A very interesting article was listed in news-medical.net this week. The open access article called ‘Animal-sourced foods improve child nutrition in Africa’ by Khonje and Qaim used representative data from five African countries—Ethiopia, Malawi, Nigeria, Tanzania, and Uganda—to show that the consumption of animal-sourced foods (ASF) contributes to improving child nutritional outcomes and that these positive effects cannot always be provided by plant-based foods alone. This counters the general calls to reduce ASF consumption for more sustainability. The authors consider that this call to lower consumption of ASF is not fully applicable to Africa, where average ASF consumption is low.

The article compares the effect on the health of children of the consumption of ASF and nutritious plant-based foods (NPBF) such as legumes, fruit and vegetables. Stunting is more common in Africa where nutrition for children is often inadequate and consumption of ASF is low. Consumption of NPSF does not reduce the likelihood of stunting as much as consumption of ASF. Eggs are the most effective ASF for increasing the height of children and reducing stunting. The authors also make the point that ASF is more likely to be available year-round. Much nutritious plant-based food is seasonable and less available in rural Africa due to poor infrastructure and refrigeration facilities.

While malaria is not mentioned in the article, in earlier posts and in my book ‘Malaria is Spread by Mosquitos?’ I have referred to the fact that incidence of malaria is linked to malnutrition. I have little doubt that if a study were carried out of the effect of the incidence of malaria on consumption of ASF it would have a very positive and statistically significant result.

Two articles in Malaria World pertaining to the two countries with the largest numbers of deaths attributed to malaria caught my attention. The first is the lead article, a BBC report about vaccine rollout in Nigeria the most afflicted country with 26.8% of deaths. The article describes the roll-out of the new vaccine called R21/Matrix-M which started in two of the worst-affected states – Bayelsa and Kebbi. It is planed is to expand it to the rest of the country by next year.

R21/Matrix-M, developed by the Jenner Institute at Oxford University, uses three doses administered four weeks apart and a booster dose given after one year. In an earlier article I described that it was not tested against a true placebo, but was compared for side effects against a rabies vaccine. My email to WHO and UNICEF asking if they had any other evidence to justify dosing malnourished children in Southern Sudan with the R21 chemical concoction received no response. Oxford was also the place the Astra-Zeneca COVID19 vaccine was developed and that did not turn out too well in the end.

Another article in Malaria Word by Alhassan et al, is Call for elimination program of Malaria among children under 5 years old living in refugee camps in eastern Democratic Republic of Congo. DRC is number two for malaria attributed deaths with 12.3% of worldwide malaria deaths. The article’s message is typical, a call to boost the traditional malaria interventions of distributing insecticide-treated nets and drugs, by improving vector control, improved diagnosis and treatment capabilities, and strengthening local health systems.

But the article in its discussions does provide important clues about why malaria is serious in deprived parts of the DRC. The authors state that refugees are more susceptible to contracting malaria infections by their lack of protective immunity, increased concentration of people in endemic settings, limited resources, their poor exposed living conditions, residing in unfinished houses, poor drainage and acute malnutrition among the children due to inadequate food rations. However, instead of proposing activities to improve these unhealthy living conditions the authors call for more of the usual supposed solutions – more testing, more poisons for people and more poisons for insects.

A very interesting article in Malaria Journal by Ashton et al, Efficacy of attractive targeted sugar bait stations (ATBS) against malaria in Western Province Zambia: epidemiological findings from a two-arm cluster randomized phase III trial, describes a large real world trial of the efficacy of sugar baits affixed to the walls of buildings laced with clothianidin-deltamethrin (Fludora® Fusion,Bayer) at preventing malaria. Mosquitos live on nectar and other natural sugar sources. Female mosquitos only require a blood meal as extra nutrition prior to laying eggs.

This study actually looks for the incidence of malaria. Previous studies showed that such baits could reduce the prevalence of Anopheles mosquitos by up to 90%. And in this detailed study with over 120,000 target population evenly split between test and control groups, the use of ATSBs did not statistically reduce the number of cases of malaria identified clinically or by RTD tests of plasmodia. And compared to the control arm, the ATSB arm had higher reports of eye irritation, although the DSMB (Data Safety Monitoring Board) determined that these adverse events were not related to the intervention.

The authors report that results of similar studies in Mali and Kenya are in preparation. The question that probably did not cross their minds, is whether mosquitos actually spread malaria, so how would killing them affect the incidence? Could this be the reason the study did not demonstrate a statistical reduction of malaria incidence?

This week I introduce similarities and differences of the approach to AIDS and Malaria in Africa. African friends express more concern about AIDS and HIV. In many cases that have known victims and it seems a more real threat. I have not examined HIV/AIDS in any great detail as many others more qualified on the topic than me have been examining the truths of it since Gallo and Montagnier first launched this new disease on the world in the 1980’s. Peter Duisberg, The Perth Group, Mike Stone in viroliegy, and many other have examined the weaknesses of the establishment case as presented in Wikipedia or by the UN in much more detail than I ever could. I recommend Virus Mania by Engelbrecht et al as a good first read on this and other diseases.

Similarities are ~600,000 annual worldwide deaths, both are usually ‘diagnosed’ with a variety of non-specific symptoms and a Rapid Diagnostic Test (RTD), and both diseases are more likely to affect the malnourished and otherwise deprived. The major difference is that HIV/AIDS is supposedly transmissible between people, usually sexually, whereas Malaria requires a vector. HIV/AIDS is more likely to affect adults whereas Malaria affects children moreso.

The telltale AIDS illnesses such as Kaposi’s sarcoma were common in Africa a long time before the supposed discovery of HIV and AIDS. And from 1985 until ~2000 AIDS was not diagnosed in Africa without the anti-body test, but with a variety of conditions that were not unusual. The ‘Bangui Definition’ diagnosed AIDS if the patient had three of four major clinical signs – loss of body weight (>10%), chronic asthenia (weakness), chronic fever and chronic diarrhoea. AIDS is notable for having widely definitions depending on country.

The supposed sexual transmission adds greatly to the stigma about HIV, especially for females, a majority of test positives in Africa. Pregnancy and other conditions often cause positive HIV tests. However, sexual transmission has not been proven. The best evidence, in particular the Padian 1997 study suggests it is not.

The cure is much worse than the disease to a much greater extent than for malaria. Many working in the field suspect that poor quality anti-virals dispensed to patients cause them harm. Many who have examined the early celebrity victims of the 1980-90s (Rock Husdon, Freddy Mercury, Rudolf Nureyev, Arthur Ashe) feel that the drugs they took contributed significantly to their demise.

HIV/AIDS is big business. The 2024 UN global AIDS Update is a large book emphasising sexual health and drugs dispensing. Of course, like many conditions it would be eliminated in the morning with one simple act – stop testing for it. But then of course they might have to attend real issues.

Malaria World this week featured the news –  New drug could help fight against treatment-resistant malaria. The article referenced by Scottish  researchers Brettell et al was published in the Journal of Medicinal Chemistry and is entitled Targeting Pf CLK3 with Covalent Inhibitors: A Novel Strategy for Malaria Treatment.

In summary, the novel compounds developed inhibit the development of Plasmodium falciparum plasmodia by inhibiting the enzyme Plasmodium falciparum cyclin-dependent like protein kinase-3 (Pf CLK3), one of a family of four protein kinases with a role in the phosphorylation and assembly of components of the RNA spliceosome. The paper includes a detailed description of the chemistry including synthesis, molecular structures and an in vitro comparison of efficacy with artemisinin at inhibiting development of plasmodia.

The paper is impressive looking with detailed graphics. The research at the University of Glasgow was carried out in association with Keltic Pharma Therapeutics Ltd who are partners of Bill and Melinda Gates Foundation and Control Malaria.

Most common malaria treatments are now generic drugs. Developing new, supposedly effective, drugs is important to the pharmaceutical industry to maximise profits.

But obviously a drug with a mechanism such as this is only going to be effective at curing malaria if the Plasmodium infections it targets are the cause of illness.  If they are the clean-up crew as I and other ‘terrain theory supporters’ believe, inhibiting their development is not going to benefit the patient and may even cause harm.

For the second time in recent weeks, I am glad to report that some malaria researchers are questioning the use of insecticides to combat malaria. A proof copy of a review paper by Oberlin et al entitled ‘Effect of Indoor Residual Spraying on Malaria in Pregnancy and Pregnancy Outcomes: A Systematic Review’ was included in Malaria World this week. The authors screened 1,845 abstracts and included 17 articles in their review, one in India and the others from various African nations.

There was confounding of different methods in the studies – IRS, IPTp and bednets. In nine of the 17 studies the insecticide used is not identified. Some studies looked for parasites. Others relied on self-reporting of symptoms, which can be subject to bias. Three studies claimed to detect a reduction in placental malaria in those exposed to IRS.

Just five studies examined pregnancy and neonatal outcomes. One study only showed a significant benefit in the group exposed to IRS for 90% of the pregnancy. Conversely, another showed a significant INCREASE in preterm births (PTB) in those exposed to IRS during pregnancy. Some studies showed a decrease in low birth weight (LBW) when exposed to IRS during pregnancy but not all. There were mixed results to the question of a reduction of fetal and neonatal fatalities.

However, one study evaluated the risk of external urogenital birth defects in male infants born to mothers exposed to IRS and found the risk of any urogenital birth defect was 33% greater in those exposed to IRS. Only five of the studies were considered good, including the two studies that found the most negative results. Most of the studies examined were considered fair or poor.

The authors concluded ‘…without high-quality evidence to understand the potential risks and benefits of its use, no clear endorsement of its use to protect pregnant women can be made. Caution is also warranted given demonstrated negative long-term impact on childhood neurodevelopment from prenatal exposure to certain insecticides’.

[picture from www(dot)swissmalariagroup(dot)ch]

This week in Malaria World, MMV (Medicines for Malaria Venture), a Swiss based NGO founded with funding from Rockefeller foundation and others, announced clinical trials of MMV371, an ester-linked acetyl derivative of atovaquone, one of the components of GSKs Malarone, a combination of atovaquone and proguanil that is taken orally.

Drugs.com report side effects for atovaquone/proguanil; severe or uncontrolled vomiting or diarrhoea; fever, mouth sores; problems with speech, balance, or walking; severe skin rash; nausea, stomach pain, loss of appetite, dark urine, clay-coloured stools, jaundice (yellowing of the skin or eyes); easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin.

Just imagine how much worse side-effects could be when directly injected.

The trial itself, in conjunction with Quotient Sciences, is taking place in Nottinghamshire, UK and it is unclear what will be given to the placebo group. The first cohort will receive 112 mg or placebo by intramuscular injections. Second and third cohorts to receive double of quadruple doses, up to 446 mg. I wonder will the placebo be a true placebo? I reported that the trial of R21 vaccine used a relatively toxic Indian polio vaccine instead of a true placebo.

More information on MMV371 development is available in Malaria Journal article by El Gaaloul et al.

Can we compare trial subjects in Nottinghamshire, UK to the likely target patients, perhaps malnourished children under five? Pending positive outcomes of the study, clinical trials in malaria-endemic countries are expected to begin in 2026. The promotors claim the final product could have the potential to complement existing interventions such as vaccines; seasonal malaria chemoprevention (SMC), mainly administered to children under five. I have more discussion of SMC drugs in my book ‘Malaria is Spread by Mosquitos?’ and previous blog posts.

I was pleasantly surprised to note that the lead article in malaria world this week is an article by the editor of Malaria World Journal, Bart Knols, expressing concern about the impact of chemicals used for mosquito control. In the article entitled ‘A shot in the foot: Could chemical control of malaria vectors threaten food security?’, Knols expresses concern that the malaria research community has become enslaved to thinking that controlling malaria mosquitos equals the use of chemical insecticides.

The article does include the unsupported statement ‘Although chemical control has undoubtedly saved millions of lives, which, morally speaking would immediately justify its continued use, it has many sides that may ultimately cost more lives than it saves.’ There is no reference to support the life saving claim of insecticide use, so this article is clearly a long way from questioning the overall transmission story. But at least it is a useful start that such an eminent researcher in the malaria community is willing to question some of the dogma.

Knols states in his article, that after a posting on LinkedIn arguing against aerial spraying of insecticides in Africa, he was called a tree-hugger!

However, Knols still wants to kill mosquitos and is a believer in the mosquito transmission story. Much of his article is promoting other methods of killing mosquitos such as traps or genetic methods. He admits he is actively involved in the development of insecticide-free products and strategies for mosquito control. He has links to a company, K&S Holding BV, that has developed mass trapping options for dengue vectors based on the use of Biogents A.G. (Germany) traps.

Nonetheless, if members of the malaria research community are starting to become aware that poisoning the environment might have negative consequences, perhaps soon some of them, less financially reliant on the purveyors of poison to kill mosquitos or ‘treat’ people, might start to look more deeply for the real causes of the deadly ailment called malaria.

(Picture from mosquitojoe.com)

Three articles this week reminded me how unquestioned the belief that malaria is spread by insect vectors is. This belief is supported by confirmation bias. Every result that suggests a connection is highlighted. Any evidence that does not support the belief is explained away or ignored. This is no different than the approach of Ross or Grassi >120 years ago.

First, in the climate sceptic website wattsupwiththat there was an article entitled ‘European Trainee Doctors to Have Fake Malaria Climate Myths Added to Their Studies’. It challenges the climate change scare that higher global temperatures will increase malaria by increasing mosquito habitats, pointing out that malaria, then know as ague was well known in England during the cold Little Ice Age. I could point out, that while present, Anopheles mosquitos are rare in England and were likely rarer in colder times. The article blames an uptick in malaria cases in USA and Europe on travellers coming from countries where Malaria is present. I commented with a reference to usmalaria.com and only received negative responses such as ‘…but given the weight of historical evidence that controlling mosquitoes reduces Malaria transmission…’ from the author Eric Worrall who does not seem to understand that correlation does not prove causation. And this is a website, most of whose readers have open minds to examine Climate Change. But not mosquito transmission of malaria.

Second, in news-medical.net an article called ‘Surge in malaria cases linked to aircraft-transported mosquitoes’. The 145 cases described from nine countries, most in France, Belgium, and Germany, were classified as airport malaria, luggage malaria, or both, and quaintly called Odyssean Malaria. Half resided or worked near or at an international airport. Half of the cases were people born in Africa. There is no evidence presented that these people were bitten by a transported mosquito and it is unclear how often this happens. It only serves to prove that if physicians have reason to suspect malaria based on belief in ‘Odysseus the Mosquito’, they are likely to test for plasmodia. Otherwise, they wouldn’t, and you won’t find what you don’t seek.

Third, in Malaria World this week an article titled ‘Why does malaria transmission continue at high levels despite universal vector control? Quantifying persistent malaria transmission by Anopheles funestus in Western Province, Zambia’ by Ashton et al. (Maybe the two are not connected? ) The detailed study, which used good scientific methods, calculated that Children not sleeping under insecticide-treated nets (ITNs) experienced 13.6 bites per person per six-month season, while ITN users received 1.3 bites per person. They conclude that one infectious bite per person per six-month transmission season, must be sufficient to maintain high malaria transmission and burden.

Many believe because they have no reason to examine the issue, like me prior to 2022 prophylaxis decision. And others because their livelihood depends on it. To increase awareness I am making pdfs of my books available free of charge.

(Image from https://www.sciencejournalforkids.org/articles/should-you-worry-about-mosquitoes-on-planes/)

In Malaria World this week there is reference to a study purported to support an increase in the dosage of Primaquine to children with Plasmodium vivax malaria. However, is that the main conclusion that can be taken from the study?

The study, ‘Primaquine for uncomplicated Plasmodium vivax malaria in children younger than 15 years: a systematic review and individual patient data meta-analysis’ by Commons et al published in Lancet Child and Adolescent Health, made two major observations from the 27 studies considered eligible for analysis, the majority of which were carried out in the Asia-Pacific region.

1) Dosing with primaquine and especially higher doses reduced the likelihood of detecting Plasmodia is the blood up to 180 days later. Their analysis suggested that increasing the total dose of primaquine from 3·5 mg/kg to 7 mg/kg would reduce the risk of recurrent Plasmodium vivax parasitaemia by more than 40% in all children and by about 60% in children younger than 5 years.

2) Compared with no primaquine, children treated with any dose of primaquine had a greater risk of serious adverse events and gastrointestinal symptoms on days 5–7 after treatment (those receiving highest dose 146% more likely than no primaquine). And, interestingly, data on adverse events and serious adverse events were only available from six (22%) of the 27 studies.

There is no detail in this meta-analysis of the testing that was carried out for Plasmodia in the included studies. I expect they were mostly RDT results. There is no indication that any of those in whom Plasmodia were detected were otherwise unwell. However, it is quite clear that those who suffered severe side effects of the drug were unwell.

Is this type of study useful discovering what aids health, or a means to justify dispensing of more pharmaceuticals? The study was organised by WorldWide Antimalarial Resistance Network (WWARN) and the authors are funded by Australian National Health and Medical Research Council (NHMRC), the Wellcome Trust, US National Institutes of Health and the US President’s Malaria Initiative (CDC), the Malaysian Ministry of Health, Medicines for Malaria Venture and Bill & Melinda Gates Foundation.