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Dr Sabine Dittrich, Head of Malaria & Fever, FIND

Effective diagnostic tools are essential to save lives of malaria patients, break the cycle of transmission — and stop the disease spreading. More R&D is needed.

The global health community needs a range of tools at its disposal if it is to eliminate malaria in regions or entire countries. Effective diagnostics are crucial, says Dr Sabine Dittrich, Head of Malaria & Fever at FIND (the Foundation for Innovative New Diagnostics), a global non-profit accelerating the development, evaluation and delivery of diagnostic tests for poverty-related diseases.

As the parasites in a malaria patient’s blood can infect mosquitoes — which then bite and infect other people — every single case of the disease must be found and treated if this deadly cycle of transmission is to be broken.

Different malaria parasites require different types of treatment

Unfortunately, malaria is not a simple disease to diagnose or treat. It can be caused by different Plasmodium parasites with different characteristics: for example, P. vivax malaria lies dormant in a person’s liver, and can cause the infection to reoccur at a later stage. A patient with this form of the disease requires ‘radical cure’ — that is, the complete eradication of P. vivax parasites from their body even if they are not causing active disease.

Thankfully, progress is being made in malaria treatment, says Dr Dittrich. Radical cure of P. vivax malaria is now available as a single-dose drug. However, it may have potentially severe side-effects for patients with G6PD deficiency, a disorder affecting red blood cells. “Careful diagnosis is very important,” explains Dr Dittrich. “Before healthcare professionals can give patients this treatment, they have to be sure that the infection is due to P. vivax, as well as to check their G6PD status to confirm that it will be safe to do so.”

Finding P. vivax parasites hiding out in the liver is only one of the many diagnostic challenges for malaria, says Dr Dittrich. “Early detection and treatment of all forms of the disease are needed to break the cycle of transmission. Aside from diagnostics that can be used in health facilities, we also need better, sensitive rapid diagnostic tests that can identify asymptomatic patients in the community.”

Integration of diagnostics for fever and malaria

If a patient is found to have malaria, urgent treatment will be required in order to save their life and stop the spread of the disease. But not everyone who presents at a health facility with a fever will have malaria, particularly in low endemic countries — and this situation will only become more common as progress is made towards malaria elimination.

What should clinicians do when the malaria test is negative? The default answer is often a course of broad-spectrum antibiotics, but if the fever is due to a virus, such a prescription will not only be ineffective, but may also contribute to the development of antimicrobial resistance.

FIND is taking a holistic approach. “Diagnostic integration for fever and malaria enables us to start with the patient, not the disease,” notes Dr Dittrich. “Yes, there must be a strong focus on breaking the cycle of malaria transmission. But healthcare professionals have a duty to diagnose and treat patients, whatever their illness.”

Going forward, better R&D that delivers new diagnostic tools is required — including improved P. vivax diagnostics, as well as tests that can identify both malaria and other diseases at the same time, says Dr Dittrich. “Eliminating malaria is both an urgent priority and a golden opportunity. If we are smart about the diagnostic tools we use to support elimination, we can help all patients with fever to access the healthcare they need.”

More about the FIND Malaria & Fever programme

By Tony Greenway