We have seen A DROP in the number of cases of cerebral malaria over the last 6-7 years.
At first, we attributed this drop to the weather (too cold, too wet, too dry, too hot ...) but last year, the weather was perfect, and the low numbers still held. It's a real phenomenon, and is likely due to a combination of interventions — but, for severe disease in children, a lot of credit has to be given to the widespread use of malaria rapid diagnostic tests (which require no equipment and no electricity) and the availability, at no cost here in Malawi, of rapidly effective treatment (artemisinin combination therapies. or ACTs) to anyone who tests positive for malaria.
IT IS WORKING!
We predicted this could happen back in 2006, in the context of a Gates Foundation-sponsored review of malaria diagnostic tests.
We gave voice to this again during the Charles F. Craig Memorial Lecture at the American Society of Tropical Medicine and Hygiene meeting in 2014.
Bob Snow's data, which charts prevalence of infection (rather than disease) corroborates the impmortance of the contribution of pairing rapid diagnostic tests with ACTs, though with the demographer's characteristic caution, he warns against attributing the observed trends to "human intervention alone."
Nevertheless, the diminution in the burden of malaria disease is palpable here in Malawi and highlights the importance of
- A robust public health system (to deploy the rapid diagnostic tests)
- A pipeline of effectiive therapies. Drug resistance will happen, and we need to be ready.
Onward and upward. While continuing to work toward malaria elimination, we may be able to negotiate a cease-fire (detente?) in the battle with the malaria parasite.
