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Published online 27 February 2008 | Nature | doi:10.1038/news.2008.622
News: Briefing
Malaria fact file
Malaria continues to be a global problem, but is the end in sight?
How many people contract malaria?
Every year roughly 500 million people are diagnosed with malaria worldwide, and more than 1 million die.
Which places are hardest hit?
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Lack of efficient malaria surveillance in Sub-Saharan countries is certainly a problem. Another one is severe deficiencies in diagnosis and lack of training of doctors, especially in countries that suffered from civil wars for decades, such as Mocambique. With a population of 18 million and a North-South extension of 2000 kilometers or more, this African country has less than 800 trained doctors (most of whom cluster in or near the capital Maputo). The majority of "doctors" have no modern training and it is common among them to diagnose most illnesses as "malaria" that are connected with fever, severe headache, or gastrointestinal problems. I have seen several non-malaria cases where Artemisinin (which is available in Mocambique) was prescribed by such doctors. It can be easily imagined that this practice will promote future development of resistance against Artemisinin, but also that the current estimate of the number of malaria cases may perhaps not be correct.
This has been a good report on malaria in the sahara& sub-sahara regions. lack of proper treatment & education about the disease lead to the epidemics in these regions.Modern & scientific trainings must be given to the Doctors& Pharmacists so that control of the disease can be made to some extent.
Amodiaquine is widely used in Africa as an antimalarial agent. Unfortunately this potent drug has a rather narrow therapeutic index. It is metabolized primarily by CYP2C8 and nearly 4% of the Zanzibar population were reported to be slow CYP2C8 metabolizers and consequently at much higher risk of suffering adverse reactions from Amodiaquine. Very likely, the frequency of CYP2C8 inactive alleles is similar in other sub-Saharan populations. Efforts for improving malaria treatment must include incentives for diagnostics makers to develop a simple pharmacogenetics diagnostic test, preferably based on the dipstick method and not requiring expensive tools, for rapidly identifying those slow CYP2C8 metabolizers so that they are prescribed with much lower Amodiaquine dosage and protected form its adverse reactions.
I do not decry any of the advances we are making, but have doubts in their sustainability unless more effort is made to provide career opportunities for local scientific staff (epidemiologists, social scientists, entomologists etc)who must form the backbone of any long termed interventions. To be sustainable, control operations must be base on coordinated strategies with local planning, mapping and expertise. Many of the failures of the WHO eradication programmes resulted from a dearth of local cimmitted expertise, while in the countries where there was local scientific infrastructure authorities were able to maintain a high level of control. I cite my own country Zimbabwe, which had a successful programme from 1947 until recently. It is essential that global authorites and donors pay attention to this need, ensure that in the endemic countries career opportunities for trained personnel are created, and that they assume the main responsibility to set the strategies and monitor and control the interventions.