Ifakara 健康研究所

The implications of climate change for malaria eradication this century remain poorly resolved1,2. Many studies focus on parasite and vector ecology in isolation, neglecting the interactions between climate, malaria control and the socioeconomic environment, including disruption from extreme weather3,4. Here we integrate 25 years of African data on climate, malaria burden and control, socioeconomic factors, and extreme weather. Using a geotemporal model linked to an ensemble of climate projections under the Shared Socioeconomic Pathway 2-4.5 (SSP 2-4.5) scenario5, we estimate the future impact of climate change on malaria burden in Africa, including both ecological and disruptive effects. Our findings indicate that climate change could lead to 123 million (projection range 49.5 million to 203 million) additional malaria cases and 532,000 (195,000-912,000) additional deaths in Africa between 2024 and 2050 under current control levels. Contrary to the prevailing focus on ecological mechanisms, extreme weather events emerge as the primary driver of increased risk, accounting for 79% (50-94%) of additional cases and 93% (70-100%) of additional deaths. Most increases stem from intensification in existing endemic areas rather than range expansion, with significant regional variation in impact. These results highlight the urgent need for climate-resilient malaria control strategies and robust emergency response systems to safeguard progress towards malaria eradication.

BACKGROUND:The feeding behaviours of the malaria vector Anopheles arabiensis, and its competitive relationships with other sibling species within the Anopheles gambiae complex, remain largely unexplored within well conserved natural ecosystems, where its known preferred hosts are scarce or absent. METHODS:Potential aquatic habitats were surveyed for An. gambiae complex larvae across a gradient of natural ecosystem integrity in southern Tanzania, encompassing fully domesticated human settlements, a partially encroached Wildlife Management Area (WMA), and well conserved natural ecosystems within Nyerere National Park (NNP). Direct observations, tracks, spoor and other signs of human, livestock or wild animal activity around these water bodies were recorded as indirect indicators of potential blood source availability. FINDINGS:While only An. arabiensis was found in fully domesticated ecosystems, its non-vector sibling species An. quadriannulatus occurred in conserved areas and dominated the most intact natural ecosystems. Proportions of larvae identified as An. arabiensis were positively associated with human and/or cattle activity and negatively associated with distance inside NNP and away from human settlements. Proportions of An. quadriannulatus were positively associated with activities of impala, warthog and possibly bushpig, implicating them as likely preferred blood hosts. While abundant impala and lack of humans or cattle in intact acacia savannah within NNP apparently allowed it to dominate An. arabiensis, presence of warthog seemed to provide it with a foothold in miombo woodlands of the WMA, despite encroachment there by people and livestock. While this antelope and suid are essentially unrelated, both are non-migratory residents of small home ranges with perennial surface water, representing potential hosts for An. quadriannulatus that are widespread across extensive natural ecosystems all year round. Despite dominance of An. quadriannulatus in well-conserved areas, An. arabiensis was even found in absolutely intact natural environments > 40km inside NNP, suggesting it can survive on blood from one or more unidentified wild species. Such self-sustaining refuge populations of An. arabiensis inside conservation areas, supported by wild blood hosts that are fundamentally beyond the reach of insecticidal interventions targeted at humans or livestock, may confound efforts to eliminate this key malaria vector. However, they might also enable insecticide resistance management strategies that could restore the effectiveness of pyrethroids in particular. This new approach to indirectly identifying commonly utilized blood sources may also be applicable to an unprecedented diversity of zoophagic mosquitoes, enabling incrimination of possible bridge vector species capable of mediating pathogen spillover from wildlife reservoirs into livestock and/or human populations.

Oxfendazole, a registered veterinary drug, has demonstrated broad-spectrum activity against multiple nematode species. First-in-human studies in healthy, predominantly Caucasian adults receiving a liquid formulation of oxfendazole demonstrated a favorable pharmacokinetic and safety profile, supporting its potential as a drug candidate for treating human helminth infections. To further advance its clinical development, we conducted a phase I bioavailability study using a field-applicable, immediate-release oxfendazole tablet. This trial investigated the pharmacokinetics, safety, and tolerability of the tablet formulation in healthy African adults residing in a filariasis-endemic country. Oxfendazole was administered as a single dose (100 or 400 mg) or as multiple doses (400 mg for 5 consecutive days) to 30 participants, randomized 8:2 to oxfendazole or placebo per cohort. Plasma concentrations of oxfendazole were measured using a validated high-performance liquid chromatography tandem mass spectrometry method, and pharmacokinetics were assessed using non-compartmental analysis. Peak plasma concentrations were reached after ~2.5-3 h. The median elimination half-life ranged from 11.6 to 13.9 h and was consistent across cohorts. Non-linear pharmacokinetics was observed, with exposure (AUC∞, Cmax) increasing less than dose-proportionally and showing high variability. Oxfendazole was well tolerated, with no adverse events reported and no clinically significant abnormalities in laboratory tests, vital signs, physical examinations, or electrocardiograms. These findings support the further development of oxfendazole in early proof-of-concept studies. Formulation optimization is suggested to reduce variability in exposure and improve the reliability of exposure-response assessments in future clinical trials.The study is registered with ClinicalTrials.gov as NCT04920292.

Nearly 5 million children die each year of preventable causes, with pneumonia being a key contributor. The Integrated Management of Childhood Illnesses guidelines improve health care workers' diagnostic and management capabilities by relying mostly on clinical signs. Though there have been successes, challenges in the consistent application of IMCI and the accurate diagnosis of conditions like hypoxemia remain. Next generation pulse oximeters add functionality to stand alone pulse oximeters, like measurement of respiratory rate, temperature, and hemoglobin. While the TIMCI project sought to address gaps in the introduction of pulse oximetry in India, Kenya, Senegal, and Tanzania, research was also conducted to strengthen the market for multimodal pulse oximetry (PO) devices by filling evidence gaps around ideal product attributes and the validation of available and near to market photoplethysmography-derived clinical measurement tools (medical device and smartphone-based). A mixed-methods evaluation measured usability and diagnostic accuracy using multimodal PO devices among primary care providers in the four countries. Results showed good usability, minimal user errors, and high satisfaction and system usability scores across all devices. Additionally, across all age categories, device performance for hypoxemia, tachycardia, and fever exceeded 80% agreement; respiratory rate measurements exhibited greater variability in percent agreement between devices. A target product profile and an open-source data repository were developed to further advance device development and market alignment. This research provided data on the performance of various multimodal PO devices, considering different form factors and product attributes. Technological progress continues to expand opportunities for the collection of clinical measurements and data. Supporting providers with decision support and automated documentation tools ensures that the information generated is actionable and utilized, while an emphasis on integrated technologies is essential to maximize provider capabilities and improve the diagnosis and management of childhood illnesses in low- and middle-income countries.

Malaria remains a significant global health challenge, particularly in Africa, which continues to bear the greatest burden. The transboundary nature of malaria necessitates regional collaboration, yet transcontinental knowledge-sharing mechanisms remain limited. The World Health Organization's (WHO) certification of China as malaria-free in 2021 presents an opportunity to leverage its expertise, cost-effective products, and elimination strategies to support Africa's malaria control efforts. The Institution-based Network on China-Africa Cooperation for Malaria Elimination (INCAM) was established in 2018 to bridge this gap, fostering cross-continental collaboration through knowledge exchange, product innovation, and policy advocacy. Between 2019 and 2025, INCAM has convened six fora, facilitated to promote the adaptation of China's anti-malaria practices to African contexts. These fora promoted the exploration of demand-driven research, the development of innovative anti-malarial products, and the advancement of evidence-based policies. INCAM exemplifies the potential of China-Africa collaboration to accelerate malaria control and elimination in Africa through solutions tailored to local contexts. To sustain this progress, there is an urgent need for stronger Public-Private-Academic Partnerships, and enhanced capacity-building programs. By addressing these gaps, INCAM can maximize its role as a leading transcontinental hub for malaria control and elimination for China and Africa.