Parel for malaria and fever diagnosis in Africa

How can the diagnosis and treatment of young children with fever be improved in Africa? This was the focus of the ZonMw RAPDIF project. Researchers in the Netherlands and Burkina Faso developed a new malaria test and identified bacteria that cause fever. On 19 November ZonMw awarded a Parel (Pearl Award) to research coordinator on the project Dr. Henk Schallig.

RAPDIF was a study performed on under-fives presenting with fever in Burkina Faso. It found that young children with fever are often prescribed both antibiotics and anti-malaria medication, even if the underlying cause of the fever is unclear. ‘Our research found that in 50 to 90% of cases, the antibiotics did not help the children’, says Dr. Henk Schallig, a parasitologist at Amsterdam UMC. He coordinated the RAPDIF study that took place in Burkina Faso from 2014 to 2018.

Doubts and poor therapy compliance

‘One critical problem is the lack of adequate diagnostics for fever’, Schallig explains. ‘Despite WHO guidelines the practice at local health clinics is complex in African countries like Burkina Faso. It’s also partly a matter of what’s available. Furthermore, health workers have justified doubts about the current rapid tests for malaria, and they are under pressure from parents to play it safe. So prescribing both antibiotics doesn’t help, and it exacerbates antimicrobial resistance. This is all made worse by poor therapy compliance. Parents often don’t ensure their child completes the course of antibiotics, because they think he or she is already better, and they save the remaining medicine for other children.’

Accurate new malaria test

RAPDIF succeeded in developing a new diagnostic malaria test that is no less than 100 times more sensitive. The test is so powerful because it works on a different principle, directly measuring the DNA of the malaria parasite, unlike the current rapid tests, which measure a protein (HPR2) produced by the malaria parasite. ‘Our study showed that the new test can determine with great certainty and accuracy whether a child with fever has malaria’, says Schallig. ‘Local healthcare workers in Burkina Faso also have more faith in this test.’

The RAPDIF project is now finished, but the research is continuing with new funding. The researchers will test their new vaccine in 2021 on some 5700 children and adults in five countries in Africa (Namibia, Sudan, Ethiopia, Kenya and Burkina Faso). The test will also be used by Amref Flying Doctors in remote areas. ‘Every country has a different strain of malaria or a different situation’, says Schallig. ‘We’ll see how well the new malaria test does and whether local health workers trust it and comply with the outcome. We expect the research to yield results by the end of 2023. If our malaria test turns out to be suitable for implementation in those five countries in Africa, it will certainly also be suitable for Southeast Asia and Latin America, where malaria is also prevalent.’

Bacterial diagnostic test

Malaria might be the most common cause of fever in young children, but there are other causes too. Research by the RAPDIF team among more than 700 Burkinabe children found that, alongside malaria, the bacteria E. coli, Salmonella typhi, Pneumococcus and Streptococcus are also common causes of fever. They then set about developing a diagnostic test which, like the malaria test, would quickly and easily detect the presence of bacteria in the blood. ‘However, it’s technically very difficult to pick up bacterial DNA in blood’, explains Schallig. ‘It’s easy if you have big, expensive facilities at an institute, but not with a portable test you can perform anywhere. We certainly have some more ideas about how to tackle this issue, but unfortunately we don’t have the funding. A rapid test for bacterial infections would allow people to be treated in a much more targeted way, with the right antibiotics, thus preventing antimicrobial resistance. That would also benefit us here in the Netherlands, because resistant sources of infection in Africa eventually spread to the rest of the world via travellers, as hsa happened with the coronavirus.’

Parel for malaria and fever diagnosis in Africa

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