2021 World Malaria Day for ‘Reaching the zero malaria target.’
April 25 is World Malaria Day! World Malaria Day recognizes global efforts to prevent and control malaria and highlights the need for continued investment and sustained political commitment.
World Malaria Day was established in 2007 by the 60th session of the World Health Assembly. Prior to the establishment of World Malaria Day, Africa Malaria Day was held on April 25. Africa Malaria Day began in 2001, one year after the historic Abuja Declaration* was signed by 44 malaria-endemic countries after the African Summit on Roll Back Malaria in 2000.
|* Abuja Declaration (https://www.who.int/healthsystems/publications/abuja_declaration/en/)
The Abuja Declarations and Frameworks for Action on Roll Back Malaria was a pledge made in 2001 by members of the African Union during a conference in Abuja, Nigeria. The African Union countries set a target to halve the malaria mortality for Africa's people by 2010, and pledged to allocate at least 15% of their annual budget to improve the health sector, and urged donor countries to scale up support.
WHO’s theme for World Malaria Day 2021 is ‘Reaching the zero malaria target.’
(Source: WHO Website (https://www.who.int/campaigns/world-malaria-day/world-malaria-day-2021))
Malaria is caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. Among the 5 parasite species that cause malaria in humans, Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax) pose the greatest threat. Malaria caused by P. falciparum infection is the most prevalent worldwide.
Anopheles stephensi mosquito (Source: Centers for Disease Control and Prevention (CDC))
Red blood cell parasitized by Plasmodium falciparum (Credit: Institut Pasteur)
It is a preventable and curable disease. Early diagnosis and treatment of malaria reduces disease and prevents deaths, and contributes to reducing transmission. Antimalarial medicines are also useful for prevention. However, new drugs are needed to respond to the recent emergence of malaria resistance to the existing drugs, such as chloroquine, and artemisinin.
Global and Regional Burdens of Malaria
WHO estimated 229 million cases of malaria and 409,000 malaria-related deaths in 87 countries in 2019. The WHO African Region shouldered 94% of all malaria cases and deaths worldwide in 2019. Thanks to the various global efforts to eliminate malaria, the global trends in malaria case incidence rate and mortality rate show downhill. Worryingly, however, children under the age of 5 continue to be the most vulnerable group, accounting for two-thirds of global deaths from malaria.
[Left] Countries with indigenous cases in 2000 and their status by 2019, [Right] Global trends in a) malaria case incidence rate and b) mortality rate (right) (Source: World malaria report 2020: 20 years of global progress and challenges. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO)
Malaria in S. Korea
Malaria may sound far for those living in S. Korea but, surprisingly, Korea is not free from this disease. According to the Korea Disease Control and Prevention Agency (KDCA), malaria was once disappeared in 1984 and re-occurred starting in 1993 in the soldiers serving in the Military Demarcation Line (MDL) region. Since then, it has spread rapidly to soldiers and gradually to civilians, and from 2002, civilians accounted for more than half of all malaria patients. In 1998-2000, there were about 4,000 patients per year and the number of patients is reducing since.
(Source: KDCA, 2020 Malaria Control Guidelines, https://health.kdca.go.kr/healthinfo/biz/health/gnrlzHealthInfo/gnrlzHealthInfo/gnrlzHealthInfoView.do?cntnts_sn=5245)
Global Efforts to Eliminate Malaria
The re-emergence of domestic malaria may have caused by a vector mosquito originating in North Korea. Moreover, the malaria incidence from overseas is recently increasing due to the travels to the areas at risk of malaria such as Africa.
Malaria prevalent in Korea is caused by P. vivax infection. It is characterized by repetitive high fever for 3 days and shows a relatively mild course of symptoms. On the other hand, malaria caused by infection with P. falciparum can lead to death, and preventive medicine is necessary when visiting the epidemic areas.
The UN’s Sustainable Development Goal set a target to end epidemics of malaria along with AIDS, TB, and other neglected tropical and communicable diseases by 2030. WHO launched ‘Global technical strategy for malaria 2016–2030 (GTS),’ which aims for a reduction in malaria case incidence and mortality rate of at least 40% by 2020, 75% by 2025, and 90% by 2030 from a 2015 baseline.
Part of the TABLE 2.1. GTS: global targets for 2030 and milestones for 2020 and 2025 Source: GTS (4). (Source: World malaria report 2020: 20 years of global progress and challenges. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO)
There are three pillars supporting the GTS to reach the target: 1) Ensure universal access to malaria prevention, diagnosis, and treatment, 2) Accelerate efforts towards elimination and attainment of malaria-free status, and 3) Transform malaria surveillance into a core intervention.
Pasteur Institutes in Korea and in Cameroon are taking part in the global efforts by developing a smartphone-based method for accurate and rapid point-of-care diagnosis of malaria!
Collaboration of Institut Pasteur Korea and Institut Pasteur Cameroon targeting to eliminate malaria
Pasteurians in Institut Pasteur Korea (IP-Korea) and Institut Pasteur Cameroon (IP-Cameroon) are joining forces to fight malaria in Africa. Dr. Regis Grailhe, Head of Tech Development Platform at IP-Korea and the founder of Smart-MD, a spin-off biotech venture of IP-Korea, and Dr. Lawrence Ayong, Director of the Malarial Research Unit at Institut Pasteur Cameroon, are working together to establish and implement quick, accurate, and easy-to-use malaria diagnostic device.
|* Institut Pasteur International Network
IP-Korea and IP-Cameroon are members of the Institut Pasteur International Network (IPIN). The IPIN, established for over 130 years, consists of 33 members based in 25 countries worldwide. The members, called ‘Pasteurians,’ are united by the shared values and missions for the benefit of all humans. Presenting in numerous endemic areas, the IPIN has demonstrated its major role as a sentinel for emerging infectious diseases.
[Left] Dr. Lawrence Ayong(left) and Dr. Regis Grailhe, [Right] Institut Pasteur International Network
Although early diagnosis helps to cure malaria, only a few of the malaria-endemic populations benefit from accurate diagnosis before getting antimalarial drug treatment. Furthermore, the current diagnostic options are neither highly accurate nor easily accessible as they require a lengthy manual process for visualization and diagnostic analysis carried out by highly trained technicians, in which human errors can occur.
As a strategy to radically improve malaria case-control, Dr. Grailhe and Dr. Ayong’s joint research team proposed an AI-based solution utilizing smartphone and computer vision technologies. The basic concept is to adapt to a traditional microscope with a smartphone equipped with an Android application dedicated to malaria parasite detection and quantification.
Integrating the AI-based approach of IP-Korea with the vast clinical resources of IP-Cameroon, the joint research team created a mobile application (App). They applied mobile health technology to automate microscopy-based diagnostics, a standard method for malaria parasite detection and quantification on thick blood smear slides.
In particular, a universal smartphone/tablet adapter was newly designed and applied in collaboration with IP-Cameroon to digitalize the clinical samples in the epidemic region and establish an image database. And a smartphone android AI-based application that automatically analyzes the images collected and diagnoses malaria was developed using deep learning technology. For this, universal smartphone/tablet adapter were produced in Cameroon using the 3D printers supplied by the support from KOICA for proximal access by healthcare centers in the region.
Main components of the AI-based malaria diagnostic app
With the support of KOICA, the clinical test of the diagnostics targeting 1,536 patients are currently performed in Yaounde, the capital of Cameroon.
“Our goal is to improve malaria diagnosis by making high quality but affordable diagnostics providing universal access,” said Dr. Grailhe.