Malaria continues to exact a tremendous toll on resource-limited regions. In 2016 alone, there were an estimated 216 million cases worldwide, resulting in 445,000 deaths.
While promising efforts are under way to eliminate malaria from low-endemic regions, Africa, which bears 90 percent of malaria’s burden, so far has seen mixed results. In both Uganda and Burkina Faso, mortality attributable to the primary pathogen, Plasmodium falciparum, has decreased, yet the overall incidence actually increased between 2015 and 2016.
My lab has been conducting research in Uganda since the early 2000s, about the same time that a treat- ment paradigm shift occurred—from monotherapies to the artemisinin-based combination therapies. In Uganda, we work with longstanding and committed collaborators at Makerere University and our shared goal is to optimize treatment among those most vul- nerable to malaria’s effects—young children, pregnant women and people living with HIV. We focus on understanding how to best treat these populations efficaciously while also preserving the effectiveness of these new drugs as long as possible, given the rapid spread of resistance.
More precisely, through careful pharmacologic and molecular genetic studies, we are trying to define the optimal treatment doses and regimens for these drugs while also limiting the likelihood that drug resistance will both emerge and be transmitted in these indi- viduals and communities. Coupled with these efforts, our lab has recently begun to implement and develop more sensitive methods of parasite detection, with the hope of better defining the true reservoir of parasites in individuals and populations over time.
Sustainable gains against this ancient blight will come only from multidisciplinary and multipronged approaches with our colleagues in the region.
Sunil Parikh
Far to the west in Burkina Faso, my lab works closely with investigators at the Institut de Recherche en Sciences de la Santé and colleagues from Colorado State University. We are combining studies of the target parasite, of humans infected with the disease and of the mosquito vector to better characterize the transmission dynamics of malaria. We have ongoing studies that focus on individuals, households and communities, with the goal of understanding how drug resistance varies across space and time. Additionally, our team is embarking on a multiyear cluster random- ized trial to assess the novel use of an old drug used for neglected tropical diseases, ivermectin, for reducing malaria incidence at the community level. This trial will be conducted in the context of ongoing interventions, including the use of insecticide-treated bed nets, artemisinin-based combination therapy and seasonal monthly chemoprevention for children.
After years of working on the scourge of malaria, my lab more fully realizes that sustainable gains against this ancient blight will come only from multidisciplinary and multipronged approaches with our colleagues in the region.