The relatively unknown mosquito-borne illness, Zika, is causing controversy around the globe, but another devastating disease — carried by the same kind of insect — is starting to loosen its hold on Africa.
Although scientists have known about the Zika virus for decades, malaria is an ancient disease: according to the World Health Organisation, it was first documented roughly 4 000 years ago. But in a fraction of that time, 15 years, public health interventions have drastically decreased the illness in Africa — since 2000 total malaria deaths have halved and declined by over 70% in young children.
In the next 15 years, global health organisations are aiming to eliminate it – with the help of new technologies. Here are four of them:
Mobile technology promises smart solutionsAbout 93% of people in Africa have access to a cellphone service but less than half have proper roads and just over half have piped water, according to a 2015 study conducted by Afrobarometer, a continental research network.
Melanie Renshaw, chief technical adviser for the African Leaders Malaria Alliance — a United Nations-backed pan-African organisation devoted to ending malaria on the continent by 2030 — says the potential for harnessing mobile technology for public health is greater in Africa than anywhere else.
“Through SMS technology malaria drug stockouts and sudden outbreaks can be identified and addressed faster than ever — especially in the context of weak health systems in many countries, which often fail to pick on problems at early stages,” she says. As smartphone technology increases on the continent, “a whole host of opportunities to tackle malaria become available”, according to Renshaw.
For example, a group of students at Makerere University in Uganda have developed a smartphone application called Matibabu, which uses a light sensor connected to a tablet to diagnose malaria — no needles or blood specimens are required.
“A noninvasive diagnostic would be amazing, especially in Africa,” says Renshaw. “There are many people who avoid health centres because they fear lancets and we’ve found that some communities, especially in rural areas, are suspicious about their blood being taken, because they fear it might be used for purposes other than simply testing.”
She says this technology would also help with logistical and safety issues related to the adequate disposal of needles and blood smears.
“Ebola is a perfect example. We had to suspend malaria testing in the beginning of the Ebola epidemic because there was cross-contamination with some of our testers falling ill. I think that, to a large extent, an application like this would mitigate those kinds of worries.”
Last year, the Matibabu team was given $55 000 by the Ugandan government to complete the development of the application.
Boosted bed-nets for night-time protectionCurrently insecticide-treated nets, which form a major part Africa’s malaria programme, last between two to four years before the insecticide loses its efficacy, according to Botswana’s former health minister, Joy Phumaphi.
“This means, ideally, every two to three years countries should provide new nets to their population, which is expensive and also a major logistical challenge,” she says.
But a new net, which uses more than one insecticide and lasts for more than seven years, could be on the market by 2020.
“This would be a great advantage not only because it will last longer and save money but the insecticides that are being used are also new. Mosquitoes would therefore not be resistant to them, which is a problem we are currently facing in some areas.”
Stamping mosquitoes out at the sourcePhumaphi says another strategy new to Africa is the process of “larviciding”, where big breeding sites for mosquitoes are identified and killed with large volumes of insecticides. This has worked in South America, where their mosquitos breed in large pools of stagnant water. “But in Africa, the mosquitos breed everywhere, from fallen leaves to hoofprints in the ground filled with a small amount of water.”
She says targeted larviciding can work in African countries where bigger stagnant pools of water can be identified.
Vaccines: the big hope Although malaria has existed for thousands of years, according to the World Health Organisation, there is no widely effective vaccine available to prevent the illness because of the complexity of the parasite.
In 2015 the European Medicines Agency approved the first malaria vaccine in history, RTSS, but it is only partially effective and is designed for children younger than five years of age.
The final clinical trial results for this vaccine were published in the medical journal Lancet in 2015 and showed that a three-dose regimen reduced malaria cases by 28% in young children and by 18% in infants. The study noted that participants also had access to insecticide-treated nets in their homes, which added to the reductions seen in clinical trials.
According to Phumaphi, more than 20 other candidate vaccines are being researched. She says the most successful of these can “optimistically” be expected to be on the market by 2025, but that it is more likely that one will be available by 2030.
“This is what everyone is hoping for — it will save countless lives.”
It would also save countries money and allow other essential health programmes to develop because existing malaria control efforts could be scaled down, says Phumaphi. “One day we may no longer need nets or insecticides and, logistically, that is a godsend.”
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