Combined Malaria and NTD Control Effort Is Cost-Effective Solution to Reduce Anemia

New Treatment Approach Would Significantly Decrease Number of Deaths in Africa.

Published on 8.6.08

WASHINGTON, D.C. (August 6, 2008)

Integrating efforts to control malaria and neglected tropical diseases (NTDs) is an inexpensive and effective solution to reduce the incidence of deadly tropical anemia in sub-Saharan Africa, according to a new analysis published in the Public Library of Science (PLoS) Neglected Tropical Diseases. In this region, many people are co-infected with malaria and NTDs such as hookworm and schistosomiasis. Malaria alone kills more than one million children every year, and NTDs afflict hundreds of millions more.

The new analysis, “Tropical Anemia: One of Africa’s Great Killers and a Rationale for Linking Malaria and Neglected Tropical Disease Control to Achieve a Common Goal,” makes a compelling case for integrating approaches to control malaria and NTDs in order to mitigate their devastating impacts in a cost-effective way. Together, malaria and the seven most common NTDs cause almost two million deaths and are responsible for the loss of nearly 100 million disability-adjusted life years (DALYs) annually - almost 20% higher than the disease burden from HIV/AIDS. Both malaria and NTDs cause immense suffering largely through anemia, a deficiency in hemoglobin often accompanied by a reduced number of red blood cells. Anemia accounts for up to half of the malaria deaths in young children, and is a major contributor to both the enormous burden of maternal deaths during pregnancy and to premature births. Chronic anemia in young children is also tied to reduction in physical growth, impaired cognition, and poor school performance.

Co-infection with malaria and one or more NTDs (especially hookworm infection or schistosomiasis, two of the most common NTDs in sub-Saharan Africa) causes a pronounced exacerbation of anemia. Co-infection of malaria and NTDs causes lower hemoglobin levels, shown to be higher than in those with only a single infection. This phenomenon is commonly referred to the “perfect storm of anemia.”

Malaria control and NTD control have each been found to reduce anemia in both children and pregnant women. “Combining malaria and NTD control practices in a unified anemia framework affords one of the best opportunities to reduce the perfect storm of anemia morbidity and mortality in sub-Saharan Africa,” said Peter J. Hotez, MD, PhD, President of the Sabin Vaccine Institute and Walter G. Ross Professor and Chair of the Department of Microbiology, Immunology, and Tropical Medicine at The George Washington University.

The analysis also stated that, “in addition to the health improvement that would result from anemia reduction, there is also some evidence that hookworm and schistosomiasis (and possibly other NTDs) may promote increased susceptibility to malaria, so that NTD control would work in synergy with nets and other measures to reduce malaria incidence.” The use of bed-nets was shown to increase substantially - in some cases nine-fold - when used alongside NTD control efforts.

“Based on this link, the public-private partnerships of the Global Network for NTDs are working to identify opportunities for integrating malaria and NTD control efforts in sub-Saharan Africa” said Kari Stoever, Managing Director of the Global Network for Neglected Tropical Diseases. “The Network’s effective system of delivering treatment through trained local community coordinators is an ideal way to enhance malaria control and NTD control efforts and, ultimately, reduce deadly cases of these diseases and anemia.”

Noting that NTD control can cost as little as 50 cents per person per year, the authors stated that this inexpensive investment would be “another promising, low-cost and highly cost-effective, and complementary approach for potentially reducing the morbidity of malaria in sub-Saharan Africa.”

“An integrated control program for tropical anemia in Africa represents one of our better hopes for a quick win in the fight for sustainable disease control and poverty reduction integration,” Dr. Hotez and Dr. Molyneux concluded. By taking a more holistic approach to disease control and prevention, we can finally help the people of sub-Saharan Africa break out of the cycle of poverty that has been plaguing them for so long.

Read the press release.