Combined Malaria and NTD Control Effort Is Cost-Effective Solution to Reduce Anemia

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New Treatment Approach Would Significantly Decrease Number of Deaths in Africa

another promising, low-cost and highly cost-effective, and complementary approach for potentially reducing the morbidity of malaria in sub-Saharan Africa.

Integrating efforts to control malaria and neglected tropical diseases (NTDs) is an inexpensive and effective solution to reduce the incidence of deadly tropical anemia in sub-Saharan Africa, according to a new analysis published in the Public Library of Science (PLoS) Neglected Tropical Diseases. In this region, many people are co-infected with malaria and NTDs such as hookworm and schistosomiasis. Malaria alone kills more than one million children every year, and NTDs afflict hundreds of millions more.

The new analysis, ''Tropical Anemia: One of Africa's Great Killers and a Rationale for Linking Malaria and Neglected Tropical Disease Control to Achieve a Common Goal,'' makes a compelling case for integrating approaches to control malaria and NTDs in order to mitigate their devastating impacts in a cost-effective way. Together, malaria and the seven most common NTDs cause almost two million deaths and are responsible for the loss of nearly 100 million disability-adjusted life years (DALYs) annually - almost 20% higher than the disease burden from HIV/AIDS. Both malaria and NTDs cause immense suffering largely through anemia, a deficiency in hemoglobin often accompanied by a reduced number of red blood cells. Anemia accounts for up to half of the malaria deaths in young children, and is a major contributor to both the enormous burden of maternal deaths during pregnancy and to premature births. Chronic anemia in young children is also tied to reduction in physical growth, impaired cognition, and poor school performance.

Co-infection with malaria and one or more NTDs (especially hookworm infection or schistosomiasis, two of the most common NTDs in sub-Saharan Africa) causes a pronounced exacerbation of anemia. Severe hemoglobin deficiencies are the manifestation of co-infection of malaria and NTDs, shown to be markedly higher than in those with only a single infection. This phenomenon is commonly referred to the "perfect storm of anemia."

Malaria control and NTD control have each been found to reduce anemia in both children and pregnant women. "Combining malaria and NTD control practices in a unified anemia framework affords one of the best opportunities to reduce the perfect storm of anemia morbidity and mortality in sub-Saharan Africa," said Peter J. Hotez, MD, PhD, President of the Sabin Vaccine Institute and Walter G. Ross Professor and Chair of the Department of Microbiology, Immunology, and Tropical Medicine at The George Washington University.

The analysis also stated that, "in addition to the health improvement that would result from anemia reduction, there is also some evidence that hookworm and schistosomiasis (and possibly other NTDs) may promote increased susceptibility to malaria, so that NTD control would work in synergy with nets and other measures to reduce malaria incidence." The use of bed-nets was shown to increase substantially - in some cases nine-fold - when used alongside NTD control efforts.

"Based on this link, the public-private partnerships of the Global Network for NTDs are working to identify opportunities for integrating malaria and NTD control efforts in sub-Saharan Africa," said Kari Stoever, Managing Director of the Global Network for Neglected Tropical Diseases. "The Network's effective system of delivering treatment through trained local community coordinators is an ideal way to enhance malaria control and NTD control efforts and, ultimately, reduce deadly cases of these diseases and anemia."

Noting that NTD control can cost as little as 50 cents per person per year, the authors stated that this inexpensive investment would be "another promising, low-cost and highly cost-effective, and complementary approach for potentially reducing the morbidity of malaria in sub-Saharan Africa."

"An integrated control program for tropical anemia in Africa represents one of our better hopes for a quick win in the fight for sustainable disease control and poverty reduction integration," Dr. Hotez and Dr. Molyneux concluded. By taking a more holistic approach to disease control and prevention, we can finally help the people of sub-Saharan Africa break out of the cycle of poverty that has been plaguing them for so long.

''Tropical Anemia: One of Africa's Great Killers and a Rationale for Linking Malaria and Neglected Tropical Disease Control to Achieve a Common Goal'' is co-authored by Dr. Peter. J. Hotez (Executive Director of the Global Network for NTDs, President of the Sabin Vaccine Institute and Walter G. Ross Professor and Chair of the Department of Microbiology, Immunology and Tropical Medicine at George Washington University) and David H. Molyneux (Professor of Tropical Health Sciences at the Liverpool School of Tropical Medicine and Director of the Lymphatic Filariasis Support Centre).

About the Global Network
The Global Network for Neglected Tropical Diseases, a major program of the Sabin Vaccine
Institute, is a partnership dedicated to eliminating neglected tropical diseases (NTDs) - the most common infections impacting one billion of the world's poorest people. The Global Network is comprised of international non-profit organizations with decades of on-the-ground experience in fighting disabling, disfiguring, and deadly NTDs. Through strong collaboration with the World Health Organization, pharmaceutical companies, and disease-endemic countries, the Global Network (http://www.globalnetwork.org) works to increase access to inexpensive, effective medicines to improve and save lives.

Members of the Global Network:

  • Sabin Vaccine Institute
  • The Earth Institute at Columbia University
  • Helen Keller International
  • International Trachoma Initiative
  • Liverpool School of Tropical Medicine
  • Schistosomiasis Control Initiative
  • The Task Force for Child Survival and Development

About the Sabin Vaccine Institute
Sabin Vaccine Institute is a non-profit organization dedicated to reducing human suffering from infectious and neglected diseases. Through its efforts in vaccine research, development and advocacy, Sabin works to provide greater access to vaccines and essential medicines for millions stuck in pain, poverty and despair. Founded in 1993 in honor of Dr. Albert B. Sabin, discoverer of the oral polio vaccine, the Sabin Institute works with prestigious institutions, scientists, medical professionals, and organizations to provide short and long-term solutions that result in healthier individuals, families and communities around the globe. For more information about Sabin's research and commitment, visit: http://www.sabin.org .

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