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The global Malaria in Pregnancy (MiP) Consortium, led by the Liverpool School of Tropical Medicine, has been awarded €11 million by the European and Developing Countries Clinical Trials Partnership (EDCTP) to undertake three new strands of research in Africa. The three grant recipients – the Liverpool School of Tropical Medicine, the Barcelona Center for International Health Research in Spain and the Prince Leopold Institute of Tropical Medicine in Belgium – will evaluate new and improved existing interventions for the prevention and treatment of malaria in pregnancy, which places up to 50 million women at risk every year.
Malaria in pregnancy is a major cause of severe maternal anaemia and preventable low birth weight in infants, which greatly increases the risk of infant death. In Africa, where malaria is endemic in most countries, its complications are responsible for as many as 100,000 infants dying needlessly every year. Malaria also accounts for approximately 10% of maternal deaths, suggesting that an estimated 25,000 maternal deaths could be prevented each year by improved control of malaria in pregnancy.
The Liverpool School of Tropical Medicine (LSTM) has been awarded €3.6 million to undertake research to optimise the use of a particular antimalarial drug, sulphadoxine-pyrimethamine or SP, given to prevent malaria in pregnancy in Africa. Intermittent preventive treatment (IPTp) has proven highly effective in reducing the adverse effects of malaria infection in pregnant women and improving birth weight (and hence survival rates) in infants. The project is seeking to optimise the regimen of SP, which is used widely as IPTp whilst also looking at alternative approaches to IPTp. Consortium leader and project coordinator Professor Feiko ter Kuile explained the significance and future relevance of the activities led by LSTM: "SP is one of the main antimalarials used for the control of malaria in pregnancy, but despite ten years of widespread use, uncertainties about the optimal dose remain. This project will allow us to explore whether pregnant women need a different dose to non-pregnant women because of changes in the way the drug is assimilated during pregnancy. The results of this research will be used to inform WHO policy recommendations on the use of SP."
The Barcelona Center for International Health Research (CRESIB) has been awarded €3.6 million to undertake research to evaluate different drug alternatives, mefloquine (or MQ) and SP, for use as IPTp in the context of insecticide treated nets to prevent malaria in pregnancy. Project coordinator Dr. Clara Menendez stressed the complexities of treating malaria: "the spread of parasite resistance to SP, particularly in Eastern Africa and the significant overlap in some regions of malaria transmission together with a high prevalence of HIV infection have raised concerns about the medium and long-term use of SP for IPTp. Among the current available alternative antimalarial drugs, MQ offers the most comparable advantages to SP".
The Prince Leopold Institute of Tropical Medicine (ITM) has been awarded €3.7 million to undertake research to determine the safety and efficacy of available Artemesinin-based combination treatments (or ACT's) to treat malaria during the second and third trimesters of pregnancy. Project coordinator Prof. Umberto D'Alessandro stated that "by completing a head-to-head comparison of four treatment drugs (Dihydroartermisinin-Piperaquine,
Mefloquine-Artesunate, Amodiaquine-Artesunate and Artemether-Lumefantrine), we can identify not only valid first line treatments but also second line rescue treatments, aimed at informing WHO guidelines and drug policy in endemic countries".
All three research projects include a significant element of capacity building in the African host nations, including infrastructural upgrading of fifteen research sites (five per project) and a series of short term training courses in Good Clinical Practice (GCP), Good Clinical Laboratory Practice (GCLP), clinical trial methodology, research ethics, statistics, and data and research management. Several longer term training positions involving MSc and PhD scholarships will also be awarded.