This new Lancet malaria seminar is one of a series of clinically focused, structured, up-to-date reviews which are grouped together in The Lancet Clinic with other relevant content. The aim of the seminars is to give a comprehensive overview of diseases to practising clinicians, emphasising recent advances, controversies and uncertainties.
Antimicrobial resistance (AMR) is a serious threat to public health. A new report describes the role of supranational networks in AMR surveillance in low- and middle-income countries (LMICs); Liz Ashley and colleagues analysed networks that were in existence between January 2000 and August 2017. This study reveals the challenges of establishing sustainable and effective networks to tackle resistance to antimicrobial medicines.
This randomised controlled trial of acetaminophen (paracetamol) in Bangladeshi patients with severe and moderately severe malaria shows that acetaminophen reduces kidney dysfunction and risk of developing acute kidney injury, particularly in patients with significant haemolysis. This proof-of-principle study supports the underlying hypothesis that acetaminophen inhibits cell-free haemoglobin-mediated oxidative kidney damage.
This study proposes path for improving surveillance of antimalarial resistance through new technologies to produce molecular assays and capacity strengthening among national reference laboratories. After identifying deficiencies in method standardisation, study authors said a range of affordable techniques, combined with improved access to standardized protocols, training and proficiency testing, could boost surveillance efforts.
A clinical trial in Cambodia evaluated the safety and effectiveness of mass drug administration (MDA) to interrupt multi-drug resistant falciparum malaria. Coverage with at least one round was 88%, no severe adverse events were reported, and MDA was associated with the absence of clinical P. falciparum cases for at least one year.
Blood from patients treated with ivermectin can kill mosquitos. Our results indicate that ivermectin mass drug administration to humans could be a potential malaria control tool to aid malaria elimination efforts in South America.
Primaquine is being promoted actively to block the transmission of falciparum malaria parasites between humans and mosquitoes to reduce the spread of highly resistant malaria ‘superbugs.’ In response, Bob Taylor and colleagues developed a primaquine dosing scheme based on age. This will be useful where there are no functioning weighing scales and when primaquine mass drug treatment will be given.
The human papilloma virus is primarily known as the causative agent of cervical cancer, but it also causes anal cancer. It is easily transmitted, but often cleared, and only few infections develop into cancer. We investigated the rate of infection and clearance in the anal canal among men who have sex with men.
The malaria parasite is a major cause of illness and deaths throughout the tropics. To survive, the malaria parasite needs to be transmitted by mosquitos form person to person. In this paper Martin Rono and colleagues show at the cellular and molecular level how the parasite balances its investment between growing efficiently in humans and maximising the chances of being transmitted by mosquitos, depending on the local environment.
Two mass drug administrations against falciparum malaria were conducted in 2015–16, one as operational research in northern Cambodia, and the other as a clinical trial in western Cambodia. During an April 2017 workshop in Phnom Penh the field teams from Médecins Sans Frontières and the Mahidol-Oxford Tropical Medicine Research Unit discussed lessons for future mass drug administrations.