The impact of this disease remains significant. One of the largest public health problems worldwide that continues to have a tremendous burden on children in the developing world is malaria, a disease transmitted by a mosquito of the species Anopheles that affects about 3.4 billion people and claims the lives of 675,000 children each year in nearly 100 countries. The global burden of malaria has declined significantly in recent times, reflecting remarkable achievements in improving access to tools to combat the disease, such as improved malaria diagnosis through rapid diagnosis tests (RDTs), effective treatment with new antimalarial drugs, and implementation of malaria control measures. Nevertheless, there is still much more to be done.
The Importance of Pediatric Malaria Research
Understanding Pediatric Malaria
It is children who are disproportionately affected by malaria. The disease and its consequences are more severe in children than in adults because their immune systems have not fully developed. For these reasons, research targeting pediatric malaria is important:
What is learned can also help us understand why malaria seems to affect children differently from adults. How do symptoms differ? Why does the disease progress in different ways? Why do some children respond well to treatment while others don’t? How do I know if my child has malaria? Disease diagnosis.
Treatment and prevention: Developing treatments and preventive interventions for children requires particular research efforts as not all standard adult treatments work well for children: children don’t always tolerate standard dosages and side-effects/drug interactions can be an issue.
Long-Term Implications: Malaria can affect children’s development as well as their brains in ways similar to other diseases such as meningitis. Learning about the long-term impact of malaria can help us understand the effects of policies and interventions focused on limiting these impairments.
Addressing Gaps in Current Research
There is also a tendency to study aspects of malaria that fit in with active research programs, which biases the sort of studies that currently get done. As a recent paper in Science notes, ‘pediatric malaria studies are an underrepresented component of the research portfolio’. That could lead to narrow therapeutic options and poor prevention. It can also contribute to insufficient options for treatment and prevention of malaria in children – in short, medicine can be designed for adults and assumed to be appropriate for kids, nothing more.
Challenges in Conducting Pediatric Malaria Research
Conducting research in developing countries, especially on pediatric malaria, presents several challenges:
1. Limited Resources
Research, by definition, is expensive in terms of the financial and infrastructural resources needed to design and implement it, such as laboratories, personnel, equipment, etc. For many developing countries, the lack of these substantially hinders the creation of good research.
2. Ethical Considerations
Since kids are often deemed too small or vulnerable for certain research, these studies come with particular safeguards to keep kids safe. At the same time, the recruitment of minors requires transparency about how the research might affect the child. Parents must give permission but the child has to agree.
3. Data Collection and Management
While data collection and management are the backbone of research, the infrastructure for such endeavors may be lacking, personnel may be inexperienced or untrained, and management systems for data may also be absent or obsolete.
4. Research Training and Expertise
Since postgraduate training and specialist-paid expertise are both likely to be concentrated in the developed world, this might mean more training and education in developing countries to build local capacity to encourage a culture of research.
Strategies for Encouraging Pediatric Malaria Research
1. Strengthening Research Infrastructure
Developing and enhancing research infrastructure is fundamental to supporting pediatric malaria studies. This includes:
- Providing Laboratory Equipment and Infrastructure: The provision of laboratory equipment and infrastructure to advance research efforts.
- Upgrading Data Management Systems: To avoid errors in storing and analyzing data, robust and efficient data management systems must be in place.
- Building Research Networks: Establishing networks of universities and research locales, along with healthcare facilities, to share expertise, infrastructure, and data.
2. Training and Capacity Building
However, it is necessary to build local research capacity to do effective pediatric malaria research. To do this:
- Training Programmes: Offer training programs to researchers, health professionals, and students who plan to participate in any pediatric malaria-related research, emphasizing best practices in research methods, ethics, and data management.
- Training and fellowships: Providing fellowships and scholarships to students and researchers interested in specializing in pediatric malaria.
- Initiatives for Collaborative Research: Supporting partnerships between local researchers and international experts to provide support and mentorship.
3. Promoting Ethical Research Practices
Ethical considerations are paramount in pediatric research. To ensure ethical standards:
- Form Protocols: Developing clear and publicly available ethical research guidelines involving child-related research, including but not limited to best practices in ‘informed consent’ and ‘risk management’.
- Ethics Committees: To set up or strengthen one or two ethics committees to review proposals to ensure adherence to the ethical principles outlined.
- Community Engagement: Ongoing interaction with communities to explain the research purpose and procedures; gain trust and build relationships; and when applicable, encourage participation in statistical analysis.
4. Securing Funding and Resources
Securing funding is crucial for conducting research. Strategies include:
- Grant Applications: applying to international organizations, foundations, and agencies of national governments that provide funding for malaria research.
- Public-Private Partnerships: Forming partnerships with private sector organizations to secure additional resources and support.
- Local Fundraising: Encouraging local fundraising initiatives to support research activities.
5. Encouraging Research Dissemination and Utilization
Publicizing research results and ensuring that they are used appropriately will increase the value of pediatric malaria studies.
- Promotion of Research Findings: Researchers must publish their research findings in reputable academic journals and presentations at conferences.
- Translating research to practice: Working with policymakers and health care providers to turn research findings into real-life practices and policies.
- Community Education: Developing methods aimed at raising malaria awareness so that local communities will adopt proven malaria prevention and treatment strategies.
Success Stories and Case Studies
Several initiatives have successfully fostered pediatric malaria research in developing countries:
1. The Malaria Consortium’s ACTwatch Study
The Malaria Consortium’s ACTwatch study examines access and use of artemisinin-based combination therapies (ACTs), antimalarial medicines comprised of artemisinin and partner drugs, for treating children in Africa and South-East Asia. Its data and analysis have prompted policy action to enhance treatment access and efficacy.
2. The World Health Organization (WHO) Malaria Elimination Initiative
Following a needs analysis, the WHO’s Malaria Elimination Initiative, a specialized group dedicated to improving malaria control and elimination programs, has supported research on pediatric malaria and new ways to diagnose, treat and prevent childhood malaria. These projects have provided new tools, better guidance, and improved management of pediatric malaria.
3. The PATH Malaria Vaccine Initiative
Through the PATH Malaria Vaccine Initiative, we have also funded substantial research on malaria vaccines, some focused on children’s specific responses to vaccines. This is necessary to make sure that vaccine designs are safe and effective in children.
Building a culture of research in pediatric malaria is dependent upon the investment of resources in several areas, including ethics; human research conduct; data management; capacity-building of the clinician-scientist; and the development of infrastructure, establishing important collaborations, and raising funding to support these initiatives and drive meaningful and relevant research.
Knowledge gained from pediatric malaria research helps to focus treatment and prevention strategies and can bring about long-term health benefits to the children involved. Together, attention to the ethical questions that arise, appropriate implementation of study protocols, and effective dissemination of research results can make inroads in this area, and help to improve the health of children in developing countries.
