Confronting malaria from all sides

PATH-pioneered approaches to malaria control and elimination have helped save 6.2 million lives over 15 years. Photo: PATH/Gabe Bienczycki.

At PATH, we know that there is no single solution to combating a complex infectious disease like malaria. The first step of our multipronged approach includes supporting country partners in their efforts to strengthen prevention, diagnosis, and treatment. We're working with country partners to scale up interventions and to develop new prevention, diagnostic, and treatment methods to accelerate progress toward elimination.

The world has made dramatic progress in controlling malaria thanks in part to a malaria control model led by African countries with support from PATH. Since 2000, the number of new malaria cases has declined by 37 percent globally, and deaths from malaria have fallen by 58 percent, saving an estimated 6.2 million lives over the course of 15 years.

PATH is working with country partners to expand the reach of proven malaria control tools, such as bednets and household spraying. In order to track progress and make data more accessible to local decision-makers, we're working with countries to enhance malaria surveillance. In Zambia, tactics employed by PATH and our partners helped cut the rate of malaria in half in two years among children under age five.

To improve care for people infected with malaria, we work with partner countries to achieve high nationwide coverage of accurate diagnosis and appropriate treatment. As the leader of the MalariaCare partnership, we focus these efforts across 15 countries in Africa and Southeast Asia. Our approach includes:

• Expanding the use of high-quality diagnostics, including rapid diagnostic tests and laboratory-based microscopy.
• Providing training and mentorship of laboratory, clinic, and community-based health workers, so that they can more effectively manage malaria cases and other types of fever-causing illness.
• Helping countries transition to electronic information systems to make data more accessible for decision-making.
• Facilitating partnerships with the private sector to increase access to high-quality malaria care.

For example, training, supervision, and mentorship have helped health providers in the Democratic Republic of the Congo and Tanzania provide high-quality malaria case management services. In Ghana, a training and mentorship program is teaching community health workers how to treat not only malaria, but other illnesses that involve fever. In addition to ensuring that people are treated appropriately, the effort will reduce overuse of—and resistance to—malaria drugs.

Other PATH efforts to improve delivery of care include work to prevent malaria in pregnancy, which can cause miscarriage, and to optimize supply chains and health systems.

PATH is working to speed up access to effective, affordable, and highly sensitive diagnostic tools that detect malaria among people who show few or no symptoms of infection, especially in areas that are very close to malaria elimination.

We're also developing new diagnostic tests that will guide proper treatment. In our quest to rid the world of malaria, we're focusing not only on diagnosis of the deadliest strain of the disease—Plasmodium falciparum—but also on the more widespread strain Plasmodium vivax. Common in Asia, Latin America, and East Africa, P. vivax is the most difficult form of malaria to eliminate because it causes recurring illness, which perpetuates the cycle of infection. All malaria parasites in the body must be killed to stop this cycle.

To complicate matters, treatment with certain drugs commonly used to treat P. vivax is often harmful to people with a common, hereditary enzyme deficiency. To improve safe and effective treatment, we're developing point-of-care diagnostic tests to identify this genetic trait, called glucose-6-phosphate dehydrogenase (G6PD) deficiency.

Finally, millions more people are now benefiting from the gold-standard malaria treatment, thanks to a global partnership convened by PATH to create a stable, high-quality source of the key ingredient in artemisinin-based combination therapies. Artemisinin is derived from the sweet wormwood plant, which is mainly cultivated in Asia. Historically, supply of plant-derived artemisinin has not always kept pace with demand.

Semisynthetic artemisinin complements the botanical supply, helping to strengthen the supply chain, stabilize pricing, and ensure access to treatment. Enough semisynthetic artemisinin can be produced each year to meet one-third of the total global need. In the first year after its introduction, 39 million malaria treatments with semisynthetic artemisinin were shipped to 23 countries.