topnaman | Malaria blog

(image credit: gandhiserve.org)

What a stirring image! It’s one of my favorite photographs and depicts the potential of science to serve. The Mahatma Gandhi Institute of Medical Sciences a medical university in Maharashtra, India devoted to rural health aptly adopted the image in its logo. The image was taken in 1940 in front of the Sevagram ashram’s guest house, which Bapu later coverted into a 15 bed hospital, and is now part of the institute.

While many captions indicate Gandhiji was observing Mycobacterium leprae, the university suggests the slide contained Plasmodia:

There have been many conjectures about what Gandhiji was looking at in the microscope. Since his intrest in leprosy was well known, it was assumed that he was looking at Mycobacterium leprae. However, Dr KV Desikan, a leprologist of international standing, differs. He says that Shri Prabhakarji, a close associate of Mahatma Gandhi and Dr Sushila Nayar, had told him that Gandhiji was looking at malarial parasites. Prabhakarji has also told him that Gandhiji himself had malaria and had been treated by Dr BC Roy. What he did not know, however, was whether, in the picture, Gandhiji was examining a smear of his own blood. Dr Desikan feels that since Prabhakarji had lived and worked with the doctors during the very inception of the institute, his words would be authentic.

Check out the malaria lyrics in this smooth beat from The Himalayan Project. MCs Chee Malabar and Rainman paint scenes from rural India in a critique of romanticizing identity.

No.

According to a recent report by the Evidence to Policy Initiative (funded by the Gates Foundation which in turn also supported the ACT subsidy idea) . The conclusions are no surprise (see here and here for previous discussions on the idea of selling subsidized artemisinin combination therapy in pharmacies). The summary points were:

• Pilots found a rapid rise in ACT availability in private outlets (pharmacies, drug stores, and other retail outlets), as did one national program. Subsidies were associated with reduced consumer prices (i.e., these subsidies were largely passed along the supply chain to the consumer)
• ACT market share increased rapidly in pilots, crowding out other anti-malarials (e.g., CQ, SP, artemisinin monotherapy), but market share did not increase rapidly in national programs
• Pilots found conflicting evidence on ACT use (one trial was positive, one was negative) and national programs found very little change in use
• The available evidence suggests that ACT price subsidies have less impact among poor, remote communities than among wealthier, urban communities

Notice the first two points arose from small pilots, while the latter deal with scaled programs and are more important to note. None of the evaluations addressed patient-facing outcomes, as a good friend would quickly point out, which are likely to be even worse. Thanks to Devi for the link.

The tragic Pakistan floods have apparently led to a phenomenon best understood as spider-trees. Words will not suffice; look at this picture:

To avoid the water the spider, en mass, took refuge in nearby trees. The web encased trees snare most of the local mosquitoes reportedly leading to reduced malaria in the area (thanks Saket).

Malaria mortality in India caused much controversy last fall. The study estimated almost 10 times the number malaria deaths in India during 2001-2003 compared to the estimates of the Government of India and WHO. The key strength of the work by Dhingra et al. was the use of a nationally representative sample of deaths during that period. However, the method for assigning the cause of death, verbal autopsy, is known to be problematic particularly for non-specific illness such as malaria and has come under much criticism. Some good early critiques appeared in Nature and Tropika and now The Lancet has published our reply as well as four others. The authors have also responded and the Government of India is setting up a panel to examine the findings and reconcile the available data.

To enable a proper assessment of research involving burden estimates, The Lancet and other journals should require authors to: 1) perform a validation exercise of the study instrument 2) conduct sensitivity analysis using validation results and other parameters of uncertainty and 3) make the underlying sample, or at least fully disaggregated tables, available for external verification. Otherwise we risk appearing to promote sensationalism over science. It is surprising such standards are not already in place.

Truth, with a little humor from one of my favorite comics XKCD:

The goal of this event is to honor the life of Sujal Parikh and to carry on his vision by bringing together a community to advance health and social justice. Themes for the symposium include curricula as an agent for social change, defining health equity, and innovations in global engagement.

Date: March 26th, 2011

Location: University of Michigan, Ann Arbor, MI

More information and get involved at: http://sujalsymposium.org/get-involved/

The deadline for free registration is March 12, 2009 – see you there.

6,000 Aedes mosquitoes (the species that transmits dengue) were released in an uninhabited site in the center of the country. The purpose of the field trial is to study the dispersal and life span of these modified mosquitoes under natural conditions. The idea is simple:  replace natural mosquitoes with insects engineered to be either resistant to a microbe or ones with defective offspring in later generations as in this case. Still, in order to replace existing populations, new mosquitoes must out-compete their natural relatives. Not surprisingly, many civil society groups are concerned about potential harms if a new super mosquito that is able to transmit diseases emerges. I’m just skeptical that a single new variant could dominate products of long-term evolution especially across multiple ecological niches. Similar research is underway with malaria transmitting Anopheles mosquitoes – is it as far along?

A host of information to keep you busy:

• Looks like RDTs through drug shops won’t work. The same story with subsidized drugs?
• Mass drug administration with ivermectin to reduce mosquito survival (very novel research with a drug better known for river blindness control)
• World Malaria Report 2010 – at a glance looks great but do we need a new report annually? I know it’s a lot of work for the WHO staff…
• The malaria eradication research agenda in PloS from the malERA group – better than the Lancet series but many read like meeting reports

via Gizmodo, the ‘brutal’ invasion of a red blood cell by a malaria parasite (thanks to Saket)!