[Clinical research on malaria: what for the future?].
Malaria still remains one of the main public health problems in the world. In spite of early and numerous clinical trials, the situation seems to have been worsening in the last ten years. Malaria clinical research involves several levels: Several meta-analyses have been performed on this topic (in particular, the Cochrane Database Library has published studies on malaria prevention during pregnancy, management of clinical malaria attacks, vaccine trials or impregnated bed net trials). All these studies show the uneven quality of trials (only 10% to 50% can be kept in the analysis for methodological reasons), which seldom lead to similar conclusions. Besides, as resistances of both parasites and vectors to drugs or insecticides are regularly increasing, trials have to be repeated and new molecules have to be found and evaluated. Finally, practical application of such interventions may be difficult, due to the heterogeneity of epidemiological situations and the poverty of target populations. Various initiatives aiming to develop malaria clinical research have recently been launched. Donators are public or international (Global Fund, Roll Back Malaria Initiative, NIH, EDCTP programme), as well as private (Bill & Melinda Gates Foundation). These substantial funds should enhance the research of new antimalarial drugs and large-scale, adequately designed trials. However, to make sure these trials really benefit to populations exposed to the disease, ethical principles should be co-elaborated with developing countries, within collaborative networks between laboratories from industrialized and developing countries.
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UR 010 (Santé de la mère et de l'enfant en milieu tropical), IRD, Faculté de Pharmacie, 4, avenue de l'Observatoire, 75270 Paris Cedex 06. Michel.Cot@ird.fr
D000328:Adult; D000349:Africa / Q000453:epidemiology; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use; D035843:Biomedical Research / Q000941:ethics / Q000639:trends*; D002986:Clinical Trials as Topic; D003906:Developing Countries; D005260:Female; D005544:Forecasting; D006801:Humans; D008288:Malaria / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control* / Q000628:therapy; D017780:Malaria Vaccines / Q000008:administration & dosage; D008297:Male; D015201:Meta-Analysis as Topic; D011203:Poverty; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D012109:Research Support as Topic
D000962:Antimalarials; D017780:Malaria Vaccines