James Watson: Data driven definitions of severe malaria

My name is James Watson. I work at the University of Oxford in the Nuffield Department of Medicine, and I'm Associate Director of the Infectious Diseases Data Observatory. My work focuses on severe malaria in young children in Africa.

My recent research on severe malaria has been working on trying to improve how we define severe malaria, and how we diagnose severe malaria. A lot of children will present to hospital, they'll be severely ill. And the difficulty is going, well, is this malaria that's the cause of the severe illness or is it something else? And so, we're gathering data from lots of clinical studies and cohorts to then try and work out how to best find severe malaria versus other causes of severe illness.

Maybe surprisingly to a lot of people, one of the biggest questions is actually how many children die of severe malaria in sub-Saharan Africa. We don't really know this to a very accurate degree. And one of the reasons is that there's not good data on cause of death. A lot of the data that exists are from what we call verbal autopsy, where someone comes round to a family and then asks them some questions about if there was a death did that child have a fever, diarrhoea etc. Verbal autopsy is not very good at distinguishing death from malaria versus death from other infections. So, what I'm interested in is using the number of cases of severe malaria which you can measure more accurately in hospitals as a proxy for how many children might be then dying from malaria. So, if you get a lot of severe malaria, a proportion of those children will die, and that can give you an insight into malaria attributable burden in a in a particular area.

If you get malaria and that malaria deteriorates and becomes severe illness, then the most important thing is that you get treated rapidly. So, it's very important that it gets identified and diagnosed correctly as severe malaria, and then from that diagnosis that you get rapid treatment. So having a better way of defining who has severe malaria versus who doesn't have severe malaria, and making that diagnosis easy to do in a low resource setting I think will then improve how children are treated and hopefully reduce their chance of dying from this preventable disease.

I think this research matters because a lot of children still die of malaria, it's thought to be about half a million children every year, and this is a preventable disease. So really that number could be zero if there were enough resources. I think it matters because hopefully it will help improve lives of young children in low resource settings.