However, malaria remains the disease with the largest burden of illness and death of all preventable causes of child illness today, especially in the sub-Saharan Africa region, where under-fives bear a disproportionate share of disease. Vaccines such as the RTS, and S/AS01 (AMAECHA; Mosquirix) have slightly lowered childhood infections, but additional strategies to add to vaccination are very clearly needed. New malaria prevention technologies for children are stepping into this gap. In this article, we explore some of the most promising innovations beyond the vaccine that could transform the way we protect children from malaria.
The Need for Innovative Pediatric Malaria Prevention
Below the age of five, children are most vulnerable to severe malaria requiring hospitalization and high mortality; even with better drug treatments and new vaccine approaches, challenges associated with vaccine coverage, drug resistance, and logistical issues – especially in remote areas – highlight the need for complementary prevention technologies. To overcome this, new approaches to prevention outside the realm of traditional vaccination are needed.
Novel Pediatric Malaria Prevention Technologies
1. Long-Lasting Insecticidal Nets (LLINs)
LLINs remain a mainstay of malaria prevention, and recent redesigns have made these nets both more effective and child-friendly.
- Improved insecticides: New formulations of insecticides, some with two active ingredients, provide better efficacy and longer-lasting protection against mosquitoes.
- Child-Specific Designs: Newer LLINs have features such as bright colors and patterns that are more attractive to children and potentially more acceptable in the home.
2. Insecticide-treated curtains and Mosquito Repellent Fabrics
Other alternatives include insecticide-treated curtains and other mosquito-repellent fabrics that ensure that children have indoor protection from mosquito bites.
- Insecticide-Treated Fabrics: Use curtains, clothing, and bedding treated with long-lasting insect repellents as additional physical barriers to block mosquito bites.
- Customized to specific settings and tastes: Tailor these solutions to specific settings and preferences to enhance their acceptance.
3. Biological Control Methods
Biological control interventions aim to further reduce the incidence of malaria by ‘managing’ mosquito populations with their natural predators or pathogens.
- Larvicides: certain larvicides may be introduced to breeding sites to attack the larvae of mosquitoes without affecting other species, such as Bacillus thuringiensis israelensis (Bti).
- Predator Species animals (such as fishes and some insects that naturally eat mosquito eggs and larvae) that eat mosquitoes and help to control mosquito populations at breeding sites.
4. Genetic Control Technologies
Traits sterilization via the CRISPR-Cas9 machine, or coding to prevent a mosquito from biting or developing and carrying the malaria parasite, would reduce number of insects, or their transmission ability.
- Genetically Modified Mosquitoes: The release of genetically modified mosquitoes that cannot transmit malaria can depress local mosquito populations.
- Sterile insect techniques: using irradiated male insects to mate with wild females, which produces female offspring that die.
5. Innovative Drug Delivery Systems
Novel drug delivery systems can enhance the efficacy of antimalarial treatments as well as adherence to these treatments – particularly in young children.
With their mild, painless, and precise administration, microneedle patches can deliver antimalarial drugs much more effectively, serving to bolster compliance in pediatric populations.
Orally Disintegrating Tablets: These tablets quickly dissolve in the mouth so that a glass of water is not usually needed for children to swallow the tablet: orodispersible tablets
6. Wearable Technology
Wearable technology can provide real-time monitoring and protection against malaria.
Smart, hypoallergenic wristbands: equipped with sensors, they can access ongoing environmental conditions, warning of any surge in mosquito activity to prevent episodes of malaria.
Fever: Small, wearable temperature sensors able to detect a child’s fever early on could lead to prompt diagnosis and treatment for malaria.
7. Environmental Management Technologies
Scientific innovations that help to control the environment could reduce both the breeding sites of mosquitoes and the overall transmission of malaria.
Automated Breeding Site Surveillance: Sensors and drones can be used to surveil and manage mosquito breeding sites and intervene in ‘just-in-time’ ways.
Benefits of Novel Prevention Technologies
1. Increased Effectiveness
The products made possible by new technology often also bring new efficiencies, because many new drugs and insecticides last longer and are more effective than older ones.
2. Better Adherence and Acceptance
Child-centered technologies – for example, attractive LLIN and easy-to-use drug-delivery systems — can increase adherence and acceptability, enhancing access for children as well as their caretakers.
3. Complementary Protection
By combining different types of technologies, we can develop multiple prevention layers to cover all modes of malaria transmission and provide greater overall protection.
4. Reduced Vector Populations
Genetic and biological control techniques can limit mosquito populations and malaria transmission as they reduce mosquito populations and lower their vectorial capacity. As a result, over several years there will be a reduction in malaria incidence.
Challenges and Considerations
1. Cost and Accessibility
This costs money, of course – something always vulnerable in resource-poor settings. The realization of the dream needs low-cost, and wide adoption.
2. Integration into Existing Programs
For new technologies to have the biggest impact, they have to be worked into existing programs to prevent and control malaria. This means coordinating with the people and agencies already using those programs.
3. Safety and Efficacy
Every new technology undergoes rigorous testing to ensure safety and effectiveness, particularly when used with vulnerable groups like children. Researchers conduct thorough clinical trials, paving the way for careful regulatory approval.
4. Community Acceptance
The Way Forward
Transformation of novel pediatric malaria prevention technologies will only be realized through:
- Investing in research and development is crucial for driving innovation and ensuring that new technologies provide health benefits while remaining affordable. This investment acts as a catalyst, enabling advancements that improve lives.
- Strengthen Health Systems: Developing robust health systems that can support the distribution, monitoring, and maintenance of new technologies, will be key to their success.
- Foster Partnerships: Governments could also enhance collaboration with NGOs, private sector partners, and communities to develop and deliver new solutions.
- Foster education and awareness: Educating communities about the benefits and use of new technologies, and about why it is important to use them, fosters acceptance and compliance.
Investing in the development and scaling up of novel malaria prevention technologies for young children can provide a powerful complement to existing chemoprophylaxis strategies as well as marker-guided modifications of antimalarial drug use in these vulnerable children. In addition to behavioral approaches to prevent malaria, such as prompt and complete use of ITNs, the optimization of existing vector-control tools and new genetic control strategies are crucial. Moreover, novel drug formulations designed for improved compliance or more targeted drug-delivery modalities could serve as important adjuncts to the current armamentarium used for this age group.
The next decade and beyond promise to offer innovative and powerful technological tools to protect young malaria-endemic children. Specifically, as new drugs, novel drug formulations, genetic control tools, and more effective mosquito control strategies develop, they can enable us to reach the goal of eradicating malaria and liberating many more children from the debilitating effects of this ancient scourge. Ultimately, these advancements hold the potential to significantly improve the health and well-being of vulnerable population
