the extent to which recently registered clinical trials report the use of standard of care and post-trial obligations in trial registries, and whether trial characteristics vary according to setting...

Tyagi RK, Sharma PK, Vyas SP, Mehta A. Various carrier system(s)- mediated genetic vaccination strategies against malaria. Expert Rev Vaccines. 2008 May;7(4):499-520
The introduction of vaccine technology has facilitated an unprecedented multiantigen approach to develop an effective vaccine against complex pathogens, such as Plasmodium spp., that cause severe malaria. The capacity of multisubunit DNA vaccines encoding different stage Plasmodium antigens to induce CD8(+) cytotoxic T lymphocytes and IFN-gamma responses in mice, monkeys and humans has been observed. Moreover, genetic vaccination may be multi-immune (i.e., capable of eliciting more than one type of immune response, including cell-mediated and humoral). In the case of malaria parasites, a cytotoxic T-lymphocyte response is categorically needed against the intracellular hepatocyte stage while a humoral response...

Malaria continues to haunt 40% of the world’s population. It infects more than 500 million people per year and kills more than 1 million. The burden of malaria is heaviest in sub-Saharan Africa but the disease also afflicts Asia, Latin America, the Middle East and even parts of Europe.

World Malaria Day - which was instituted by the World Health Assembly at its 60th session in May 2007 - is a day for recognizing the global effort to provide effective control of malaria. It is an opportunity:

• for countries in the affected regions to learn from each other’s experiences and support each other’s efforts;
• for new donors to join a global partnership against malaria;
• for research and academic institutions to flag their scientific advances to both experts and general public; and
• for international partners, companies and foundations to showcase their efforts and reflect on how to scale up what has worked.

On this year’s World Malaria Day, the Roll Back Malaria Partnership - which includes WHO - will focus on malaria as a global health problem. The partners will engage the international community in their fight against malaria.

Today, 25 April 2008, the first World Malaria Day is being commemorated globally under the theme: “Malaria – a disease without borders”. Concurrently, the African Region is celebrating Africa Malaria Day, under the slogan: ‘‘United to Combat Malaria” This slogan underscores the urgent need to scale up malaria control interventions.

In countries where malaria is highly endemic, priority should be given to accelerating implementation of cost-effective interventions and strengthening surveillance, monitoring and evaluation systems to enable us to measure progress. The benefits of scaling up interventions are already being reaped in countries such as Eritrea, Ethiopia, the Gambia, Sao Tome & Principe, South Africa, Swaziland, Tanzania and Togo. In Rwanda, strong commitment and investment, since 2005, has led to the distribution of 3 million Long-Lasting Insecticide-treated Nets (LLINs) and constant supply of medicines for Artemisinin-based combination therapy in health facilities. As a result, in 2007, outpatient malaria cases among all age groups fell by 36%, malaria admissions decreased by 55% while malaria deaths dropped by 35% .Cross-border initiatives such as The Lubombo Spatial Development Initiative between the governments of Mozambique, South Africa and Swaziland have helped reduce malaria transmission in target areas. These successes show that coordinated support, increased financing and intercountry initiatives are critical for making a good impact. We must systematically document and share these best practices.

We must recognize that the vision of eliminating malaria will only become reality through countrywide implementation of interventions. That will require improved governance and accountability, increased advocacy, better communication, social education and mobilization, and predictable and sustainable financing from governments and development partners In this regard, coordination of the efforts of all stakeholders in the public and private sectors and in civil society is crucial. There is need to strengthen health systems and community-based interventions Improved partnerships are needed to sustain and consolidate achievements.

Accelerating progress in the continuum from malaria control to malaria elimination will require increased resources for thorough analysis and appropriate response to implementation bottlenecks and for rigorous monitoring and evaluation of performance

That is why we must be ‘‘United to Combat Malaria”.

Let us unite our efforts to ensure:

• that all those at risk of malaria including children,