Malaria (16)

Malaria continues to be a global public health problem. Statistics from the Centre for Disease Control and Prevention (CDC) show that 3.2 billion people living in 106 countries and territories are at risk of malaria transmission. In 2015, approximately 214 million clinical episodes and 438, 000 malaria deaths were recorded according to the World Malaria Report 2015.

The World Bank has estimated that in Africa, half the population may be at risk, with 47% exposed to medium and high risk. To address the challenge, a report from the University of Pretoria says researchers at the Institute for Sustainable Malaria Control (UP ISMC) use satellite data to predict malaria outbreaks and mHealth to control and monitor the disease. The predicting techniques include Geographical Information Systems (GIS) and satellite imaging to detect environmental factors associated with emerging malaria risks. The team uses the data to improve the accuracy and reliability of predicted malaria outbreaks. The forecasts can look ahead by as much as three to six months. Predications have proven accurate, and shown to be 90% effective.

In 2015, UP ISMC in collaboration with French National Centre for Space Studies, the South African National Space Agency, South African Weather Service and other stakeholders initiated the Remote Sensing for Malaria Control in Africa Programme. It uses satellites to collect data on variables that associated with malaria, and carried out in the northern part of the Vhembe district, Limpopo province, across the border in Matabeleland South province and in Zimbabwe. It’s being extended to Maputo, Mozambique, particularly in Namaacha near the Swaziland, Mozambique and South African borders. This means that malaria outbreaks can be detected and early-warning systems triggered to aid in the fight against malaria.

An article in eHealthNews says UP ISMC uses mSpray and Malaria Buddy apps. Malaria Buddy, avails data on malaria risk, prevention and symptoms for travellers in areas where malaria’s endemic.  mSpray focuses on malaria control data management for annual indoor residual spraying programmes, a chosen method for malaria control in locations at risk. Previously, during malaria seasons, spray workers would go into homes and spray walls manually. However, there was no clear database recording on the substances used and no centralised digital database to access to establish if spraying was effective and safe. The new malaria programme hopes to address many of these shortfalls.

Malaria’s Africa’s fourth biggest killer. It takes between 25% to 40% of outpatient visits, and 20% to 50% of hospital admissions, depending on the African country. Making diagnosis easier and quicker’s a step forward in combating the disease and easing healthcare demand. A report in Disrupt Africa says Brain Giitta, a Makerere University graduate, has developed Matibabu, a non-invasive device  with a smartphones to diagnose malaria.

His company thinkIT is developing the technique where light sensors can read blood oxygen content through people’s skin. Plasmodium, the parasite, in affected people changes red blood cells’ shape and chemical properties and contain hemozoin, a crystal-like substance. Matibabu looks for these differences compared to uninfected blood. Users insert a finger into the device, plugs it into a smartphone, select “start diagnosis” on the phone, and wait for the diagnosis. About a minute later, it’s available.

The device helps malaria disease management by providing simple, cost-effective and early diagnoses. Benefits include:

  1. Reduces the number of people who suffer malaria’s severe effects
  2. Reduces medication
  3. Shorter treatment times
  4. No need for trained health workers
  5. Prevents appearance of symptoms
  6. Reduces malaria’s large socio-economic burden.

thinkIT financed Matibabu development with grants and partnerships that include the Resilient Africa Network and Merck, and prizes from competitions. It’s now seeking finance for further development to reach markets before the first quarter of 2018. Potential customers are domestic and foreign. They include individuals, hospitals, health ministries and NGOs. Uganda’s the primary market, then Sub-Saharan Africa. It can soon be part of Africa’s eHealth plans.

Genetic Modification (GM) technology’s being applied to mosquitos with malaria in laboratories, described in an eHNA post. Scientists are also moving ahead to trials for the GM Aedes aegypti mosquitos, an urban dweller, to carry a gene causing their offspring to accumulate a toxic protein and die before adulthood, reducing mosquito populations that transmit dengue, Zika, and chikungunya viruses.

An article in Science says Oxitec, a UK biotech firm that can control insects that spread disease and damage crops, wants to trial the GM project in Florida. Since 2009, it’s been releasing mosquitoes in small area field trials in the Cayman Islands, Malaysia, Brazil, and Panama. Oxitec has reported reductions in mosquito populations of over 90%. The GM gene isn’t 100% lethal. Oxitec says about 4% of offspring survive.

The US Food and Drug Administration (FDA) has approved the project in the Florida Keys Mosquito Control District, but there’s local resistance. Evidence and concerns raised by Florida residents and mosquito experts include:

  1. Could a GM mosquito bite a Floridian? It’s possible because Oxitec will release only males, which don’t bite, but up of 0.2% of released mosquitos are female
  2. Could a GM mosquito transfer genes to a human, or make them sick? It’s highly unlikely, because mosquitoes have been feeding on people and other animals for millennia without evidence of DNA transfers, and there’s a negligible risk that GM mosquitos’ saliva will have any toxic or allergenic effects on people
  3. Could genes from the Oxitec strain spread to wild mosquitoes? If the 4% of offspring that beat the GM gene live long enough and are healthy enough to mate, they’ll introduce the GM gene into the wild population
  4. Could mosquitoes become resistant to the Oxitec strategy? They could if surviving larvae carried genetic variants that protect them from Oxitec’s GM gene.

Despite legitimate concerns, GM technology seems to have an increasing role in vector-borne diseases prevalent in Africa. It’s important that eHealth for surveillance’s in place to track the changes and progress.

About 6% of all deaths in Africa are due to malaria. A report in Science How Stuff Works describes a project at the University of California, Irvine, led by Prof Anthony James to use Genetic Modification (GM) to neutralise malaria transmission. The team put 1,200 GM mosquitoes and 1,200 unmodified mosquitoes in a cage with mice infected with malaria. The 50:50 mix after nine mosquito egg cycles changed to 70% GM mosquitoes slowly replace unmodified mosquitoes. The researchers thinks that GM probably weakened the malaria-resistant mosquitoes, but that they gained a survival advantage because the parasite couldn't develop in their gut, so they lived longer and laid more eggs than their malaria-infected counterparts.

It’s not a solution yet. Several issues need resolving. Only females of specific species of mosquitoes of the Anopheles genus transmit malaria through Plasmodium, a one-celled parasite. Most females don’t pick up the parasite, so GM for mosquitoes to replace unmodified ones and reduce malaria transmission, they have to survive them when parasites aren't present.

GM worked when mosquitos collected the parasite. To succeed, they needed to be work when it’s not part of their food sources. Other issues are that so far, GM only works with parasites that infect mice. Concerns about the risks of releasing tens of thousands GM creatures into the environment need addressing too. It’s never been done before, so the long-term, actual ecological implications aren’t known

It’s estimated that it’ll take another ten years before GM mosquitos can be used. In the meantime African countries have to rely more on mHealth and related technologies to combat the dreadful disease. eHNA has a recent report on one of these initiaitives. 

Malaria is a very real life-threatening disease that kills thousands of people annually. It accounts for about 6% of all deaths in Africa. Sub-Saharan Africa carries a disproportionately high share of the global malaria burden. In 2015, WHO said the region had 88% of global malaria cases and 90% of malaria deaths.

Malaria’s preventable and curable, and increased efforts are dramatically reducing the malaria burden. Researchers at the University of Pretoria Institute for Sustainable Malaria Control (UP ISMC) has turned to satellite data to track malaria outbreaks and smartphone apps to control and monitor the disease, says an article in IT-ONLINE.

Satellites help the team to predict malaria outbreaks using Geographic Information Systems (GIS) and advanced satellite imaging to identify the environmental factors that allow mosquitos to breed, thrive and spread malaria. Outbreaks can now be predicted with increasing accuracy. “Using remote sensing as part of an early-warning system for outbreaks, we can forecast malaria occurrences from three to six months in the future,” says UP ISMC doctorate student Abiodun Morakinyo Adeola. “Our predictions using his model have been correct nine out of 10 times in all five Mpumalanga communities which formed part of the study.”

The university been helping to predict outbreaks and involved in developing an mHealth app to control the disease. mSpray focuses on malaria control data management for the annual Indoor Residual Spraying (IRS) programme. It was developed at the University of California Berkeley (UCB) with input from researchers at the UP ISMC, specifically Prof Riana Bornman.

The IRS programme is the current preferred method for malaria control in risk areas. Until recently there was no centralised digital database to ensure that spraying was effective, regular and safe. “Previously, the spray workers would go into homes, spray the walls and fill in cards,” says Prof Tiaan de Jager, director of the UP ISMC. “Come the next malaria season, they would go back and spray, but there was no clear database recording what substance was use, where was sprayed or when.”

Spray workers use mSpray to record information about pesticides sprayed, the number of structures sprayed, concentrations and application procedures on their mobile phones. The app reduces the time needed to record or access data and ensures a safer and more efficient IRS programme.

The University launched another mobile app in early 2016, Malaria Buddy, in collaboration with Travel With Flair. It is available for Android and iOS and assists travelers to malaria-endemic areas with information on risk, prevention and symptoms.  The UP ISMC team and Travel with Flair are currently designing an updated version to include GPS technology to direct users to the nearest healthcare centre if symptoms are detected.

Prof de Jager is enthusiastic about using mHealth to combat malaria. “We should continue to use cell phone technology as it is much more efficient than manual means to control malaria.”

Malaria causes about 6% of Africa’s deaths. Roughly have the HIV/AIDS death rate. The Malaria Atlas Project (MAP) says 663 million cases have been averted this century.

Since 2000, an anti-malaria campaign included an unprecedented high coverage across sub-Saharan Africa. It recognised that the effect of malaria interventions across Africa’s varied epidemiological settings is poorly understood. The main limitations are a lack of reliable surveillance data and simplistic approaches underlying current disease estimates. Addressing these, and their effects on efforts to control the disease are vital to inform control planning.

A MAP study in Nature quantified the attributable effect of controlling Africa’s malaria efforts. Between 2000 and 2015, infection prevalence and endemic from plasmodium falciparum, a protozoan parasite and a plasmodium species that causes malaria in people, halved. The incidence fell by 40%. Nets treated with insecticide were the most widespread intervention and the largest contributor to the improvements.

The parallel bad news’s that malaria cases are still below target. Averting even more cases is the current challenges. These differ between countries. MAP a cluster of data sets that show the scale of malaria across all-Africa:

  1. Plasmodium falciparum parasite rate in 2-10 year olds
  2. Plasmodium falciparum incidence rate
  3. Insecticide treated bed net coverage
  4. Indoor residual spraying coverage
  5. Artemisinin-based combination therapy coverage.

MAP also has a heat map with access to each country’s data. All these combine into essential tools for countries to compare their anti-malaria challenges, and keep developing their strategies, plans and efforts. Alongside MAP, recent initiatives using the web for malaria information, reported by eHNA, might help to nudge malaria cases down a further notch or two. 

Malaria’s death rate in Africa is about half that of HIVAIDS, but at 6% of all deaths, it’s still high. Better diagnosis can help. A study by a team from Manchester in the UK, reported in the Journal of Medical Internet Research (JMIR), says an eHealth solution using a virtual microscope on the web’s on its way.

It aims to comply with the reference standard for analysing the form and structure of samples, their morphology, to analyse blood films for malaria diagnosis. A big challenge of existing arrangements is supporting the skills needed for accurate morphological diagnosis.

This study tested digital slides of blood infected with malaria using a virtual microscope on website and users with different access to training and computing facilities. The feasibility was established by users comparing their testing and recording performances with other users.

High quality images and digital slides were prepared for 56 stained thick and thin blood films. They were combined using Adobe Photoshop’s photomerge function, then adjusting them to ensure the resolution and reproduction of essential diagnostic features. Digital Slidebox was used for digital microscope viewing and image annotation, with data gathered from participants.

The results were:

  1. High engagement, with images viewed by 38 participants in five countries in a range of environments and a 75% mean completion
  2. Parasite detection was 78%
  3. Species identification accuracy was53%, comparable with results of equivalent studies using glass slides
  4. The systems complies with the morphological features needed to diagnose malaria and recognise species
  5. Data collection enabled users to compare performance with other users over time and for each individual case
  6. Participants were positive about the virtual microscope system, finding it easy to use and access
  7. Increased communication correlated with increased participation.

Showing that high-quality digital images are effective offers new opportunities for Africa’s health systems. Their eHealth strategies can be updated to include this approach.


The African Innovation Foundation (AIF) has announced the top ten nominees for its landmark programme, the Innovation Prize for Africa (IPA). Now celebrating its fifth year under the theme Made in Africa, IPA offers a grand share prize of $150 000 to spur growth and prosperity in Africa through home-grown solutions, an article in IT-Online says.

The IPA has seen considerable growth in applications and increasing interest from both innovators and innovation enablers over the years. IPA 2016 attracted a record of over 3,600 innovators and received 985 successful submissions from 46 African countries. African ingenuity this year showcases new breakthroughs in public health, including malaria, HIV/AIDS and cancer, smart solutions for farmers and dynamic energy initiatives. 

AIF will host the IPA 2016: Made in Africa awards ceremony on 22 and 23 June 2016 in Gaborone, Botswana. Collaborating partners include the Ministry of Infrastructure, Science and Technology (MIST), and the Botswana Innovation Hub (BIH). 

The healthcare solutions in the top 10 IPA 2016 nominees include:

Urine Test for Malaria (UMT)

Dr Eddy Agbo from Nigeria developed the UMT, a rapid non-blood diagnostic medical device that can diagnose malaria in less than 25 minutes. Africa has the highest number of malaria cases worldwide. The inability to quickly diagnose and commence malaria treatment can lead to various complications including kidney failure, build-up of lung fluid, aplastic anaemia and even death. UMT uses a dip-stick to get accurate results within half an hour. The technology detects malaria parasite proteins in urine of patients with fever due to malaria. UMT’is simple and affordable, and a potential game changer in managing malaria across Africa. 

Api-Palu

Valentin Agon from Benin also developed a solution to curb the spread of malaria. Api-Palu is an anti-malaria drug treatment developed out of natural plant extract. It is significantly cheaper than available anti-malarial drugs, and has great inhibitory effects on 3D7 strains of plasmodium falciparum the causative agent of malaria. According to the WHO, Sub-Saharan Africa is home to 88% of malaria cases and 90% of malaria deaths reported globally with some African governments spending up to 40% of their public health budgets on malaria treatment. Api-Palu manifests as a fast rate of malaria parasite clearance from the blood following short term treatment, with relatively lower doses. It is available in tablets, capsules or syrup. The drug has been approved in Benin, Burkina Faso, Tchad, and Central Africa Republic because of its therapeutic and non-toxic effects.

Exatype

Dr Imogen Wright, South Africa, solution addresses a different healthcare issue facing many African countries, HIV/AIDS. Exatype’s a software solution that enables healthcare workers to determine HIV positive patients’ responsiveness to Antiretroviral Drugs (ARV) drug treatment. According to WHO, 71% of people living with HIV/AIDS reside in Africa. 

A growing number of people on ARVs are resistant to drug regimens, leading to treatment failure, further exacerbating the continent’s HIV/AIDS burden. Exatype processes the highly complex data produced by the advanced next generation of DNA sequencing of HIV DNA in patients’ blood. A simple report detects drugs resistant to patients, then highlights the need to avoid these to ensure successful treatment. Exatype has the potential to contribute towards effectively managing HIV/AIDS in Africa, and also holds promise in helping detect drug resistance for other disease burdens such as Tuberculosis (TB) and malaria.

Aceso

Dr Kit Vaughan, also from South Africa, created an imaging technology, capable of performing full-field digital mammography and automated breast ultrasound at the same time, dramatically improving breast cancer detection. Annually, there are more than half a million cancer deaths in Africa and these numbers are expected to double in the next three decades. If diagnosed early enough, the chances of treating the cancer successfully increases dramatically. However, because 40% of women have dense tissue, their cancers cannot be seen on X-ray. Furthermore, a false negative finding can have devastating consequences. Aceso is a single device that can acquire dual-modality images, full-field digital mammography and automated breast ultrasound at the same time. This world first system’s protected by international patents and has been successfully tested in two separate clinical trials with 120 women.

Having four healthcare solutions emerging from the top ten Innovative solutions across the different sectors is very encouraging. All four address critical healthcare issues facing African health systems and have the potential to have a real impact and save lives across the continent.

The WHO African Region continues to bear the brunt of the global burden of malaria. In 2015, 88% of global cases and 90% of global deaths occurred in African. A child dies every minute from malaria in Africa where it is estimated that 9 out of 10 malaria deaths occur. In 2013, there were 528 000 deaths from malaria and about 78% of these were in children under 5 years of age.

The search for more effective diagnosis and treatment of the disease has led to the invention of a new device called Deki™ Reader. The new device for malaria analysis, brought in by Africare in collaboration with a Canadian technology company, Fio Corporation will be put to use in Akwa Ibom and Rivers communities in Nigeria says an article in allAfrica.

Launched on World Malaria Day, this collaboration introduces Fio’s integrated diagnostic and data technology into frontline malaria services provided through an existing Africare programme supported by ExxonMobil: Malaria Prevention in ExxonMobil Supplier Communities (MAPS-C).

Thirty health facilities currently offer on-the-spot malaria testing and treatment services to rural communities in Akwa Ibom and Rivers states through the MAPS-C program. Health workers at these facilities will receive the Deki™ Reader, to help them more accurately diagnose malaria and record results. Programme managers will be able to log on to the Fionet™ web portal to review real-time reports automatically generated from diagnostic data and other valuable information that health workers capture while carrying out their routine activities.

Services provided by the web portal and mobile tool include: 

Web-based tools:

  • Timely, accurate and complete records from individual patient visits
  • Reports generated from aggregated, primary data
  • Two-way messaging with companion devices
  • Data transfer and IT integration

Mobile companion devices:

  • In-process quality control checks
  • Configurable workflows for standardizing care delivery and data capture

All data that health workers capture with Deki Readers at MAPS-C facilities will be available through the Fionet web portal to authorized personnel at the Ministry of Health and other stakeholders involved in eliminating malaria in Nigeria. 

Africare, commenced training personnel from 30 health facilities on the use of Deki Reader in ExxonMobil host communities of Eket and Ibeno on May 3. The training exercise will involve the training of master trainers and another 62 end users selected from the two local government areas of Eket and Ibeno.

A mobile dialysis device can extract blood cells infected with malaria by using a magnet. A study in 2009 reported in Science Direct measured the magnetism. While Malaria deaths are falling, it’s still a high priority for more progress. WHO Afro has a list of ten facts on malaria. Most malaria cases globally, 88%, and deaths, 90%, in 2015 occurred in Africa. Children are extremely vulnerable. In 2015, 438,000 children died from malaria globally. About 306,000, about 70%, were under five. In sub-Saharan Africa, malaria takes a child’s life every 2 minutes.

 

Alongside these tragedies, malaria often causes catastrophic spending for households. When this’s scaled up to communities, it’s an obstacle to their social and economic development.

George Frodsham’s a biochemical engineer, created MediSieve in 2015. It uses a magnetic sieve as part of dialysis to remove infected blood cells directly from patients’ bloodstreams, a technique of Magnetic Blood Filtration (MBF). He presented his achievement at the Royal Society of Medicine’s 12th Innovation Summit in April. His ambition’s for MediSieve’s treatment to be an essential component for severe and drug-resistant patients, especially children and pregnant women. It’ll overcome the critical challenge of these patients that they only receive anti-malarial drugs once their infection burden is too high to be effective.

MediSieve’s a life-saving intervention for these patients. Capturing the magnetised, infected blood cells, it can reduces the infection rate by 90%. It then enables drugs to be more effective. The results are promising and coupld help reducte the number of malaria deaths, fewer side-effects from toxins, shorter recovery times and shorter hospital episodes. Removing the infected cells doesn’t worsen patients’ anaemia because the cells aren’t working properly. 

The next step’s to move on to clinical trials later in 2016. These could be in DRC, Ghana, Nigeria and Tanzania. There’s also scope to review the potential of the MBF for sepsis and leukaemia/

Finance for the project’s from numerous sources, including the Wellcome Trust and Innovate UK. A challenge is to set MediSieve into Africa’s health systems resources. A sustained training programme will ensure the high-value benefits are realised.