Articles

Focus on VSO Malawi: their humanitarian projects

Our partnership with VSO Malawi (Voluntary Service Overseas) is becoming more concrete as they are carrying on a comparative study using the xRapid-Malaria app. The purpose of this study is to assess the accuracy of the xRapid-Malaria diagnostic test in comparison to the traditional microscopy diagnostic. Three main parties are working alongside on this project: VSO Malawi, xRapid and medical institutions such as CHAM (Christian Health Association of Malawi) and the College of Medicine. By now, 23 lab technicians have been recruited by VSO Malawi to enable the accomplishment of the study and ultimately to fight malaria. We will communicate on the results by the end of April.

As a major charity, VSO Malawi is currently leading other projects in three main fields: Education, Health and Secure Livelihoods. For each field, the NGO is investing a lot of efforts to make Malawi a better place to live in.

VSO’s Education program is made of many projects but one main goal remains: making sure children can read and enumerate. 68 teachers have been taught how to use digital education technology (using iPads app). It resulted in improving learners’ global skills, increasing enrollment, assessing them in a better way and enhancing individual help. They also trained key players at the district level on budget management to help them register a visible impact on the education they provide.

VSO’s Health program comprises different projects which all aim to improve Malawians’ health practices, especially women’s and prisoners’. Aside from the comparative study with xRapid-Malaria, VSO Malawi has a major role in local prisons. The NGO is mainly active in four prisons in the country (prisons for women, youth and mixed ones). They are working to improve the prisoners’ nutrition and provide them with HIV tests and treatments. Furthermore, they chose to anticipate the prisoners’ release by training warders to conduct psychological sessions.

VSO’s Secure Livelihoods program directed most of its effort towards making communities resilient to climate change and improving communities’ economic status. They organised focus group discussions that involved several stakeholders in the organic coffee value chain (including the Government of Malawi as well as 98 farmers and other main stakeholders). Their goal is to improve market access for the poorest.

« As Malawians cut many trees for charcoal production purposes, we are trying to improve environmental awareness in local communities »

VSO seeks to have a strong impact on environment in Malawi. « As Malawians cut many trees for charcoal production purposes, we are trying to improve environmental awareness in local communities » said Anock Kapira, Head of Program at VSO Malawi. Simultaneously, they started a tree plantation program to replace trees that had been cut down.

Even if the country is politically and socially stable, VSO Malawi is redoubling its efforts to improve significantly the standards of living for local communities in the south-east African country. At xRapid, we are very proud to contribute to their Health Program by providing them with a way to prevent and eradicate malaria, and thus, save lives. We would like to thank Anock Kapira, from VSO Malawi, for his contribution to this article.

Superbug: an emerging and quickly spreading threat to the race against malaria

While the malaria death count in Cambodia dropped to just one case in 2016, a new threat to the race against the disease arises in south-eastern Asia: superbugs. A superbug is a drug-resistant, human-killing parasite that modern medicine struggles to combat.

In the case of malaria, the superbug that is currently spreading in south-eastern Asia is multi-drug resistant. This means that the DHA-piperaquine therapy (that combines both artemisinin and piperaquine drugs) used nowadays to treat falciparum malaria, is becoming useless. This superbug is spreading rapidly in western Cambodia, north-eastern Thailand and southern Laos and only concerns the deadliest form of malaria: Plasmodium falciparum.

How did this superbug appear? Humans have unintentionally helped the parasite to develop itself. The DHA-piperaquine therapy, when taken correctly, is very efficient against malaria. But in many cases, people only take artemisinin on its own, take incomplete courses or take substandard-quality drugs. In other cases, they don’t even make it to clinics for diagnosis and treatment. All these cases, which are very common in the world’s poorest areas, drive drug resistance. That is what happened recently in south-eastern Asia.

Scientifically speaking, the emergence of the superbug is due to a single mutant parasite lineage, that replaces parasites containing less artemisinin-resistant mutations. This lineage appears to be fitter, more transmissible and able to spread more widely.

The phenomenon had already been observed twice in history. The first time (from the late 1950s to the 1970s) chloroquine-resistant malaria parasites appeared in Asia and then spread into Africa leading to a resurgence of malaria and causing millions of deaths. Chloroquine had then been replaced by sulfadoxine-pyrimethamine treatment and the exact same sequence of events happened.

If this scenario repeats itself, it could lead to a global public health disaster. Specialists say superbugs are the most dangerous threat to the progress achieved so far. Efforts to control malaria in Asia must be stepped up urgently before it spreads into Africa and becomes close to untreatable.

What are the solutions to overcome the threat? The Global Fund has created the Regional Artemisinin-Resistance Initiative (RAI) to fight this superbug. “We are currently working to close gaps in supply chains, so the right drugs are in the right places at the right time” reported the RAI Head of Program. Another solution lies in the efficient gathering of surveillance data (via efficient diagnosis reporting) so that when an outbreak flairs up, an appropriate response can be deployed immediately.

 

Malaria & Poverty : a vicious cycle

Malaria is one of the most important challenges to global public health and is often referred as the epidemic of the poor. Whilst the disease is in large part determined by climate and ecology, and not to poverty per se, the impact of malaria takes its toll on the poorest. Recent studies estimate that the disease costs Africa $US 12 billion in lost Gross Domestic Product. Countries with high malaria transmission have historically had lower economic growth than in countries without malaria.  Their economy growth slows by 1.3% per year as a result of lost life and low productivity.

The direct cost includes high public expenditure to attempt to maintain health facilities and infrastructures, manage effective malaria control campaigns and provide public education. Malaria costs are also widely felt as workers productivity lowers with increased sick leave, absenteeism and premature mortality of the workforce. The disease is as much burdensome for families and households. According to the European Alliance Against Malaria “The permanent neurological and physical damages caused by severe episodes of the disease hamper children’s schooling and their general well-being. They can directly affect their education and ability to learn in later life.”

Malaria and poverty constitute a vicious cycle. These two plagues need to be tackled together. Social and economic conditions need to be addressed while malaria control should be seen as a poverty reduction strategy.

A look back at 9 months of xRapid in Papua Indonesia

For the past nine months, xRapid has been assisting two health workers in their daily work life in Papua, the easternmost province of Indonesia. Due to the hot humid climate, the island is endemic to malaria. The whole population has been affected by the Plasmodiumparasite, mainly vivax and few falciparum.

In order to fight this deadly disease, these health workers have reached us through our Indiegogo campaign “End Malaria on Bangka Island, Indonesia” back in 2015. Shortly after, in November, they received a protocol training in Jakarta with xRapid’s CTO Professor David Mendels and started diagnosing patients two months later.

Early diagnosis is the gateway for effective malaria treatment, and thanks to xRapid the nurse was able to save a three days old baby. The newborn wasn’t feeling well, could not eat and had a fever. Even though it is unlikely that babies are born with malaria, the nurse still decided to test her with the automated diagnostic app and the result was positive. Without xRapid, the little girl wouldn’t be alive today.

Being able to use xRapid to know if malaria is involved helps relieve some of my stress when trying to treat patients with limited diagnostic resources, plus appropriate treatment can be given.” – Nurse

As early adopters these health workers helped us adapt our protocol to harsh conditions. “The nurse doesn’t have access to many medical consumables, thanks to her we discovered that we can make the hemolysis with just water instead of the Saponin solution. The slides are less clear of course, but the app can still run and identify the parasites.” – Pr David Mendels, xRapid’s CTO.

We hope that these health workers keep saving many other lives.

Malaria – An Ongoing Cycle

How malaria traps the most vulnerable people in the world.

« Of those who die from avoidable, poverty-related causes, nearly 10 million, according to UNICEF, are children under five. They die from diseases such as measles, diarrhea, and malaria that are easy and inexpensive to treat or prevent. » – Peter Singer

We are told in the media and elsewhere that malaria is a disease caused by poverty, and that it only serves to make the situation of those without the economic means to combat it worse. This is simply a statement of fact; malaria thrives where communities do not have access to the financial, social and educational capital to understand, prevent and control the disease. However, one of the sad facts of the status quo is that the most vulnerable people in these communities are the worst effected. These people already make up the burden of care for society; children, the sick, pregnant women and the elderly. Whilst almost all disease does most of its damage to these sorts of people, malaria causes a cycle that is very difficult to break. It prevents children from attending school and learning about the dangers of the disease, it tears security away from childbearing mothers and saps the finances of those trying to provide a better life for their families. Malaria traps people, and it’s grip is firmest on those that cannot fight on their own.

 

Every minute that passes a child dies of malaria in Africa.

Child mortality accounts for 78% of all malaria deaths worldwide and the majority of the children who die from the disease are under five years old. Protecting these children is a top priority for some of the largest charities around the world with the Global Fund to Fight HIV, Tuberculosis and Malaria alone providing over $10bn across 131 separate grants. Despite these heroic efforts, malaria is still a major global public health concern, and the communities and people who need help the most are still not being reached.

Because malaria is so dangerous for children it is often critical that care begins as soon as possible. This is exemplified by a story I encountered on World Malaria Day. The story is told from the perspective of a Kenyan father, who details the difficulties his family encountered after his daughter fell ill with malaria. Initially diagnosed due to her symptoms, the girl was treated for malaria and for a time the symptoms subsided. However, the malaria returned in the following few days so her parents took her to hospital where she was diagnosed with typhoid. Because malaria shares common symptoms with several other diseases this is an easy mistake to make based on a symptomatic diagnosis. Nevertheless, her condition continued to decline dangerously. It was only after she was clinically diagnosed and treated with the correct artemisinin combination therapy that started making a good recovery, but the severity of her condition up to the point of proper diagnosis and treatment was critical. Thankfully she did make a full recovery, but others are not so lucky.

Plan USA ran a series of stories from children in Togo about their experiences with malaria. One story speaks about the importance of education around the disease in poor communities in the country. 16 year old Iréne tells of a very poor family who received an insecticide treated bed net from a local NGO. The father kept the net provided for himself, claiming that he needed to be strong to work and provide for the family. Two weeks later his children fell ill, and despite spending a large amount of the money he had earned on treatment, his youngest sadly died soon afterwards. This story shows that the weakest are a priority when it comes to malaria prevention but he saddest fact about this particular story is the ongoing cycle of malaria and its symbiotic relationship with poverty. If the father had given the net to his children and contracted malaria himself, he would have been sporadically unable to work and provide for his family. This is just one way in which malaria traps people that are already in a difficult situation.

Children are often put in danger from malaria before they are even born, and the mothers that carry them are equally at risk. Pregnant women are three times more likely to develop serious disease from a malaria infection than non-pregnant women due to a typically lowered immune response during pregnancy. Furthermore, an infection can cause anemia which in turn increases the chances of stillbirth and mortality during childbirth due to hemorrhaging. Women in high transmission settings that have developed an immunity to the disease are still at risk. Whilst external symptoms of malaria may not show in a person that has developed an immunity, a certain amount of the parasite remains in the blood, which can travel to the placenta. Placental infection for expecting mothers can result in low birth weight, a contributing factor in post natal mortality.

As with children, protecting pregnant women is a high priority in malaria management and control and again, this begins with education. In an excerpt from personal stories compiled by Stand Up For African Mothers, 35 year old mother of five Ruth Nabakka expresses joy at the knowledge local health workers have helped her community gain, leading to a significant decrease in malaria cases in her area.

« I am happy. Because we do not fall ill as often as we used to, we are able to use the money we used to in hospital on other things. It fills my heart with joy to see my family well.”

Many of the expectant mothers in Ruth’s village in Uganda fell ill and suffered miscarriages at the hands of malaria, but the knowledge passed to them by AMREF trained community health workers about how to protect themselves and their families from malaria saved the lives of some and prevented the tragedy and misery of others. The health workers taught them that using prevention measures such as bed nets, and the correct medical course of action to take if infection occurs is the best way to combat the disease.

Ruth’s story shows that there are ways to disrupt the cycle, and free the vulnerable people that are trapped by malaria. Educating people to take measures to prevent malaria such as using treated mosquito nets is highly important in protecting these people, but as we can see with the story of the Kenyan father, it is also vital to follow protocol from prevention all the way through diagnosis and treatment. Currently poorer communities effected by malaria often do not have access to this protocol, or choose a different course of action than that which is needed. The solutions to breaking this cycle exist at ever layer of malaria case management, but education, accessibility and financing are all obstacles in bringing these solutions to the people who need them most. At xRapid we take a holistic view on the direction of global malaria efforts. We endeavour to work with the people who are already working so hard to break down these obstacles by providing a new diagnostic tool that has the portability to reach anyone who needs it.

Half of the population of the world is at risk of malaria, half of the children, half of the mothers. 3.8bn people living with shadow of the cycle looming over them, many of them already trapped and unable to break out on their own. It is a difficult concept to wrap your thoughts around properly, but by using anecdotal evidence as we have seen above, we can put a human face on those that struggle with the disease. Malaria is a global problem, and it requires a global solution. Through compassion, education, innovation and endeavour, we as a global society can pull those most vulnerable out of the quicksand.