This week malaria world featured an interesting article about the ‘collateral damage’ caused by insecticides used against mosquitos and how the effect on nuisance insects is a major reason people continued to use insecticide treated nets. The authors are concerned that the development of resistance by bedbugs and cockroaches to the insecticides usually used on insecticide treated nets was discouraging continued use of these products.
They found that recipients of insecticide treated nets and other indoor and outdoor insecticide treatment programmes are more likely to continue their use if they are effective against nuisance insects such as bedbugs, cockroaches and house flies. But as insecticide resistant strains of these pests become more common, they are more likely to discontinue their use.
This suggests that many people in the target countries (including Tanzania, Gambia, Papua New Guinea, Botswana, India, Ethiopia) may value the effect of these insecticides more on reduction of nuisance insects than they do as a prevention of bites by the supposed disease vector mosquitos. They do not seem as concerned with preventing mosquito bites.
If the instinct of the potential victims is ambivalent, again, the question has to asked – why are malaria researchers so convinced that the disease diagnosed as malaria is actually spread by mosquitos? The underlying basis for this belief, the research carried out 120 years ago by Ross, Grassi and others is far from convincing. I refer to my books ‘Malaria is spread by mosquitos?’ and translation of Grassi’s ‘Studies Of A Zoologist About Malaria’ for more information.
The core of the research, sponsored by the Wellcome Trust, is that the efficacy of artemisinin derivatives, the cornerstone of current treatments for malaria, is being compromised in Africa. Mutations indicating artemisinin-resistance have been found in more than 10% of malaria infected individuals in Ethiopia, Eritrea, Rwanda, Uganda, and Tanzania. Dr Mehul Dhorda recommends that “Combining an artemisinin derivative drug with two partner drugs in triple artemisinin combination therapies (TACTs) is the simplest, most affordable, readily implementable, and sustainable approach to counter artemisinin resistance.”
The Kokori article goes to great length to extol the benefits of three treatments together instead of one but the evidence does not seem very convincing. They note that adding mefloquine or amodiaquine to existing artemisinin-based combinations was associated with a slight increase in the incidence of vomiting. And adding amodiaquine slightly prolonged the QTc interval (a measure of the heart’s electrical activity), although it did not reach levels associated with cardiac arrhythmias. And as for efficacy, TACT was not inferior to ACT for treating uncomplicated Plasmodium Falciparum malaria!
Also, coincidentally this week I saw for the first time a tweet associating artemisinin with detoxification of COVID-19 vaccines (and also as a treatment for COVID). This information from China is interesting. I have no reason to suspect that it is any more effective at treating these than it is at treating malaria, but if were suffering seriously from the side-effects of you know what I might be inclined to try it.
I am suspicious of the description of illnesses as asymptomatic especially since such reports were used to raise fears during the COVID19 pandemic. In this paper three methods were used to identify asymptomatic cases. The overall prevalence of Asymptomatic malaria in pregnancy (AMiP) was 15.3%. It was 11.3% measured by rapid diagnostic tests (RTD), 11.8% by microscopy and 17.6% by PCR. (With PCR the prevalence of ‘asymptomatic illness’ is significantly greater than the other two methods of detection. It is unclear how it can be considered a valid diagnostic test).
Those who tested positive were associated with not utilizing insecticide-treated net (ITN) within the previous week, having a history of malaria within the previous year and lack of indoor residual spraying (IRS) within the previous year. The second observation is obvious. The other two observations imply that if they had used the treated nets or sprayed their homes, they would have been less likely to contract their asymptomatic ‘illness’. But it does not say what other factors might be associated with these two factors and be the more likely reason. Poverty and malnutrition are probably associated with those who had less access to the interventions.
What was also interesting was the underlying justification for the research, that preventing asymptomatic malaria in pregnancy is a worthy enough goal to justify insecticidal and pharmaceutical interventions. Two articles were cited in the background for this. The first by Saito et al (2020) contains no evidence to support this. The second by Fried and Duffy (2017), a review article has a supporting reference, McGready et al (2012) with data that may support the goal.
This study of 17,613 chosen from 48,424 pregnant women in Thailand used microscopy to screen for malaria and determine if it was Plasmodium falciparum or Plasmodium vivax. Of the 17,613 pregnant women 80% delivered babies and 20% miscarried. 95% did not have malaria in the first trimester. The data state that 32% of those with asymptomatic malaria miscarried and 47% of those with symptomatic malaria miscarried. This does suggest that there is an association of asymptomatic malaria to increased risk of miscarriage, although notes in the article state than many data are missing.
But what does this mean? The microscopy analysis finds plasmodia in the blood. These organisms clean up dead cells and so indicate possible recent illness. Clearly those without symptoms are not as unwell as those with obvious symptoms but may have just recovered. As such it is not surprising that they were slightly more likely to have adverse pregnancy outcomes, but better than those with symptoms. It is also worth noting that most of those with symptomatic malaria in the study were treated with chloroquine, quinine or artesunate and were still very likely to miscarry.
And none of this research in any way supports the underlying mosquito-malaria hypothesis or proves that treatment will improve outcomes.
My Blog post from last week reported a correlation between incidence of malaria in 0-5 year olds and their mother’s participation in IPTp programmes during pregnancy. Clearly there is no mechanism by which this could be the cause so it is one case in which correlation is not linked to causation. The purpose of IPTp is to prevent malaria during pregnancy. So what evidence is there that IPTp is effective?
The introduction of the Xu paper references the WHO World Malaria Report, 2023, and states malaria is mostly found in tropical countries and poses the greatest risk to vulnerable populations, such as pregnant women, young children, international tourists, and people living with HIV. The report claims that in 2022, 35% of pregnant women in susceptible African nations were ‘exposed to malaria infection’. However, 22% of the population as a whole in these countries were exposed. There is greater risk, but could it be explained by other factors?
The increased incidence of malaria during pregnancy was shown in 1983 by Brabin in An analysis of malaria in pregnancy in Africa. But women in all countries suffer from additional health issues while pregnant. Is it surprising that potentially malnourished pregnant women in poorer countries where ‘malaria’ is a commonly diagnosed illness might be more susceptible?
Based on this increased susceptibility, the WHO in 2012 updated recommendations that IPTp treatment with sulfadoxine-pyrimethamine (SP) should be administered as part of ante-natal care in susceptible countries at every ante-natal visit starting as early as possible in the second trimester, provided that doses are at least one month apart. The WHO claims sulfadoxine-pyrimethamine (SP) is safe and effective for pregnant women, a claim somewhat doubted by US FDA who grade it Pregnancy category C. Risk not ruled out: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
So why are there no well-controlled studies in humans showing a benefit? No evidence is provided in the Xu et al paper, or any other research article I have reviewed, that there are benefits to pregnant women from administration of this toxic medication. I wonder why these research results are not available?
Malaria World this week has an interesting research article published in BMC by Mbishi et al that finds that poverty is a significant factor in the prevalence of malaria. The findings of the pooled data research article found that maternal education, household wealth and rural/urban place of residence had significant effects on the occurrence of malaria. This result concurs with observations from other studies and seems to point to the importance of factors other than mosquito bites.
But the article also found a positive benefit linked to Fansidar uptake during pregnancy. Fansidar is a Hoffmann-La Roche trademark for the malaria drug sulfadoxine/pyrimethamine frequently used in Intermittent Preventive Treatment of Malaria (IPT) programmes in target countries. This drug has the usual long list of potential side effects including stomach pain, feeling full, hair loss, headache, muscle weakness, depression, nervousness, ringing in your ears, sleep problems (insomnia), diarrhoea, dizziness, nausea, vomiting, and loss of appetite. An FDA warning states FATALITIES ASSOCIATED WITH THE ADMINISTRATION OF FANSIDAR (sulfadoxine and pyrimethamine) HAVE OCCURRED DUE TO SEVERE REACTIONS, INCLUDING STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS.
The benefit was associated with use during pregnancy. The data sheet also states There are no adequate and well-controlled studies in pregnant women. However, due to the teratogenic effect shown in animals and because pyrimethamine plus sulfadoxine may interfere with folic acid metabolism, Fansidar (sulfadoxine and pyrimethamine) therapy should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Women of childbearing potential who are traveling to areas where malaria is endemic should be warned against becoming pregnant, and should be advised to practice contraception during prophylaxis with Fansidar (sulfadoxine and pyrimethamine) and for three months after the last dose.
It is difficult to understand how their mothers taking Fansidar during pregnancy could cause a 26.9% reduction in the prevalence of malaria in children under five. It is not that the children are taking it. Given the side-effects it is probably wise for them not to. I won’t speculate. It could simply be a confounding of factors, perhaps a greater proportion of wealthier, urban women were enrolled in the IPTp programmes.
This week there was an article in Malaria World Newsletter of interest to those of us who do not live in countries in which malaria is supposedly endemic. The subject is blood donations. I am an active donor. I give blood because it supposedly reduces blood pressure. It is easy to see how this would be a short-term effect but would the effect last? But whether this is true or not, the blood may be of use to an accident victim, and my blood is uncontaminated with experimental medications.
But for 12 months after returning from Africa the Irish Blood Transfusion Service did not want my donations. I visited Gaborone in Botswana which is not on the malaria map. But because I changed planes in Addis Ababa in Ethiopia my blood was not wanted. I didn’t see a single mosquito at the airport, but the fact that I was transported to and from my planes by bus disallowed me as a donor for 12 months.
I doubt the mosquito-plasmodium link to malaria and do not see the benefit of this blood donation ban imposed by western countries. But the recent paper published in BMC based on data from Spain by Corbacho‑Loarte et al comes to the conclusion that blood donations are being restricted by the current rules and tests, even if one believes in the role of mosquitos and plasmodia.
In this study the blood of 121 potential donors, both immigrants and Spanish travellers from malaria endemic countries, who had positive results in immunological tests were retested using sensitive PCR assays. The PCR tests detect genes coding for ssrRNA, AMA1 or Plasmepsin of P. falciparum, P. malariae, P. ovale, P. vivax and P. knowlesi. All 121 tested negative for the Plasmodia.
Nevertheless, because of the positive immunological tests all 121 are still not eligible blood donors. One wonders what the objective of these restrictions are.
I am responding to your call to build collaborative partnerships for resource mobilization, research and innovation to further the goal that no one shall die of malaria.
First, I have a question for you – How do you know that malaria is spread by mosquitos?
The story of malaria transmission was first developed by medical officers in colonial armies – Charles Lavaran, a French army physician in Algeria and Ronald Ross, a British army Surgeon-major in India. Western health organisation and aid agencies continue the promotion of the transmission story and ‘cures’ based on it in a manner that has overtones of post-colonial interference. I expect that most of the aid workers have the best of intentions. They may not be aware that they are acting in a colonial manner using methods that are not in the best interests of your people and are more in the interest of western organisations.
I have a second question – how do you know that poisoning your children and your mosquitos will eliminate the scourge of malaria?
If malaria is not spread by mosquitos these ‘cures’ may cause only harm and do no good?
I have good news that may help you reduce the burden. I would like to collaborate, develop partnerships and innovate by looking at malaria in new ways.
Malaria is a disease that affects the malnourished and those without access to clean water and sanitation. It seems unlikely that it is a disease spread by mosquitos. Mosquitos are present in many countries that do not have malaria.
We can educate you about malaria, about its history, the difficulties with conventional treatment and an approach based on nutrition and WASH. The treatments promoted by some health organisations have not been proven effective such as the R21 vaccine discussed in my blog. https://usmalaria.com/blog/
The book is also available as a paperback, ebook and audiobook. Visit https://usmalaria.com/ for more information and links to the book.
I was very surprised to find out in the first few lines of the paper that it was a double-blind randomised study and the control group received an Indian rabies vaccine called Abhayrab. Listed on the netmeds website are the following side effects, and a lot more on the topic.
SIDE EFFECTS OF ABHAYRAB PF VACCINE
COMMON
Headache, dizziness
Rash, hives
General discomfort
Fatigue, weakness
Fever
Swollen glands
Decreased appetite
Nausea, vomiting, diarrhoea, stomach pain
Muscle pain, joint pain
Pain, redness, swelling, itching or bruising at the site of injection
Hardness of the skin at the site of injection
RARE
Tingling sensations
Sweating, chills
Stop receiving ABHAYRAB PF VACCINE and contact your doctor if you experience any of the following side effects: Signs of anaphylactic reactions (serious allergic reactions) such as shock (severe drop of blood pressure), itching, skin rash, swelling of face and/or neck, breathing difficulties, bluish discoloration of the tongue or lips, low blood pressure, rapid heart rate, weak pulse, skin coldness, dizziness and fainting
From April 26, 2021, to Jan 12, 2022, researchers from Oxford poisoned 5477 children in Burkina Faso with R21 or Abhayrab. Why is one supposed to take such a study seriously? R21 is marginally less toxic than a toxic vaccine against rabies, another dubious disease.
I visited Africa for the first time this winter. It was great to leave dreary wet Northern Europe to enjoy the sun vertically overhead near the Tropic of Capricorn in December. What was also pleasant was the optimism of the people and the feeling that Africa is developing quickly and the living standards of the people could soon catch up with the west.
Nearly everyone has a smart phone and the 4G coverage is good. One of the first things I did was get a local SIM to avoid roaming charges. The cars were the same as in West – mostly Japanese and typical western brands. The roads around the capital city of Botswana, Gabarone, are mostly well built. There are many new flyovers recently built by Chinese construction companies.
I was struck by a feeling that Africa has a future. I see similarities with the Ireland of 1970s in which I grew up. There are many small children. The continent is vast with much space to accommodate a rising population. There is much mineral wealth. There is a great climate for growing food and cash crops.
There are three major issues to be tackled to allow Africa to flourish – Energy, Water and governance.
While it needs much improvement, of the three we should be less worried about governance. Historically, much of Africa was ruled by colonial masters whose modus operandi was to divide and conquer the local peoples. This legacy continues with the borders of nation states typically the same as the colonial boundaries. Countries with less tribal division like Botswana do not suffer from the same issues. As the people’s expectations increase their tolerance of poor governance will decline and they will find ways to live peacefully and productively.
Availability of clean water is a major issue. Africa is the second driest continent with 9% of worlds fresh water for 16% of world population. Despite this relative lack of water, with good management there is sufficient water for drinking, agriculture and industrial needs.
Water is not evenly distributed geographically and rainfall is typically seasonal. Water distribution infrastructure is not well developed in many places.
For future economic developments in industry and agriculture more water is needed. To meet this need more infrastructure is required. More reservoirs, pipelines and associated purification facilities are needed. Many projects will cross borders.
These projects are feasible. With organisation and support there is no reason why water scarcity will continue to be an issue except in the most arid and sparsely populated areas.
Energy is not as available or reliable as elsewhere in the world. There is a deficiency of electricity infrastructure and a shortage of bottled hydrocarbon fuels for cooking, etc. In many places people have no options other than burning dung or timber to cook and heat. This results in poor internal air quality which contributes to respiratory illnesses and felling of many trees which causes environmental harm.
Africa is rich in minerals including carbon fuels. It has many great rivers not yet harnessed for hydroelectricity. With investment it should be possible to develop the fuel supply and build power power stations and a distribution network. Unfortunately, for Africa it has been affected by the climate catastrophe issue that dominates western politics. Despite much evidence that the effects of CO2 have been greatly exaggerated and investment in carbon based fuels causes many more benefits than harms, the world bank and other western sources of finance pander to the loud activists. They are reluctant to support investment for carbon fuelled energy in Africa. Unless there is a major change these projects will be supported instead by China and India. The people will demand proper electricity and their leaders will do what it takes to get it.
I recently made a presentation to a delegation developing a major carbon fuel infrastructure project in Africa about how unrealistic it is to expect to make such investments and comply with the climate change commitments made at the Paris climate conference.
Africa has a great future. Power and water infrastructure development will help it happen.
