Malaria Chemoprevention Strategies

Dear Colleagues,

Malaria remains a global public health problem despite a dramatic decrease in both morbidity and mortality over the last twenty years. However, sustained efforts are required to achieve the ambitious goals set up in the Global Technical Strategy (GTS) for malaria by the World Health Organization (WHO), aiming at reducing malaria prevalence by 90% in 2030 compared to 2015, and eliminating malaria in at least 35 countries. Malaria control programs rely mainly on vector control by the use of long-lasting insecticide-treated bednets (LLINs), and prompt diagnosis and case management with highly efficacious antimalarial drugs. Those interventions have proven to be highly effective, but progress has stalled over the last few years, mainly in high-burden countries, and additional strategies are urgently needed to avoid a rebound and further decrease malaria-associated morbidity and mortality. Moreover, all those gains are hampered by the emergence of resistant parasites to first-line antimalarial treatements, i.e., artemisinin-based combination therapies (ACTs), and vector resistance to most widely used insecticides. Chemoprevention strategies are expected to contribute significantly to malaria control and elimination if largely deployed in malaria endemic settings. Intervention such as intermittent preventive treatment in pregnant women (IPTp) and seasonal malaria chemoprevention (SMC) have proven to be highly effective, even though development of resistance to the current regimens (sulfadoxine-pyrimethamine and amodiaquine) warrants the implementation of alternative antimalarial drugs in the near future. Intermittent preventive treatement in infants (IPTi) has been shown to have a substantial impact on morbidity and malaria-related anemia, but its full impact is yet to be investigated in large-scale implementation studies. As transmission decreases in some settings, there is an age shifting of disease burden in older infants, and intermittent preventive treatment in schoolchildren (IPTc) is being explored in some countries. Mass drug administration (MDA) is another strategy, mainly used in elimination settings that has been shown to work in some settings, but not in others. Specific strategies are also needed for P.vivax, as the implementation of radical cure drug-based strategies is associated with potential lethal hemolysis in G6PD-deficient patients. To maximize the impact of all those interventions, new antimalarial drugs will be required, as the effectiveness of those currently used is either descreasing or may decrease in the near future. In the meantime, innovative strategies must be implemented to extend the useful therapeutic lifespan of the antimalarial drugs we currently have, and different drugs should be used for chemoprevention and case management to reduce drug pressure and minimize the chances of drug resistance development. This Special Issue focuses on the different chemoprevention strategies available for malaria control and elimination, their potential impact in reducing both malaria morbidity and mortality, and challenges associated with their large-scale deployment in malaria endemic settings.

Dr. Christian Nsanzabana
Dr. Kamala Thriemer
Prof. Dr. Sunil Parikh
Guest Editors

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• Malaria
• P. falciparum
• P. vivax
• Case management
• Chemotherapy
• Drug
• Chemoprevention
• Intermittent preventive treatment
• Mass drug administration
• Surveillance
• Antimalarial
• Resistance
• Control
• Elimination
• Radical cure
• G6PD deficiency
• Eradication
• Amodiaquine
• Sulfadoxine–pyrimethamine