Malaria Treatment & Prevention

This is an excellent suggestion. In addition to saving some lives of the
children receiving the SMC, it would potentially have the, perhaps more
important, result of reducing the spread of malaria in a community. This
is because mosquitoes can only receive the malaria parasite from infected
people. If even subclinical cases of malaria are treated by this
intervention, there will be fewer reservoirs of malaria infected children
to infect more mosquitoes.

Control of malaria requires doing everything we can to reduce malaria
transmission, from mosquitoes to humans, but also from humans to mosquitoes.

We in public health love acronyms. My question is: what is the difference
between SMC and IPTi (Intermittent Preventive Therapy in infants)?

Best, Charles

Seasonal prevention of malaria makes a lot of sense because it is targeted to the high transmission period were malaria slide positivity rates are high in health facilities. If efficiently deployed, it will not only reduce transmission  for that season but it will have profound effect on the malaria rates in the low transmission seasons. The caveat that must be effectively communicated is that the full doses of the medicines must be taken. When aggressively followed up with other interventions during and after the high transmission season, the post-transmission season outcome for that year is likely to be significant.

Another point of interest that must be carefully considered. Every well planned malaria intervention must not only be sustained, but should be made as robust as possible with clear measurable deliverables to avoid resurgence that would require far more resources to stabilize. Are malaria endemic countries ready to sustain the gains of successful malaria interventions? 


Wellington Oyibo

Some argue that seasonal chemo-prevention will not work in areas where the disease kills all-year-round, but would only work where the condition are right. The question is: Why not implement it in those areas where the conditions are "right" ? I think it is a strategy worth trying in conjunction with the treated bed nets and residual spraying. And of course it will come at a cost to Ministries of Health, but the thing is at present a lot of money is being spent during malaria seasons e.g. on transfusions, hospital admission sustenance costs for instance here in Namibia.

Seasonal prevention of malaria is very
important. Malaria remains the most important public health problem in tropical
and subtropical areas.
Community members’ attitude towards
malaria as a disease is important in understanding their health seeking
behavior and use of preventive methods. Some studies have indicated that
communities now regard malaria as a dangerous disease that can kill and affects
more children under five years than the adults. Studies reviewed also indicate
that most community members strongly felt that malaria can be prevented. Such positive
attitudes are essential opportunities for behavior change campaigns.
 
Evidence of interactions between malaria
and HIV in non pregnant adults is accumulating. In areas with stable malaria,
HIV increases the risk of malaria infection and clinical malaria in adults,
especially in those with advanced immunosuppressant. In settings with unstable
malaria, HIV-infected adults are at increased risk of complicated and severe
malaria and death.
 
There is a good book that you can buy “ Guidelines
for the Treatment of Malaria. Second Edition" can be purchased through
internet at : www.who.int/bookorders. Customers in developing countries
will take advantage of a discounted price. Those who cannot purchase online can
contact the sales agents dept (list available in the bookstore ...

Seasonal prevention of malaria is very
important. Malaria remains the most important public health problem in tropical
and subtropical areas.
Community members’ attitude towards
malaria as a disease is important in understanding their health seeking
behavior and use of preventive methods. Some studies have indicated that
communities now regard malaria as a dangerous disease that can kill and affects
more children under five years than the adults. Studies reviewed also indicate
that most community members strongly felt that malaria can be prevented. Such positive
attitudes are essential opportunities for behavior change campaigns.
 
Evidence of interactions between malaria
and HIV in non pregnant adults is accumulating. In areas with stable malaria,
HIV increases the risk of malaria infection and clinical malaria in adults,
especially in those with advanced immunosuppressant. In settings with unstable
malaria, HIV-infected adults are at increased risk of complicated and severe
malaria and death.
 
There is a good book that you can buy “ Guidelines
for the Treatment of Malaria. Second Edition" can be purchased through
internet at : www.who.int/bookorders. Customers in developing countries
will take advantage of a discounted price. Those who cannot purchase online can
contact the sales agents dept (list available in the bookstore homepage http://www.who.int/library/services/en/)
or our sales office in Geneva at email: or fax +41 22 791
4857.



________________________________
From: GHDonline (Violet Chaka) <>
To: Waner Jerome <>
Sent: Sunday, June 10, 2012 8:08 AM
Subject: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Violet Chaka added a new discussion to the Malaria Treatment & Prevention community.

Title: Seasonal prevention of malaria in African children

Discussion contents:
"Seasonal malarial chemoprevention (SMC) is a new tool in the fight against malaria. According to new research SCM could potentially save tens of thousands of lives and lead to significant public health improvements."

Attached resource:
* <http://www.ghdonline.org/malaria/discussion/seasonal-prevention-of-malaria-in... prevention of malaria in African children: analysis of life-saving potential


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Seasonal prevention of malaria is very
important. Malaria remains the most important public health problem in tropical
and subtropical areas.
Community members’ attitude towards
malaria as a disease is important in understanding their health seeking
behavior and use of preventive methods. Some studies have indicated that
communities now regard malaria as a dangerous disease that can kill and affects
more children under five years than the adults. Studies reviewed also indicate
that most community members strongly felt that malaria can be prevented. Such positive
attitudes are essential opportunities for behavior change campaigns.
 
Evidence of interactions between malaria
and HIV in non pregnant adults is accumulating. In areas with stable malaria,
HIV increases the risk of malaria infection and clinical malaria in adults,
especially in those with advanced immunosuppressant. In settings with unstable
malaria, HIV-infected adults are at increased risk of complicated and severe
malaria and death.
 
There is a good book that you can buy “Guidelines
for the Treatment of Malaria. Second Edition" can be purchased through
internet at : www.who.int/bookorders.
Customers in developing countries will take advantage of a discounted price.
Those who cannot purchase online can contact the sales agents dept (list
available in the bookstore ...

Seasonal prevention of malaria is very
important. Malaria remains the most important public health problem in tropical
and subtropical areas.
Community members’ attitude towards
malaria as a disease is important in understanding their health seeking
behavior and use of preventive methods. Some studies have indicated that
communities now regard malaria as a dangerous disease that can kill and affects
more children under five years than the adults. Studies reviewed also indicate
that most community members strongly felt that malaria can be prevented. Such positive
attitudes are essential opportunities for behavior change campaigns.
 
Evidence of interactions between malaria
and HIV in non pregnant adults is accumulating. In areas with stable malaria,
HIV increases the risk of malaria infection and clinical malaria in adults,
especially in those with advanced immunosuppressant. In settings with unstable
malaria, HIV-infected adults are at increased risk of complicated and severe
malaria and death.
 
There is a good book that you can buy “Guidelines
for the Treatment of Malaria. Second Edition" can be purchased through
internet at : www.who.int/bookorders.
Customers in developing countries will take advantage of a discounted price.
Those who cannot purchase online can contact the sales agents dept (list
available in the bookstore homepage http://www.who.int/library/services/en/)
or our sales office in Geneva at email: or fax +41 22 791
4857.

Thanks everyone, very interesting discussion. The reference mentioned earlier: WHO Guidelines for the Treatment of Malaria. Second Edition, is available online in PDF here http://whqlibdoc.who.int/publications/2010/9789241547925_eng.pdf
and there are Q&As here: http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html

I wonder if anyone in the community could try to respond to previous questions in this discussion:
> What is the difference between Seasonal malarial chemoprevention (SMC) in children and IPTi (Intermittent Preventive Therapy in infants)?
> What are the measurable deliverables for these interventions and what is the long-term strategy?
> What are the "right" conditions for SMC? Where is it implemented and what are the outcomes so far?
> How do you talk to people and patients about SMC in endemic malaria areas?

Thank you, Sophie

Dear all:
The idea of chemoprophylaxis in endemic areas for semi immunes (i.e. people already exposed to transmission and having sustained infections in the past) is something that should be reserved for very specific cases and only where the use of drugs is under close supervision. It should not be considered for widespread use. The concept of using sustained but irregular drug pressure on the parasite population, which is what will happen in reality, is to be strongly opposed. It is a sure way to select for resistant parasites, and please remember we do not have much in the way of alternatives..if we lose artemisinin to resistance it will be catastrophic. There needs to be a strong message sent to the endemic world about careful management in the use of the few drugs we have in place.
Clive Shiff

I strongly urge that rapid malaria testing end up in the hands of community healthcare workers and eventually families themselves. As a pediatrician I have given home rapid strep test to parents and had a 33% reduction in visits for sore throats and thus reduce overuse of antibiotics. Empowering families and healthcare workers is key to elimination and eradication different from vaccine required eradications such as smallpox.
Lester Hartman

Dear Lester,

It is heart warming to have this information. In some settings, it is believed that getting community members to do some kind of testing is like "Task shifting" and the  some laboratory health workers are not comfortable with community members handling blood. what wa syour experience in your setting.

Wellington



----- Original Message -----
From: GHDonline (Lester Hartman) <>
To: Wellington Oyibo <>
Cc:
Sent: Thursday, June 21, 2012 1:30 PM
Subject: Re: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Lester Hartman replied to the discussion "Seasonal prevention of malaria in African children" in the Malaria Treatment & Prevention community.

Reply contents:
"I strongly urge that rapid malaria testing end up in the hands of community healthcare workers and eventually families themselves. As a pediatrician I have given home rapid strep test to parents and had a 33% reduction in visits for sore throats and thus reduce overuse of antibiotics. Empowering families and healthcare workers is key to elimination and eradication different from vaccine required eradications such as smallpox.
Lester Hartman
________________________________________
From: GHDonline (Clive Shiff)
Sent: Thursday, June 21, 2012 8:05 AM
To: Hartman, Lester
Subject: Re: [Malaria ...

Dear Lester,

It is heart warming to have this information. In some settings, it is believed that getting community members to do some kind of testing is like "Task shifting" and the  some laboratory health workers are not comfortable with community members handling blood. what wa syour experience in your setting.

Wellington



----- Original Message -----
From: GHDonline (Lester Hartman) <>
To: Wellington Oyibo <>
Cc:
Sent: Thursday, June 21, 2012 1:30 PM
Subject: Re: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Lester Hartman replied to the discussion "Seasonal prevention of malaria in African children" in the Malaria Treatment & Prevention community.

Reply contents:
"I strongly urge that rapid malaria testing end up in the hands of community healthcare workers and eventually families themselves. As a pediatrician I have given home rapid strep test to parents and had a 33% reduction in visits for sore throats and thus reduce overuse of antibiotics. Empowering families and healthcare workers is key to elimination and eradication different from vaccine required eradications such as smallpox.
Lester Hartman
________________________________________
From: GHDonline (Clive Shiff)
Sent: Thursday, June 21, 2012 8:05 AM
To: Hartman, Lester
Subject: Re: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Clive Shiff replied to the discussion "Seasonal prevention of malaria in African children" in the Malaria Treatment & Prevention community.

Reply contents:
"Dear all:
The idea of chemoprophylaxis in endemic areas for semi immunes (i.e. people already exposed to transmission and having sustained infections in the past) is something that should be reserved for very specific cases and only where the use of drugs is under close supervision. It should not be considered for widespread use. The concept of using sustained but irregular drug pressure on the parasite population, which is what will happen in reality, is to be strongly opposed. It is  a sure way to select for resistant parasites, and please remember we do not have much in the way of alternatives..if we lose artemisinin to resistance it will be catastrophic. There needs to be a strong message sent to the endemic world about careful management in the use of the few drugs we have in place.
Clive Shiff

-----Original Message-----
From: GHDonline (Sophie Beauvais) [mailto:]
Sent: Wednesday, June 20, 2012 4:46 PM
To: Shiff, Clive
Subject: Re: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Sophie Beauvais replied to the discussion "Seasonal prevention of malaria in African children" in the Malaria Treatment & Prevention community.

Reply contents:
"Thanks everyone, very interesting discussion. The reference mentioned earlier: WHO Guidelines for the Treatment of Malaria. Second Edition, is available online in PDF here http://whqlibdoc.who.int/publications/2010/9789241547925_eng.pdf
and there are Q&As here: http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html

I wonder if anyone in the community could try to respond to previous questions in this discussion:
> What is the difference between Seasonal malarial chemoprevention (SMC) in children and IPTi (Intermittent Preventive Therapy in infants)?
> What are the measurable deliverables for these interventions and what is the long-term strategy?
> What are the "right" conditions for SMC? Where is it implemented and what are the outcomes so far?
> How do you talk to people and patients about SMC in endemic malaria areas?

Thank you, Sophie"

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Hello Wellington,

In my own office we had a 33% reduction in office visits for sore throats with no harm to patients. I will send you a poster presentation on this. Presently I am collaborating with the Beth Israel Deaconess Drs Warner Slack, Gary Horowitz, Stan Finkelstein, and David Diamond) and the MIT Health Center on a 2 year study to see if we can show if parents can do it properly. This is really no more complicated than the pregnancy test. Families feel very empowered Go to my practice website ( www.wmpeds.com) and look under patient education on the red tabs and go to sore throat- I teach families how to perform the test on a You Tube video. The biggest barrier is healthcare paternalism.
Thanks,
L
________________________________________
From: GHDonline (Wellington Oyibo)
Sent: Friday, June 22, 2012 1:42 AM
To: Hartman, Lester
Subject: Re: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Wellington Oyibo replied to the discussion "Seasonal prevention of malaria in African children" in the Malaria Treatment & Prevention community.

Reply contents:
"Dear Lester,

It is heart warming to have this information. In some settings, it is believed that getting community ...

Hello Wellington,

In my own office we had a 33% reduction in office visits for sore throats with no harm to patients. I will send you a poster presentation on this. Presently I am collaborating with the Beth Israel Deaconess Drs Warner Slack, Gary Horowitz, Stan Finkelstein, and David Diamond) and the MIT Health Center on a 2 year study to see if we can show if parents can do it properly. This is really no more complicated than the pregnancy test. Families feel very empowered Go to my practice website ( www.wmpeds.com) and look under patient education on the red tabs and go to sore throat- I teach families how to perform the test on a You Tube video. The biggest barrier is healthcare paternalism.
Thanks,
L
________________________________________
From: GHDonline (Wellington Oyibo)
Sent: Friday, June 22, 2012 1:42 AM
To: Hartman, Lester
Subject: Re: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Wellington Oyibo replied to the discussion "Seasonal prevention of malaria in African children" in the Malaria Treatment & Prevention community.

Reply contents:
"Dear Lester,

It is heart warming to have this information. In some settings, it is believed that getting community members to do some kind of testing is like "Task shifting" and the some laboratory health workers are not comfortable with community members handling blood. what wa syour experience in your setting.

Wellington



----- Original Message -----
From: GHDonline (Lester Hartman) <>
To: Wellington Oyibo <>
Cc:
Sent: Thursday, June 21, 2012 1:30 PM
Subject: Re: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Lester Hartman replied to the discussion "Seasonal prevention of malaria in African children" in the Malaria Treatment & Prevention community.

Reply contents:
"I strongly urge that rapid malaria testing end up in the hands of community healthcare workers and eventually families themselves. As a pediatrician I have given home rapid strep test to parents and had a 33% reduction in visits for sore throats and thus reduce overuse of antibiotics. Empowering families and healthcare workers is key to elimination and eradication different from vaccine required eradications such as smallpox.
Lester Hartman
________________________________________
From: GHDonline (Clive Shiff)
Sent: Thursday, June 21, 2012 8:05 AM
To: Hartman, Lester
Subject: Re: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Clive Shiff replied to the discussion "Seasonal prevention of malaria in African children" in the Malaria Treatment & Prevention community.

Reply contents:
"Dear all:
The idea of chemoprophylaxis in endemic areas for semi immunes (i.e. people already exposed to transmission and having sustained infections in the past) is something that should be reserved for very specific cases and only where the use of drugs is under close supervision. It should not be considered for widespread use. The concept of using sustained but irregular drug pressure on the parasite population, which is what will happen in reality, is to be strongly opposed. It is a sure way to select for resistant parasites, and please remember we do not have much in the way of alternatives..if we lose artemisinin to resistance it will be catastrophic. There needs to be a strong message sent to the endemic world about careful management in the use of the few drugs we have in place.
Clive Shiff

-----Original Message-----
From: GHDonline (Sophie Beauvais) [mailto:]
Sent: Wednesday, June 20, 2012 4:46 PM
To: Shiff, Clive
Subject: Re: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Sophie Beauvais replied to the discussion "Seasonal prevention of malaria in African children" in the Malaria Treatment & Prevention community.

Reply contents:
"Thanks everyone, very interesting discussion. The reference mentioned earlier: WHO Guidelines for the Treatment of Malaria. Second Edition, is available online in PDF here http://whqlibdoc.who.int/publications/2010/9789241547925_eng.pdf
and there are Q&As here: http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html

I wonder if anyone in the community could try to respond to previous questions in this discussion:
> What is the difference between Seasonal malarial chemoprevention (SMC) in children and IPTi (Intermittent Preventive Therapy in infants)?
> What are the measurable deliverables for these interventions and what is the long-term strategy?
> What are the "right" conditions for SMC? Where is it implemented and what are the outcomes so far?
> How do you talk to people and patients about SMC in endemic malaria areas?

Thank you, Sophie"

--
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<http://www.ghdonline.org/malaria/discussion/seasonal-prevention-of-malaria-in...>

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<http://www.ghdonline.org/users/clive-shiff/edit/>

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Hi Lester,

Can you share the poster presentation with everyone in the community? With
appreciation, Sophie

What does the community think about Seasonal Malaria Chemoprophylaxis
being a form of Mass Drug Administration but under a different name? And
if this is the case- can we start talking about Mass Drug Administration
as a tool to control and eliminate malaria?
--
Dr Roly Gosling MD, PhD

Associate Professor
Lead, Malaria Elimination Initiative
Global Health Group,
University of California, San Francisco

50 Beale Street, Suite 1200, Box 1224
San Francisco, CA 94105 USA

Tel: (+1) 415 597 8114
Cell: (+1) 415 254 6524
Fax: (+1) 415 597 8299
email:
Skype: Rolygosling
www.malariaeliminationgroup.org <http://www.malariaeliminationgroup.org/>






On 6/22/12 12:00 PM, "GHDonline (Sophie Beauvais)" <>
wrote:

>Sophie Beauvais replied to the discussion "Seasonal prevention of malaria
>in African children" in the Malaria Treatment & Prevention community.
>
>Reply contents:
>"Hi Lester,
>
>Can you share the poster presentation with everyone in the community? With
>appreciation, Sophie"
>
>--
>View this post online:
><http://www.ghdonline.org/malaria/discussion/seasonal-prevention-of-malari
>a-in-african-children/#reply-7268?id=10989067&format=text&type=instant>
>
>Unsubscribe or change your email notification settings:
><http://www.ghdonline.org/users/roly-gosling/edit/>
>
>Contact the GHDonline team:
><http://www.ghdonline.org/contact/>
>
>You can reply to ...

What does the community think about Seasonal Malaria Chemoprophylaxis
being a form of Mass Drug Administration but under a different name? And
if this is the case- can we start talking about Mass Drug Administration
as a tool to control and eliminate malaria?
--
Dr Roly Gosling MD, PhD

Associate Professor
Lead, Malaria Elimination Initiative
Global Health Group,
University of California, San Francisco

50 Beale Street, Suite 1200, Box 1224
San Francisco, CA 94105 USA

Tel: (+1) 415 597 8114
Cell: (+1) 415 254 6524
Fax: (+1) 415 597 8299
email:
Skype: Rolygosling
www.malariaeliminationgroup.org <http://www.malariaeliminationgroup.org/>






On 6/22/12 12:00 PM, "GHDonline (Sophie Beauvais)" <>
wrote:

>Sophie Beauvais replied to the discussion "Seasonal prevention of malaria
>in African children" in the Malaria Treatment & Prevention community.
>
>Reply contents:
>"Hi Lester,
>
>Can you share the poster presentation with everyone in the community? With
>appreciation, Sophie"
>
>--
>View this post online:
><http://www.ghdonline.org/malaria/discussion/seasonal-prevention-of-malari
>a-in-african-children/#reply-7268?id=10989067&format=text&type=instant>
>
>Unsubscribe or change your email notification settings:
><http://www.ghdonline.org/users/roly-gosling/edit/>
>
>Contact the GHDonline team:
><http://www.ghdonline.org/contact/>
>
>You can reply to this discussion by responding directly to this e-mail;
>it will be shared with all community members and posted as is. Files
>cannot be added via email attachment and must be uploaded directly to
>GHDonline.

Here is the poster presentation. Hope it works!
Lester

________________________________________
From: GHDonline (Sophie Beauvais)
Sent: Friday, June 22, 2012 3:03 PM
To: Hartman, Lester
Subject: Re: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Sophie Beauvais replied to the discussion "Seasonal prevention of malaria in African children" in the Malaria Treatment & Prevention community.

Reply contents:
"Hi Lester,

Can you share the poster presentation with everyone in the community? With
appreciation, Sophie"

--
View this post online:
<http://www.ghdonline.org/malaria/discussion/seasonal-prevention-of-malaria-in...>

Unsubscribe or change your email notification settings:
<http://www.ghdonline.org/users/lester-hartman/edit/>

Contact the GHDonline team:
<http://www.ghdonline.org/contact/>

You can reply to this discussion by responding directly to this e-mail; it will be shared with all community members and posted as is. Files cannot be added via email attachment and must be uploaded directly to GHDonline.

Can we talk about MDA regardless?

-----Original Message-----
From: GHDonline (Roly Gosling) [mailto:]
Sent: Friday, June 22, 2012 12:07 PM
To: Regina Rabinovich
Subject: Re: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Roly Gosling replied to the discussion "Seasonal prevention of malaria in African children" in the Malaria Treatment & Prevention community.

Reply contents:
"What does the community think about Seasonal Malaria Chemoprophylaxis being a form of Mass Drug Administration but under a different name? And if this is the case- can we start talking about Mass Drug Administration as a tool to control and eliminate malaria?
--
Dr Roly Gosling MD, PhD

Associate Professor
Lead, Malaria Elimination Initiative
Global Health Group,
University of California, San Francisco

50 Beale Street, Suite 1200, Box 1224
San Francisco, CA 94105 USA

Tel: (+1) 415 597 8114
Cell: (+1) 415 254 6524
Fax: (+1) 415 597 8299
email:
Skype: Rolygosling
www.malariaeliminationgroup.org <http://www.malariaeliminationgroup.org/>






On 6/22/12 12:00 PM, "GHDonline (Sophie Beauvais)" <>
wrote:

>Sophie Beauvais replied to the discussion "Seasonal prevention of
>malaria in African children" in the Malaria Treatment & Prevention community.
>
>Reply contents:
>"Hi Lester ...

Can we talk about MDA regardless?

-----Original Message-----
From: GHDonline (Roly Gosling) [mailto:]
Sent: Friday, June 22, 2012 12:07 PM
To: Regina Rabinovich
Subject: Re: [Malaria Treatment & Prevention] Seasonal prevention of malaria in African children

Roly Gosling replied to the discussion "Seasonal prevention of malaria in African children" in the Malaria Treatment & Prevention community.

Reply contents:
"What does the community think about Seasonal Malaria Chemoprophylaxis being a form of Mass Drug Administration but under a different name? And if this is the case- can we start talking about Mass Drug Administration as a tool to control and eliminate malaria?
--
Dr Roly Gosling MD, PhD

Associate Professor
Lead, Malaria Elimination Initiative
Global Health Group,
University of California, San Francisco

50 Beale Street, Suite 1200, Box 1224
San Francisco, CA 94105 USA

Tel: (+1) 415 597 8114
Cell: (+1) 415 254 6524
Fax: (+1) 415 597 8299
email:
Skype: Rolygosling
www.malariaeliminationgroup.org <http://www.malariaeliminationgroup.org/>






On 6/22/12 12:00 PM, "GHDonline (Sophie Beauvais)" <>
wrote:

>Sophie Beauvais replied to the discussion "Seasonal prevention of
>malaria in African children" in the Malaria Treatment & Prevention community.
>
>Reply contents:
>"Hi Lester,
>
>Can you share the poster presentation with everyone in the community?
>With appreciation, Sophie"
>
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Seasonal prevention is less likely to be associated with resistance problems since the entire community is given the drug in one go.However,it is important to ensure compliance and workers should personally administer the tablets rather than handing them over.A possible scenario(which I have personally encountered) is that patients think these are fever tablets and keep them for"emergency use" rather than take them when given.

Thanks Sandeep and Gina - Lets talk about MDA!

I would argue the opposite regarding Sandeeps point, that as SMC only
treats a portion of those infected because of an age cut off (usually 5
years of age) selecting resistance is less likely. This is because there
are many wild type infections left circulating in the population in people
above 5 years of age. Thus, wild type (non-resistant genotypes) will
remain in circulation. I would also say that in any MDA campaign, we would
want people to be treated at the same time, as happens with SMC and like
SMC, there would be multiple rounds of treatment.

I think that there are 3 main differences between SMC and MDA, firstly,
that the age range is restricted which means that many with parasite
carriers are missed, secondly,that drugs are given during the malaria
season, whereas modeling suggest pre-season treatment would be better as
there are fewer people carrying parasites and thirdly, there is a fixation
in measuring passively detected cases as the outcome (the number of cases
of people arriving at health care facilities with malaria) whereas with
MDA we want to measure a reduction in transmission (usually measured by a ...

Thanks Sandeep and Gina - Lets talk about MDA!

I would argue the opposite regarding Sandeeps point, that as SMC only
treats a portion of those infected because of an age cut off (usually 5
years of age) selecting resistance is less likely. This is because there
are many wild type infections left circulating in the population in people
above 5 years of age. Thus, wild type (non-resistant genotypes) will
remain in circulation. I would also say that in any MDA campaign, we would
want people to be treated at the same time, as happens with SMC and like
SMC, there would be multiple rounds of treatment.

I think that there are 3 main differences between SMC and MDA, firstly,
that the age range is restricted which means that many with parasite
carriers are missed, secondly,that drugs are given during the malaria
season, whereas modeling suggest pre-season treatment would be better as
there are fewer people carrying parasites and thirdly, there is a fixation
in measuring passively detected cases as the outcome (the number of cases
of people arriving at health care facilities with malaria) whereas with
MDA we want to measure a reduction in transmission (usually measured by a
prevalence rate, although a consequence of reduced transmission should be
a reduction in cases).

Regarding the communities willingness to discuss MDA- It seems to me that
the main objection to MDA is that there is a risk of selecting resistant
parasites. What is the evidence for this- excluding the use of chloroquine
added to salt in the 1950s? A reminder that in most other parasitic
diseases MDA is a common control method and nobody is saying that MDA
should occur in isolation - we are saying it should be used as an additive
to other malaria control methods.

I look forward to hearing more.
--
Dr Roly Gosling MD, PhD

Associate Professor
Lead, Malaria Elimination Initiative
Global Health Group,
University of California, San Francisco

50 Beale Street, Suite 1200, Box 1224
San Francisco, CA 94105 USA

Tel: (+1) 415 597 8114
Cell: (+1) 415 254 6524
Fax: (+1) 415 597 8299
email:
Skype: Rolygosling
www.malariaeliminationgroup.org <http://www.malariaeliminationgroup.org/>






On 6/22/12 9:26 PM, "GHDonline (Sandeep Saluja)" <>
wrote:

>Sandeep Saluja replied to the discussion "Seasonal prevention of malaria
>in African children" in the Malaria Treatment & Prevention community.
>
>Reply contents:
>"Seasonal prevention is less likely to be associated with resistance
>problems since the entire community is given the drug in one
>go.However,it is important to ensure compliance and workers should
>personally administer the tablets rather than handing them over.A
>possible scenario(which I have personally encountered) is that patients
>think these are fever tablets and keep them for"emergency use" rather
>than take them when given."
>
>--
>View this post online:
><http://www.ghdonline.org/malaria/discussion/seasonal-prevention-of-malari
>a-in-african-children/#reply-5182-2?id=10989067&format=text&type=instant>
>
>Unsubscribe or change your email notification settings:
><http://www.ghdonline.org/users/roly-gosling/edit/>
>
>Contact the GHDonline team:
><http://www.ghdonline.org/contact/>
>
>You can reply to this discussion by responding directly to this e-mail;
>it will be shared with all community members and posted as is. Files
>cannot be added via email attachment and must be uploaded directly to
>GHDonline.

I had an opportunity to use SMC with no age cut offs and universally.I would agree if age cut offs were used,it would not be a very good idea.

Even as an additive to other control options, IRS for example, MDA provided little lasting benefit (in hyperendemic settings) despite high coverage and the rigor of a study setting. See the amazing data from the WHO Garki project report of the 70s.

Even those it's a useful strategy for other parasitic diseases they are generally larger organisms (in smaller numbers and with longer generation times) and cause more chronic illness.

Back to the earlier discussion, as Dr Shiff wisely notes, SMC is effective in very limited settings. In order to target it well, there will need to be some decent surveillance data available at local levels. Such stratification, and the indirect planning and operational costs are more substantial than they sound even for experienced programs like India and Thailand let alone elsewhere.

Thank you Naman for continuing this thread. Two points to add:

1) MDA will most likely be effective in lower transmission settings and
seasonal settings. So a setting such as Garki would not be my premier
site. IN settings of lower transmission there maybe better or improving
infrastructure. In lower transmission settings, areas of transmission are
likely to be highly clustered. If these villages, sub- villages or areas
can be identified MDA can be targeted to them, reducing the logistics of
delivering MDA to the whole population.

2) Malaria as well as other parasitic diseases is a long term infection.
With the use of molecular test we are finding that there are much larger
numbers of infections below the detection of microscopy or RDTs than
previously thought. Currently in models we usually assume a malaria
infection can last naturally for 120 days, however, evidence from highly
seasonal malaria in Sudan, suggests asymptomatic infections at least
lasting between seasons.

Regarding Garki- I do not have a detailed knowledge of Garki, but
colleagues tell me that even in the Garki setting, towards the centre of
the area, malaria transmission was brought down to very low levels, and
after stopping interventions, transmission increased ...

Thank you Naman for continuing this thread. Two points to add:

1) MDA will most likely be effective in lower transmission settings and
seasonal settings. So a setting such as Garki would not be my premier
site. IN settings of lower transmission there maybe better or improving
infrastructure. In lower transmission settings, areas of transmission are
likely to be highly clustered. If these villages, sub- villages or areas
can be identified MDA can be targeted to them, reducing the logistics of
delivering MDA to the whole population.

2) Malaria as well as other parasitic diseases is a long term infection.
With the use of molecular test we are finding that there are much larger
numbers of infections below the detection of microscopy or RDTs than
previously thought. Currently in models we usually assume a malaria
infection can last naturally for 120 days, however, evidence from highly
seasonal malaria in Sudan, suggests asymptomatic infections at least
lasting between seasons.

Regarding Garki- I do not have a detailed knowledge of Garki, but
colleagues tell me that even in the Garki setting, towards the centre of
the area, malaria transmission was brought down to very low levels, and
after stopping interventions, transmission increased from the edges
inwards. I am in agreement, though, that using MDA in highly endemic areas
with poor infrastructure will not work. The good news is that in settings
with previously high malaria, where scaling up of access to diagnosis and
treatment and vector control have occurred, malaria transmission can
become low and seasonal, such as Zanzibar and areas of Zambia and offer
the opportunity to try MDA out.
--
Dr Roly Gosling MD, PhD

Associate Professor
Lead, Malaria Elimination Initiative
Global Health Group,
University of California, San Francisco

50 Beale Street, Suite 1200, Box 1224
San Francisco, CA 94105 USA

Tel: (+1) 415 597 8114
Cell: (+1) 415 254 6524
Fax: (+1) 415 597 8299
email:
Skype: Rolygosling
www.malariaeliminationgroup.org <http://www.malariaeliminationgroup.org/>






On 6/23/12 9:13 PM, "GHDonline (Naman Shah)" <> wrote:

>Naman Shah replied to the discussion "Seasonal prevention of malaria in
>African children" in the Malaria Treatment & Prevention community.
>
>Reply contents:
>"Even as an additive to other control options, IRS for example, MDA
>provided little lasting benefit (in hyperendemic settings) despite high
>coverage and the rigor of a study setting. See the amazing data from the
>WHO Garki project report of the 70s.
>
>Even those it's a useful strategy for other parasitic diseases they are
>generally larger organisms (in smaller numbers and with longer generation
>times) and cause more chronic illness.
>
>Back to the earlier discussion, as Dr Shiff wisely notes, SMC is
>effective in very limited settings. In order to target it well, there
>will need to be some decent surveillance data available at local levels.
>Such stratification, and the indirect planning and operational costs are
>more substantial than they sound even for experienced programs like India
>and Thailand let alone elsewhere."
>
>--
>View this post online:
><http://www.ghdonline.org/malaria/discussion/seasonal-prevention-of-malari
>a-in-african-children/#reply-5285-2?id=10989067&format=text&type=instant>
>
>Unsubscribe or change your email notification settings:
><http://www.ghdonline.org/users/roly-gosling/edit/>
>
>Contact the GHDonline team:
><http://www.ghdonline.org/contact/>
>
>You can reply to this discussion by responding directly to this e-mail;
>it will be shared with all community members and posted as is. Files
>cannot be added via email attachment and must be uploaded directly to
>GHDonline.

Many thanks for this timely and important discussion. It is widely agreed that we must attack malaria with all the tools available. If SMC can save millions of lives, in the right places, that makes it an appealing potential strategy in our arsenal. The main concern whether this approach may exacerbate the selection for drug resistance, which might diminish the already limited options for effective treatment, as rightly cautioned by Dr. Shiff and others members of the community. One recommendation is to build in tracking for drug resistance prevalence in SMC and non-SMC areas. Such data would be helpful in decision-making, collected either in further studies or in programmes starting to introduce SMC. Comparative data on adverse events are also needed, especially since typical SMC administration is monthly. Empirically collecting all the parameters, including cost, compliance etc as well pointed out, would help model the gains and losses of SMC to effectively guide policy by region.

Thanks, Roly. I concur with your sentiments.

Dr Gosling, it is my pleasure.

1) Yes, MDA will be more effective in lower transmission settings. We know from models and practice that the infectious reservoir is, proportionally, a greater determinant of transmission when vectorial capacity is low. I think MDA is worth some experimenting but it depends on the context. In an elimination setting, over a small geographic area high coverage will be possible over a defined time-frame. If the region is isolated preventing re-introduction will be possible. Obviously, this applies to a limited set of settings.

In the context of control or pre-elimination in larger countries, I suspect targeting will be more difficult than we imagine. Targeting errors will go undetected and can be fatal to achieving the needed coverage. Next, how will MDA interact with other campaign activities of the health system? If the targeting criteria is different it may complicate integration. Third, can it be applied without distracting from the implementation of current interventions which needs much work themselves? Finally, sustained coverage is difficult in large populations over several years as experience with MDA using DEC has shown.

2) You may be conflating asymptomatic and sub-microscopic here... While they are often related they need not ...

Dr Gosling, it is my pleasure.

1) Yes, MDA will be more effective in lower transmission settings. We know from models and practice that the infectious reservoir is, proportionally, a greater determinant of transmission when vectorial capacity is low. I think MDA is worth some experimenting but it depends on the context. In an elimination setting, over a small geographic area high coverage will be possible over a defined time-frame. If the region is isolated preventing re-introduction will be possible. Obviously, this applies to a limited set of settings.

In the context of control or pre-elimination in larger countries, I suspect targeting will be more difficult than we imagine. Targeting errors will go undetected and can be fatal to achieving the needed coverage. Next, how will MDA interact with other campaign activities of the health system? If the targeting criteria is different it may complicate integration. Third, can it be applied without distracting from the implementation of current interventions which needs much work themselves? Finally, sustained coverage is difficult in large populations over several years as experience with MDA using DEC has shown.

2) You may be conflating asymptomatic and sub-microscopic here... While they are often related they need not be. In any case, studies of both are complicated by one-time assessments. It's not clear that parasitemia would not have later increased or symptoms would have later developed in the absense of intervention. Clearly, each phenomenon exists but I dubious of most measurements of their extent. Finally, in the context of declining transmission, their importance may be overstated. We know the maintenance of clinical immunity requires frequent re-exposure. If you have successful control and general reduction of transmission for some sustained years, any asymptomatic carriers will cease to exist once their original infection is cleared and their immunity wanes. Heterogeneity in exposure and immune responses complicate the theory somewhat and research in this area is needed. However, the type of longitudanal follow-up needed to answer such questions is ethically and logistically challenging.

Naman.