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EDITIONS
Thursday, 3 October, 2002, 06:57 GMT 07:57 UK
On the malaria frontline
More than 90% of malaria occurs in sub-Saharan Africa
Researchers have announced a breakthrough in the fight against malaria. The DNA blueprints of the malaria parasite and the mosquito which transmits it to humans have been completed.

The data will help experts to develop new treatments for the disease which is one of the world's biggest killers.

Nine out 10 malaria cases occur in sub-Saharan Africa. BBC health correspondent Chris Hogg has been to Kilifi, in Eastern Kenya, to report on the fight against the disease there, and the possible impact of this latest research.


It's 11am. The outpatients department at Kilifi District Hospital has been busy since first light.

Fieldworker Epson Kahindi is trying to find out what might be wrong with Sidi Charo's six-month-old son.


It is simply the commonest serious illness that children get right across Africa

Professor Kevin Marsh
Dr Michael Makanga is a clinical pharmacologist working with the Wellcome Trust.

"The fieldworkers here, they help to screen out children that are presented with malaria; symptoms that are suggestive of malaria," he told me.

The nurse takes a blood sample from Sidi's baby son. If he does have malaria, Dr Makanga's team will try to include him in their latest clinical trial.

"When they come over to the research outpatients clinic we check the blood for the presence of any malaria parasites," Dr Makanga said.

"At the same time we tell them about the investigation drug, the risks and benefits - and this is administered in their local language so that they clearly understand all about the studies."

Child killer

Most families here are only too willing to take part in these studies. Malaria is a deadly disease which kills hundreds of thousands of the youngest children.

The head of the Kemri Research Centre here in Kilifi is Professor Kevin Marsh.


The current drugs will not be there forever

Professor Gilbert Kokwaro
"During the malaria season the outpatients here will be packed," he said.

"It's pretty busy as you can hear today but it'll be packed with hundreds of children every day all suffering from malaria.

"It is simply the commonest serious illness that children get right across Africa it's there all the time."

At the Wellcome Trust laboratories in Kenya, they are already using data from the genome project.

The malaria parasite passes into the blood stream when you are bitten by an infected mosquito.

The problem is the parasite evolving constantly - developing resistance to new treatments.

Greater understanding

Professor Gilbert Kokwaro says that now the parasite's genome has been sequenced - that is reduced it to its smallest constituent parts - researchers have gained a much better sense of how it works.

"The current drugs will not be there forever and what the genome project has done is really to give us the opportunity to look at the parasite in more detail and hopefully identify new targets for future drug development."


Having the genome sequence is absolutely crucial

Professor Kevin Marsh
Sequencing the genome of the malarial parasite is a big step. The more you know about the organism the easier it is to find ways to destroy it.

But we are not going to see new drugs or even a new vaccine produced overnight as a result of this work.

So in villages like this, health workers concentrate on prevention and trying to spot the disease as early as possible.

The youngest children in Bicharo Ngumbao - a homestead about an hour's drive from the hospital - are used to the visits from the health workers now.

Regular checks on the basic health of those growing up here help researchers to plot how malaria moves through the local population.

And as one of the epidemiologists, Tabitha Mwangi, told me, the information collected will be used to test the effects of new vaccines or treatments on people living here in years to come.

"This is very important because if you do introduce an intervention, for example if you bring bednets or if you have a vaccine, especially once a good vaccine is found and is brought down to the field - then it's very easy to say this was what the situation was before the vaccine.

"You monitor in the same way then you'll be able to tell that the vaccine actually has an effect - or it doesn't have an effect."

Meanwhile, much simpler innovations are also being developed to contain the spread of the disease.

Village shop

The village shopkeeper Harrison Koi has been trained to spot the symptoms of a malarial fever and sell the appropriate drugs to treat it.

Early intervention can mean the difference between life and death.

Wilfred Mutemi from Kenya's ministry of health says it's more realistic than expecting mothers to travel long distances to a hospital.

"We train them basically to discuss with the mother the signs that the mothers have noticed in their children when they come to buy drugs.

"They should be able to identify what drugs they should give these fevers for every fever they should add an anti-malarial drug and an adequate dose for that fever."

On the children's ward back at Kilifi district hospital already many of the beds are filled with malaria cases, even though it'll be some weeks before the height of the malaria season.

Professor Kevin Marsh's team of doctors care for patients here in addition to carrying out their research work.

"There is an enormous amount which can be done right now in terms of prevention of malaria, of development and implementation of new drugs.

"It is essential that that carries on at the same pace because that is what's just allowing us to keep up with the problem.

"But at the same time there has got to be a long term programme to develop new approaches.

"Essentially, the best hope must come from the development of a vaccine and that's I think where having the genome sequence is absolutely crucial."

The next generation will be looking to the genome project to produce new treatments to combat this disease.

For communities blighted by malaria, these treatments can't come soon enough.


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