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Commitment of countries with high incidence of malaria towards research of the disease: profile from Medline

Date: Poster sessions
Source: Forum 11
Authors: Divya Srivastava, Assistant Director General, Division of Publication and Information, Indian Council of Medical Research, India
with Rajnikant SRO

Abstract

Approximately 300­500 million people worldwide are affected by malaria with 1 to 1.5 million deaths every year. It is confined to Africa, Asia and Latin America. Approximately 75% of all recorded cases outside of Africa are concentrated in nine countries: India, Brazil, Afghanistan, Sri Lanka, Thailand, Indonesia, Viet Nam, Cambodia and China. Plasmodium falciparum infections increased during the 1990s in India and Sri Lanka because of resistance in Plasmodium falciparum to multiple drugs.

For successful control of the disease it is necessary to take stock of the trend of research being done in the area of disability-adjusted life years (DALYs) due to malaria. With this aim, the current study was conducted on the basis of papers from the Medline database that were published between 1980­2005, using five-year intervals. The data has been analysed for developing countries with high DALYs, particularly with reference to control measures.

The growth of malaria research parallels that of biomedical research (from an estimated 0.36% of total research during the 1980s to 0.43% today). Over the period studied, country-specific sources of malaria research were the United States of America (30.73% of research), the United Kingdom (26.88%) and France (5.344%) among developed countries, and India (3.59%), China (2.04%), Thailand (1.67%) and Brazil (1.21%) from developing nations.

Much of the malaria research identified was relatively basic in nature (research level = 2.7 based on individual title words), compared with some other diseases where there is more focus on patient treatment and clinical trials.

There has been an apparently large increase in the amount of malaria research taking place in Thailand. Other countries experiencing increases were India (0.78% in 1980 to 1.38% in 2005), China (0.29% in 1980 to 0.82% in 1995) and Brazil (0.34% in 1980 to 1.42% in 2000). The subject analyses indicated that the most prominent areas of research activities were: drugs, mosquito control, drug development (antimalarials), drug resistance and immunological studies (including vaccines), and artemisinin- based combination therapies (ACT). The data indicates that work on chloroquine has decreased and the newer drug artemisinin is gaining in research popularity. Of the other approaches, genetics is rising steadily, but mosquito study and control is declining in interest. What is perhaps more interesting is the variation between countries in the subjects on which they concentrate. The relative commitment to research subjects from developing countries were: Thailand (general malaria 5.25%, malaria control 1.81%, antimalarials 2.23%, mosquito control 1.22%); India (general malaria 1.47%, malaria control 0.36%, antimalarials 1.03% and immunology 0.18%), China (general malaria 0.38%, malaria control 0.10%, antimalarials 0.54%, immunology 0.05%); Brazil (general malaria 0.96%, immunology 0.19%, antimalarials 0.43%). Results for India indicate that most effort during earlier years was in research on spraying with dichloro-diphenyl-trichloroethane (DDT), dieldrin and other insecticides, but in later years the trend changed in favour of more modern and front- line areas of control measure like bed nets, biological control and use of pyrethroids etc.