MPF Proposal

MALARIA PREVENTION FOUNDATION
Evelyn Li
Julia Moore
Kelsey Murphy
Jennifer Quach
Hao-Ting Sun
NGO Grant Proposal
Professor Peter Huk
Writing 107G
Summer 2012


2

Date: Monday, July 16, 2012
To: World Health Organization
From: Malaria Prevention Foundation (MPF)
Re: Regional Prevention for Malaria in India
Malaria Prevention Foundation (MPF) is an NGO that provides treatment,
prevention, and education on malaria in Assam, India. We will establish clinics to
provide treatment, prevention and education. Our goal is to help treat and
reduce the cases of malaria, as well as educate the civilians on how to protect
themselves and prevent malaria in Assam, India. The individuals in the group
are Jennifer Quach, Evelyn Li, Hao-Ting Sun, Julia Moore, and Kelsey Murphy.
We all are researching on the Assam, India. Each of us will share what we obtain
from the research we do, and after that we will tailor treatment, prevention, and
education to those specific countries.
Malaria Prevention Foundation will be treating and reducing the cases of malaria
in Assam, India, as well as educating the civilians on how to prevent themselves
from being infected by malaria. We are working on this because many people in
the world are affected by malaria everyday; however, we decided to focus on
India because it is the most vulnerable country in the region of Southeast Asia.
In order to cut costs, we will partner with various organizations such as
Architecture for Humanity, Global Brigades, Bestnet, Medicines for Malaria
Venture, National Institute for Malaria Research, Center for Disease Control
(CDC), and the Bill and Melinda Gates Foundation.
This issue is an ongoing problem in the world, and since most of the current
attention and aid is focused on African countries, we wanted to bring more
attention to the region of Southeast Asia.


3

TABLE OF CONTENT
Introduction 5
1.0 Treatment 8
1.1 Diagnosis 10
1.1.1 Microscopy 10
1.1.2 Rapid Diagnostic Test 10
1.2 Uncomplicated Malaria 11
1.3 Severe Falciparum Malaria 13
1.4 WHO Recommendations for the Diagnosis and 14
Treatment of Malaria
2.0 Prevention 16
2.1 Malaria Prevention in Assam, India 17
2.1.1 Assamʼs People and Conditions 18
2.1.2 Establish and Integrate New or Revisited 19
Interventions
2.1.3 Identify Opportunities to Integrate Efforts with 20
Other Initiative
2.1.4 Research and Developing in the Laboratory and 20
the Field
2.1.5 Investigate Immune Responses and Immunity 21
2.1.6 Characterize Genetic Contribution to Drug 21
Resistance, Immunity, and Disease
2.1.7 Development and Evaluation of Vaccines, 22
Host-Parasite Biology, and Non-Human Primate
Models
2.2 Research Resources and Services 23
2.2.1 CDCʼs Insectary 23
2.2.2 Mosquito Colonies 23
2.2.3 CDCʼs Animal Facility 24
2.2.4 MPFʼs Fight for Malaria 24
3.0 Education 25
3.1 Education System in India 26
3.2 Clinic 27
3.3 Target Audience for Education 28
4.0 Partnerships 29
4.1 Overview of Partnerships 30
4.2 Architecture for Humanity 30
4.3 Global Brigades 30
4.4 Bestnet 31


4

4.5 PATH 32
4.5.1 PATHʼs Malaria Vaccine Initiative 33
4.6 Medicines for Malaria Venture 33
4.7 National Institute for Malaria Research 34
4.8 Center of Disease Control 35
4.8.1 CDC Foundation 35
4.9 Partnerships with the Locals 36
5.0 Finance 37
5.1 Overview of MPFʼs Finances 38
5.2 Grants 41
6.0 Conclusions 42
7.0 Works Cited 44


5

INTRODUCTION
HAO-TING SUN


6

Malaria is a devastating parasitic disease transmitted through the bite of infected,
female Anopheles mosquitoes. More than one-third of the worldʼs population is at
risk of contracting malaria, which sickens 225 million people annually and causes
nearly 800,000 deaths each year. Malaria is also devastating because of its
severe economic consequences, in which countries with a high incidence of
malaria can suffer a 1.3% loss of economic growth.
In the human body, the
parasites multiply in the
liver, and then infect red
blood cells. Symptoms of
malaria include fever,
headache, and vomiting,
and usually appear between
10 and 15 days after the
mosquito bite. Malaria is
curable if effective treatment
is started early. If not
treated, malaria can quickly
become life-threatening by
disrupting the blood supply to vital organs. In many parts of the world, the
parasites have developed resistance to a number of malaria medicines.
India has the most malaria cases in South East Asia. Around 1.5 million
confirmed cases are reported annually by the National Vector Borne Disease
Control Programme (NVBDCP), of which 40–50% are due to Plasmodium
falciparum. In 2010, 1.31 million total cases were reported in India along with 753
deaths. Assam is one of the most endemic states in India with 47,397 cases and
45 deaths in 2011.
Malaria can be prevented through the use of antimalarial drugs, insecticidal nets,
and indoor residual spraying with insecticide to control the vector mosquitoes.
One of the most effective and widely used method of treating malaria is the use
of artemisinin-based combination therapies (ACTs).
The purpose of our project is to reduce malaria cases and deaths through the
use of nets, antimalarial drugs, and ACTs. We also hope to achieve more
success by educating local residents in Assam through the use of pamphlets and
volunteers at local clinics. We have also partnered up with various non-
governmental organizations (NGOs) to help us achieve our goal. These


7

organizations include Architecture for Humanity, Global Brigades, Bestnet, and
Medicines for Malaria Venture, National Institute for Malaria Research, Center for
Disease Control (CDC), and the Bill and Melinda Gates Foundation.


8

TREATMENT
EVELYN LI


9

Malaria is a widespread disease in the Indian state of Assam. The two main
parasites in Assam are plasmodium falciparum and plasmodium vivax.
With no effective malaria vaccine on the horizon and rising operational costs,
there has been a shift in strategy from eradication to vector control with overall
objectives to reduce morbidity and mortality. Currently the most effective
treatment in Assam is for uncomplicated, Plasmodium falciparum malaria. Dr.
Dev. V. ʻs research paper, Therapeutic efficacies of antimalarial drugs in the
treatment of uncomplicated, Plasmodium falciparum malaria in Assam, north-
eastern India explains that patients who tested positive for P. falciparum malaria
were initially treated with chloroquine (CQ). If the CQ treatment failed, they were
given sulfadoxide-pyrimethamie (SP), and if the SP treatment failed they were
treated with the drug Quinine. Although 75.7% of the 144 subjects evaluated by
Dr. Dev were successfully treated by CQ, six early (4.2%) and twenty-nine
(20.1%) late CQ treatments failed. Of the 34 CQ treatment failures, 31 (91.2%)
responded positively to SP treatment. 66.7% of those who were irresponsive to
SP treatment were successfully treated by parenteral quinine. Those who were
not successfully treated with parenteral quinine were given an artemisinin
derivative to achieve a clinical cure.
Malaria is a curable disease as long as it is diagnosed and treated promptly and
correctly. This chapter discusses the treatment of uncomplicated and severe
malaria. Management of the disease should be carried out according to clinical
diagnosis of the patient and the judgment of the physician. Warning signs of
severe malaria have been listed below so attending physicians or volunteers are
able to recognize the condition and give the appropriate treatment correctly
before referring the patient for more intensive care. These guidelines should be
helpful for those involved in the management of malaria at the clinic.
Treatment of malaria is dependent upon whether it is uncomplicated or severe
malaria


10

1.1 DIAGNOSIS
1.1.1 MICROSCOPY
Microscopy of stained thick and thin blood
smears is the gold standard for confirmation
of diagnosis of malaria. The advantages of
microscopy are:
• High sensitivity; it is possible to detect
malarial parasites at low densities. It
also helps to quantify the parasite load.
• It is possible to distinguish the various
species of malaria parasite and their
different stages.
1.1.2 RAPID DIAGNOSTIC TEST
Rapid Diagnostic Tests are based on the
detection of circulating parasite antigens.
Several types of RDTs are available


11

(http://www.wpro.who.int/sites/rdt). Some can only detect P. falciparum, while
others are able to detect other parasite species. The latter kits are expensive and
highly sensitive to temperature changes. NVBDCP currently supplies RDT kits for
detection of P. falciparum at locations where microscopy results are unobtainable
within 24 hours of the sample collection.
Since several companies produce RDTs, there may be differences in the
contents and the manner of testing. The userʼs manual should always be read
and the instructions followed meticulously. It is the responsibility of the clinician,
or the technician, performing the rapid test to ensure that the kit is within its
expiry date and has been transported and stored under recommended
conditions. Failure to observe these criteria can lead to false/negative results. It
should be noted that Pf HRP based kits may take up to three weeks to show
positive results after the first day of treatment.
Early diagnosis and treatment of malaria aims to:
• Accurately cure
• Prevent uncomplicated malaria from progressing to severe malaria
• Prevent deaths
• Interrupt transmission
• Minimize risk of selection and spread of drug resistant parasites.
1.2 UNCOMPLICATED MALARIA
Definition of Uncomplicated Malaria:
Uncomplicated malaria is defined as symptomatic malaria without signs of
severity or evidence of vital organ dysfunction.
Uncomplicated Falciparum malaria:
Antimalarial combination therapy is recommended by WHO for the management
of uncomplicated falciparum malaria. Antimalarial combination therapy is the
simultaneous use of two or more blood schizontocidal drugs with independent
modes of action and thus unrelated biochemical targets in the parasite. Rationale
for combining two different antimalarial with different mode of action is to
counteract resistance and to improve therapeutic efficacy. Antimalarial
combination therapy recommended for Falciparum malaria is Artemisinin
based combination therapy recommended for Falciparum malaria is


12

Artemisinin based combination therapy.
Rationale behind Artemisinin based combination therapy
Artemisisnin and its derivative produce rapid clearance of parasitaemia (by a
factor of approx 10,000 in each asexual cycle), rapid resolution of symptoms and
are eliminated rapidly. When given in combination with rapidly eliminated
compounds (tetracyclines, clindamycin), a 7-day course of treatment; slowly
eliminated antimalarials, shorter courses of treatment (3 days) are effective.
The following ACTs are currently recommended (alphabetical order):
Artemether + Lumefantrine
Artesunate + Amodiaquine
Artesunate + Mefloquine
Artesunate + Sulfadoxine–pyrimethamine
The choice of ACT in a country or region will be based on the level of resistance
of the partner medicine in the combination:
In areas of multidrug resistance (South-East Asia):
Artesunate + Mefloquine or Artemether-Lumefantrine
The Artemisinin derivative components of the combination must be given for at
least 3 days for an optimum effect.


13

2. Uncomplicated Vivax malaria
• Chloroquine sensitive Vivax Malaria: chloroquine 10 mg base/kg stat
followed by 5 mg/kg at 6, 24 and 48 hrs. Or Chloroquine 10 mg base /kg
stat followed by 10 mg/kg at 24 hrs and 5mg/kg at 48 hrs.
• Chloroquine resistant Vivax malaria: relatively few data are available on
Chloroquine resistant Vivaxmalaria. Studies have shown that Mefloquine;
Quinine; Artemether-Lumefantrine; Amoidaquine can be used. However
clinical data at present is insufficient.
• Radical cure: radical cure is to prevent relapses. P.Vivax forms
hypnozoites, parasite stages in the liver that can result in multiple relapses
of infection, weeks to months after the primary infection. Primaquine
should be given in the dose of 0.25 mg/kg OD for 14 days. As Primaquine
can cause hemolytic anemia in G- 6 PD deficiencies, they should be
preferably screened for the same prior to starting reatment. As infants are
relatively G-6 PD deficient, it is not recommended in this age group. In
cases of borderline G6PD deficiency,once weekly dose of Primaquine
0.75 mg/kg is given for 8 weeks. In severe G6PD deficiency Primaquine
should not be given.
1.3 SEVERE FALCIPARUM MALARIA
Definition of severe Falciparum malaria:
In a patient with P. falciparum asexual parasitemia and no other obvious cause of
their symptoms, the presence of one or more of the clinical or laboratory features
classifies the patient as suffering from severe malaria


14

Recommendations of treatment of severe Malaria
After rapid clinical assessment and confirmation of the diagnosis, full doses of
parental antimalarial treatment should be started without delay with which
effective antimalarial is first available.
In low transmission areas or outside Malaria endemic areas:
• Artesunate 2.4 mg/kg bw i.v/i.m on admission then at 12 h and 24 h, then
once a day for 7 days (change to oral once patient can tolerate orally.
Tetracycline / Doxycycline/Clindamycin is added to Artesunate as soon as
patient can swallow and should be continued for 7 days
In high transmission areas; the following antimalarials are recommended
• Artesunate 2.4 mg/kg bw i.v/i.m on admission then at 12 h and 24 h, then
once a day for 7 days (change to oral once patient can tolerate orally).
• Artemether 3.2 mg/kg bw i.m given on admission then 1.6 mg/kg bw per
day for 7 days.
• Quinine 20 mg salt/kg /bw diluted in 10 ml of isotonic fluid/kg by infusion
over 4 hrs. Then 12 hrs after the start of loading dose of 10 mg salt/kg
over 2hrs.This maintenance dose should be repeated every 8 hrs,
calculated from beginning of infusion, until patient can swallow, then
Quinine tablets 10 mg salt /kg 8hrly to complete a 7 days course (plus)
Tetracycline / Doxycycline/Clindamycin is added to Artesunate as soon as
patient can swallow and should be continued for 7 days.
1.4 WHO RECOMMENDATIONS FOR THE DIAGNOSIS AND TREATMENT OF
MALARIA.
1. WHO recommends that treatment of Malaria should be based on a
laboratory-confirmed diagnosis, with the exception of children less than 5
years of age in areas of high transmission in which treatment may be
provided on the basis of a clinical diagnosis.
2. All uncomplicated P. falciparum infections should be treated with an
artemisinin-based combination therapy and P. vivax with chloroquine and
primaquine (except where P. vivax is resistant to chloroquine, when it
should be treated with ACT and primaquine). In Central America, the only
remaining region where P. falciparum is sensitive to chloroquine, the
change to ACT should be made when chloroquine failure rates reach 10%.
3. Four ACTs are currently recommended for use: artemether-lumefantrine,
artesunate-amodiaquine, artesunate-mefloquine and
artesunatesulfadoxine- pyrimethamine. The choice of the ACT should be
based on the efficacy of the partner medicine in the country or area of


15

intended deployment.
4. Patients suffering from severe malaria presenting at the peripheral levels
of the health system should be provided prereferral treatment with quinine
or artemisinins, and transferred to a health facility where full parenteral
treatment and supportive care can be given.
5. Severe malaria should be treated parenterally with either an artemisinin
derivative or quinine until the patient can swallow, when a complete
course of ACT must be administered.


16

PREVENTION
JULIA MOORE


17

2.1 MALARIA PREVENTION IN ASSAM, INDIA
Visitors to all parts of the Indian subcontinent—in both rural areas and in some
cities but except for the high mountains—are at risk of contracting malaria.
Plasmodium vivax is the most prevalent form of malaria parasite in Assam, India,
but Plasmodium falciparum is also present and is often resistant to chloroquine.
Mixed infections with these parasites can occur. Various methods to control
malaria in the general north-eastern region of India have been adopted that the
Malaria Prevention Foundation will utilize. These include:
⁃ integrated vector control through selective spraying of residual insecticides
to interrupt transmission by reducing vector longevity (praying DDT in
high-risk areas)
⁃ the use of in-secticide-impregnated bed nets
⁃ mass collection of blood slides form the community
⁃ implement improved diagnosis and prophylactic chemotherapy
⁃ information education and,
⁃ communication (IEC) activities in the villages to make the public aware of
the disease
The magnitude of present malaria problems in the region, particularly in Assam,
have become serious because almost all the districts of Assam report malaria
attributable morbidity and mortality annually, and are vulnerable to focal
outbreaks of the disease.
The Malaria Prevention Foundation (MPF) has many traditional health programs
in mind to control malaria as listed above. Though, we want to take these
preventive measures one step further because in other high risk communities
throughout Asia these methods have shown results but no appreciable change in
malaria incidence. A clear understanding about the health-seeking behavior of
households is crucial for an effective control program of malaria. For instance,
the implementation of the current strategy for the control of malaria is mostly
based on early diagnosis. In order to develop an effective strategy, MPF is
working towards understanding the factors that determine the utilization of the
services of a health care provider for suspected cases of malaria.   Utilization
patterns of health service mainly depend on quality of service offered by health
care providers and whether it is affordable by the individual user. Moreover,
impact of quality differences on the use of health care facilities is to be assessed
simultaneously with household and individual characteristics affecting the
utilization. The preference of one health care provider over another will be
affected not only by facility characteristics (quality of service and cost of service),


18

but also by the individual characteristics such as preferences, affordability,
convenient, education level, and household income.
2.1.1 ASSAM'S PEOPLE AND CONDITIONS
In examining three P. falciparum endemic districts of Assam, namely Nagaon,
KarbiAnglong and Cachar (covering an area of 3831, 434 and 37865 km2 and
population of ~2.3, 0.8 and 1.4 million respectively). Districts Nagaon and Karbi-
Anglong are situated in the central part of Assam, whereas District Cachar is in
the southern part. Inhabitants of these districts are socioeconomically backward
and mainly belong to the tribes of aborigine. Paddy cultivation, collection of forest
products, handlooms, daily wages job etc. are their main occupations. The
villagers traditionally use scanty clothes on their bodies and are reluctant to use
mosquito nets and any other protective measures against mosquito bites.
Houses are made of bamboo with thatched roof and walls are plastered with
mud. Cattlesheds are made in open without walls adjacent to house. Most of the
villages are situated in hilly forested areas, intercepted by slow flowing perennial
streams, katcha nallahs and drains forming innumerable water pockets provided
perennial breeding sites for mosquitoes. Villages are small, sparsely populated,
inaccessible during rainy season and with poor health facilities. Low literacy rate,
reluctance to accept medical treatment, migratory mode of living, etc. are the
important features of the villagers. The annual rainfall, temperature and humidity
of the area ranged from 500 to 2200 mm, 10–33°C and 38–97%, respectively
which make the entire area conducive for mosquito proliferation.
2.2 CURRENT AND FUTURE RESEARCH
2.2.1 OPTIMIZE MIX OF CURRENT INTERVENTIONS
Old and newly proven tools for malaria control that MPF plans to utilizes include
early treatment of malaria illness with artemisinin-containing combination
treatments (ACTs), intermittent preventive treatment for pregnant women (IPTp),
and measures that reduce the risk of infection such as indoor residual spraying
(IRS) or insecticide-treated nets (ITNs). Each of these has been shown to be
effective at contributing to malaria control on its own.
As effective control programs expand these interventions, it is becoming
increasingly important to understand how they can be deployed optimally
alongside one another and on a large scale. Prevention through widespread use
of ITNs or IRS, for example, might reduce the level of malaria transmission to the
point that pregnant women are no longer at measurable risk of asymptomatic


19

malaria, suggesting that IPTp interventions may no longer be needed. Scaled-up
prevention of malaria transmission can also affect decisions about how best to
deliver treatment for malaria illness.
It is critical to understand the interaction of IRS and ITNs, two of our core
transmission reduction interventions. Understanding whether IRS, with the
addition of universal ITN coverage, results in lower malaria burden, or,
alternatively, whether high ITN coverage can help to reduce the number of IRS
rounds needed for sustained transmission reduction can help us to invest our
resources more strategically.
While both long-lasting insecticide-treated nets
(LLINs) and IRS have similar efficacy in preventing
malaria, it is unclear how best to integrate these
interventions in a coherent malaria prevention
strategy. A major question is whether LLINs and IRS
have an additive effect on malaria transmission and
malaria-related illness and death. MPF is currently
studying the combined impact of LLINs plus IRS in
comparison to LLINs alone in reducing the incidence
of new malaria infections and the burden of malaria
in Assam, India.
2.1.2 ESTABLISH AND INTEGRATE NEW OR REVISITED INTERVENTIONS
Along with scaling up proven interventions for malaria control, our researchers
are contemplating new interventions or updating previously used malaria control
interventions. These include new drugs and vaccines for treatment and
prevention, new diagnostic tests, innovative insecticide-treated materials, and
revised systems for delivering and evaluating malaria control. Understanding how
these new or revisited interventions will operate under field conditions; proving
their efficacy, effectiveness and safety; and demonstrating their interaction with
existing malaria control efforts will be crucial to advising community leaders in
Assam and global donors about when and where to introduce them to community
members.
Rapid malaria diagnostic tests have made it possible to expand laboratory
diagnosis of malaria beyond health facilities with functioning microscopes to more
outlying locations, even beyond the walls of remote health posts into endemic
communities like Assam. Understanding the performance limitations of the
current generation of rapid tests can help us decide how to deploy them most
efficiently and may provide experience and evidence that can shape the next


20

generation of diagnostic tools. Evaluating strategies based on mass screening
and treatment of Assam's healthy populous could suggest how diagnosis and
treatment might be used to respond to the localized outbreaks of malaria
transmission in settings where effective control has been achieved and may
ultimately contribute to elimination.
• The use of insecticides has evolved, along with development of long-lasting
wash-resistant applications for bed nets and new formulations for use in
indoor residual spraying (IRS). We are evaluating novel uses for these
materials, including the use of insecticide-treated materials to cover eaves
where mosquitoes often enter houses and wall coverings. We are looking
at the durability of the net fabric to determine the impact of holes on the
protective efficacy of nets and how to make nets more durable. Paints with
insecticides are also being evaluated as an alternative to IRS.
2.1.3 IDENTIFY OPPORTUNITIES TO INTEGRATE EFFORTS WITH OTHER INITIATIVES
In addition to new resources for malaria control, many other communities in India
and around the world are simultaneously rolling out programs to combat HIV/
AIDS and neglected tropical diseases, enhance health information systems and
supplies management, and reinforce maternal and child health. For each of these
to operate at its potential will require careful planning and collaboration,
especially at the most peripheral level where most of the tasks fall to the same
few health workers. Examining how interventions can be delivered and managed
in integrated ways will be key to achieving sustainable progress across multiple
health conditions.
In many parts of the malaria-endemic world, mosquito vectors also transmit other
viral and parasitic diseases. Coordinating an integrated vector management
policy could effectively reduce both malaria and other illnesses like lymphatic
filariasis or dengue. Like malaria control programs, many other health initiatives
evaluate their effectiveness through regular population surveys or routine health
facility reporting. Identifying opportunities to develop integrated evaluation tools
and reporting systems that may lead to broader gains for malaria control and
across the public health spectrum.
2.1.4 RESEARCH AND DEVELOPMENT IN THE LABORATORY AND THE FIELD
Field-based investigations provide insights into mechanisms and dynamics of
malaria parasite transmission, emerging trends such as drug resistance and the
range and type of host immune and pathological responses to malaria. They
often yield valuable specimens that provide critical information when studied
further through cutting-edge bench research in well-equipped laboratories in the


21

United States and overseas. The Center for Disease Control's (CDC) laboratories
(augmented by state-of-the-art insectaries and animal facilities) conduct more
basic and applied studies, whose findings can in turn be verified or expanded
during field investigations and lead to improved or new interventions for control
and prevention.
2.1.5 INVESTIGATE IMMUNE RESPONSES AND IMMUNITY
MPF is working towards conducting research that will reveal why manifestations
of severe disease outcomes differ in various endemic settings (intense
transmission versus seasonal transmission), how transmission pressure affects
development of immune responses, and, importantly what factors determine the
acquisition of clinical and parasitological immunity. These questions will be
addressed using various immunologic assays and the latest molecular tools. The
global malaria research community is in the process of developing vaccines
effective against malaria parasites in order to provide new interventions that will
help control and eliminate malaria. Understanding which immune responses are
active in malaria and how they are destructive to parasites is important to the
rational development of vaccines. MPF investigators will undertake ongoing field-
and laboratory-based studies in the area of Assam to define the correlates of
immunity for candidate vaccine antigens, which are critically important for guiding
and efficiently furthering malaria vaccine development.
2.1.6 CHARACTERIZE GENETIC CONTRIBUTION TO DRUG RESISTANCE, IMMUNITY, AND
DISEASE
MPF will conduct ongoing investigations into the genetic complexity of malaria
parasites and how this complexity and selection affects drug resistance,
immunity, and disease.
The MPF malaria laboratories engaged in this malaria research will develop
molecular tools and networks in the field in the north-eastern region of India that
will monitor emergence of drug-resistant malaria parasites in Assam. The
laboratories will collect and maintain malaria parasite isolates with a wide array of
defined drug-resistant properties in order to identify and characterize the
molecular and biological markers of drug resistance and, also, the mechanisms
by which drug resistance develops in these malaria parasites. Such in vivo and in
vitro adapted strains have been archived by groups like CDC and made available
to qualified malaria researchers around the world. As well, MPFʼs malaria
program will offer training to investigators in Assam on using molecular markers


22

to detect and track drug-resistant parasites and in vitro methods of testing
parasites for drug susceptibility.
MPF will also characterizing the genetic diversity in important malaria vaccine
candidate antigens. Detection of molecular diversity in candidate vaccine
antigens is elemental to the development of vaccines effective against malaria
and to the determination of the best and least variable antigens that can serve as
stable targets of immunity and for vaccine development.
A personʼs genetic factors can influence dramatically the development and
outcomes of severe disease states in malaria infections as well as the acquisition
of immune status. We will take advantage of our laboratory facilities in north-
eastern India and materials from our field-based cohort studies to identify
potential host genetic factors associated with susceptibility to or protection from
severe malarial anemia and cerebral malaria or with protection from infection.
Recent advances in human genome research have opened up new opportunities
for identifying host genetic factors associated with severe disease outcomes and
innate resistance factors that protect against morbidity and mortality due to
malaria infections. These studies in parasite and human genetics also help to
develop suitable molecular markers that could be used for tracking parasite
populations associated with severe disease outcomes.
2.1.7 DEVELOPMENT AND EVALUATION OF VACCINES, HOST-PARASITE BIOLOGY, AND
NONHUMAN PRIMATE MODELS
The development of an effective malaria vaccine faces major challenges. Most
vaccine development efforts are targeted against Plasmodium falciparum, the
most serious and deadly malaria parasite. These vaccine efforts must take into
account the genetic diversity of both the parasite and the human host and strive
to provide effective immunity against the different stages of the life cycle. With a
growing call for greater efforts to tackle malaria elimination, efforts are increasing
to produce vaccines that target P. vivax, which must take into consideration
features such as relapses and hypnozoite stages.
Other groups like MPF are developing vaccines to fight malaria. CDC scientists
have an ongoing malaria vaccine development and evaluation program that
develops models of human malaria in small New World monkeys and uses these
nonhuman primate models to investigate the immunogenicity and protective
efficacy of malaria vaccine candidates developed by CDC and other scientific
groups globally. These primate malaria models are the only methods available to


23

test the potential efficacy of human malaria vaccines prior to expensive human
clinical trials.
Other studies of the biology of the malaria parasites using these nonhuman
primate models and bench research,
1. Aim to gain a better understanding of the relationships between malaria
parasites, mosquito vectors, and vertebrate hosts, in order to improve or
facilitate the development of new methods to combat malaria such as
vaccines or new drugs.
2. Allow the modeling of parasite-host relationships with regard to immunity,
pathology, and response and susceptibility to old and newly developed
antimalarial drugs.
New isolates and strains of malaria parasites are collected, adapted to laboratory
culture or nonhuman primates, and tested using the latest available treatments.
These nonhuman primate hosts of human malarias and of the simian malaria
parasites also offer faithful models to investigate mechanisms and treatments for
severe pathology associated with malaria infections such as anemia, cerebral
malaria, and malaria in pregnancy. MPF is taking these innovative measures to
encourage research in vaccinations and preventing malaria.
2.2 RESEARCH RESOURCES AND SERVICES
2.2.1 CDCʼS INSECTARY
MPF is closely conducting research with CDC who has an insectary that
maintains colonies of Anopheles mosquitoes collected from areas of the world
where malaria is or can be transmitted. The mosquitoes are raised in a climate-
controlled insectary with additional rooms for secure biological containment of
malaria-infected vectors. These vector species are used for both transmission
experiments and vector genetics and behavioral studies.
The facilities also serve as a repository for the active collection and study of over
a dozen species and numerous isolates of malaria parasites of human and
nonhuman primates. The investigations are carried out in vivo in animals or
mosquito vectors and in vitro where possible through tissue culture of the
parasite.
2.2.2 MOSQUITO COLONIES
The vector colonies are from the United States (Anopheles quadrimaculatus and
An. freeborni); India (An. stephensi); Africa (An. Gambiae and An. arabiensis);


24

Southeast Asia/Thailand (An. Dirus, An. sawadwongporni, and An. minimus);
Papua New Guinea (An. farauti); Spain (An. atroparvus); and El Salvador (An.
albimanus).
Above: Mosquitoes being fed experimentally using a parafilm membrane; the
blood meal is pumped on top of the membrane.
2.2.3 CDCʼS ANIMAL FACILITY
MPF has also working at the CDC's animal facility. They maintain a large modern
animal facility in Chamblee, Georgia, approved by the American Association for
the Accreditation of Laboratory Animal Care, International. We use this facility as
a resource to better understand transmission, infection, and disease models. This
research will help provide the knowledge that will facilitate the improvement and
development of new malaria interventions through vaccines, chemotherapy, or
transmission reduction and elimination.
2.2.4 MPF'S FIGHT FOR MALARIA
Malaria is endemic in India with an estimated 70-100 million cases each year
(1.6-1.8 million reported by NVBDCP); of this 50-55% are Plasmodium vivax and
45-50% Plasmodium falciparum. With MPF's focus in Assam, we are working to
ultimately eliminate malaria in the north-eastern region of India. The most current
information about malaria is available from the Centers for Disease Control and
Prevention (CDC) and the World Health Organization (WHO).


25

EDUCATION
JENNIFER QUACH


26

3.1 EDUCATION SYSTEM IN INDIA
The education system in India is among the oldest in the world. Nalanda
University is the oldest university- system education in the world. The illustrious
educational system is provided by both the private and public sectors of India.
However, the control and funding of the educational system comes from three
different levels: the central government, the state, and the local government.
Although India has a world- renowned education system, a third of the population
is still illiterate. India has made progress in increasing primary education
attendance rate, and the improvement of the education is often seen as one of
the main contributors to the rise of the economic system in India.
Despite the remarkable education system provided for students, a mere fifteen
percent of students manage to make it to high school, and out of the fifteen
percent of students who
reach high school
education, only seven
percent graduate. This is
a depressingly small
amount of students, and
as such, we will focus
our malaria education in
primary education in the
earlier years, where the
target population is much
larger, and hopefully be
ingrained into the
students at a very early
age. The reason why so
few students make it to high school is perhaps how the educational system
works. The government places a heavy emphasis on primary education, which
extends until students reach the age of fourteen. The government supports about
eighty percent of schools that provide primary education, making it the largest
provider of primary education. However, due to the modest quality of public
education, many families are turning to the private sector of education. Private
schools provide superior education at a fraction of the cost of government run
institutions, but unfortunately, are unavailable to the poorer families of India.
The few opportunities children have in receiving an education is even less for
certain groups of people, such as females. Due to conservative cultural attitudes,


27

women have a much lower literacy rate than men. There are far fewer girls
enrolled in school, and many of them end up dropping out of school. Still, there
are success stories in Indiaʼs education system. Education in rural India has
improved dramatically, since the government of India viewed education as a tool
that can be utilized to bring about social change. The government has greatly
improved the quality of education in rural areas, but many government funded
schools in rural areas remain understaffed and in drastic need of more funding.
There have been major controversial issues about Indiaʼs education system in
recent years. Perhaps the most controversial issue was when the University
Grant Commission found thirty-nine fake institutions operating in India. Another
controversy is that only ten percent of manufacturers offer in- service training to
their employees, while in other countries such as China, ninety percent of
manufacturers provide training for their employees. However, despite all these
shortcomings, India has made major contributions and advances in their
educational system. Their continued improvement in education will one day
contribute to Indiaʼs economic success.
3.2 CLINIC
Malaria Prevention Foundation plans to provide education to the victims of
Malaria in Assam, India through a clinic. Within the clinic, there will be volunteers
from Global Brigades who will come educate the people on how to prevent, treat,
and reduce malaria. In addition, the clinic will also provide educational materials
such as pamphlets and handouts on even more information about malaria.
However, educational materials will not be the only thing provided, the clinic will
also provide materials for prevention and treatment of malaria as well. Prevention
materials provided at the clinic will include insecticide nets and residual
insecticide sprays to assist in keeping the mosquitos away and allowing the
people to be able to protect themselves from being bitten by the parasite carrying
mosquitos.


28

3.3 TARGET AUDIENCE FOR
EDUCATION
In addition to the clinic, Malaria
Prevention Foundation plans to
focus on educating the youth of
Assam, India on malaria since
they are the future of India.
Malaria Prevention Foundations
plans to have volunteers from
Global Brigades assist in this
area by going into the local
schools and presenting the
children with pamphlets and
information about malaria. As
we stated above earlier, Malaria Prevention Foundation plans to focus on the
youth in school since we will have a much larger target audience. This is due to
the fact that only a mere fifteen percent of the population actually makes it to
India and only a mere seven percent of that actually graduate. We believe that
educating the children at a young age will engrain the information within them,
and they will be able to pass it on later in their lives.


29

PARTNERSHIPS
KELSEY MURPHY


30

4.1 OVERVIEW OF PARTNERSHIPS
Malaria Prevention Foundation plans to lead a collaborative effort in order design
and run the MPF Clinics. The project will involve Global Medical and Public
Health Brigades, Architecture for Humanity, Bestnet, PATHʼs Malaria Vaccine
Initiative, Medicines for Malaria Venture, the National Institute of Malaria
Research, and the Center for Disease Control and Prevention (CDC) through the
CDC Foundation. The ultimate goal of the partners on this project is to
collaborate in order to develop a malaria outreach program that will integrate into
Indiaʼs mainstream health care efforts as well as to eventually expand the clinic
model to other malaria-affected communities in the country.
4.2 ARCHITECTURE FOR
HUMANITY
In order to cut the costs of
designing and building the clinic, Malaria Prevention Foundation plans to partner
with Architecture for Humanity. A partnership with Architecture for Humanity will
give MPF access to a network of more than 40,000 professionals willing to lend
their time and expertise to help those who would not otherwise be able to afford
their services (architectureforhumanity). Architecture for Humanity designs,
constructs, and develops structures where they are most critically needed. Their
mission, of channeling the resources of the global funding community to
meaningful projects that make a difference locally, is directly align with our goal
of building a malaria clinic in Assam, India (architectureforhumanity). Since they
manage all aspects of the design and construction process, our personnel will be
free to focus on other aspects of the erection of the clinic and our services in the
area (i.e. building relations with the locals).
4.3 GLOBAL BRIGADES
Global Brigades is the worldʼs
biggest student lead health and
sustainable development
organization. Since 2004,
Global Brigades has mobilized
thousands of university students
and professionals through 9- skill based service programs to improve the quality
of life in under resourced communities. By partnering with Global Medical and
Public Health Brigades Malaria Prevention Foundation will be able to acquire


31

volunteers and health professionals to work in the clinic and go into local
community centers and schools to educate children and families about Malaria.
These volunteers will work with licensed medical professionals and community
health workers to provide comprehensive health services to the Assam
community (Global Brigades). Additionally, volunteers and officials from Global
Brigades will provide case management and referrals for those suffering from
malaria.
The Brigade volunteers will work with licensed doctors in medical consultations
and assist in a pharmacy under the direction of licensed pharmacists. These
Brigades will come to Assam every three to four months and assist in the
treatment of hundreds of patients and deliver public health workshops to the local
community. The Brigades will also maintain a close relationship with the
community, providing Community Health Worker trainings to empower local
leaders to sustain a consistent level of healthcare. Electronic patient records will
be collected for future visitations and to monitor overall community health trends
(Global Brigades). Volunteersʼ duties vary based on the medical background and
skill. Volunteersʼ duties vary based on the medical background and skill.
Volunteers with little to no medical experience have the opportunity to assist the
doctors with patients, shadow doctors during consultations, and help pack
medications in the pharmacy under the supervision of the ground pharmacist.
Volunteers with greater medical experience have the opportunity to take a larger
leadership role during patient care and assisting with health education workships,
both under the supervision of licensed doctors. The education the MPF clinic
offers will mainly be taught by Global Brigade Volunteers, and the doctors at our
clinic will be provided by the Brigade Program.
4.4 BESTNET
In order to reach our
goal, it is crucial that
we provide the
community of Assam with proper prevention tools such as Long Lasting
Insecticide Incorporated Mosquito Nets (LLINs). By partnering with Bestnet, MPF
will have access to their product line which features NetProtect ® LLINs – the
worldʼs third largest bran of World Health Organization recommended LLINs for
the control of vector-borne diseases (Bestnet). Their NetProtect ® LLINs are
durable, efficient and rigorously tested for the upmost quality. MPF knows we
can put our faith in Bestnet because it employs the Six Sigma Methodology, one
of the most stringent quality control systems in the world. Additionally, Bestnets


32

advanced testing methods ensure that high standards are maintained.
Generally, tests for Netprotect ® LLINs mosquito nets can be divided into three:
bioassay/efficiency evaluation, chemical and physical tests (Bestnet).
As the worldʼs third largest manufacture of LLINs, Bestnet recognizes that to be a
truly socially responsible company means finding unique solutions to help
organizations – like MPF – meet the needs of underprivileged and isolated
communities around the globe (Bestnet). By providing our organization with
50,000 donated Netprotect ® LLINs, Bestnet is fulfilling its company goal of
providing life-improving and life-saving products and services to people at risk in
developing countries (Bestnet). Bestnet is also aware that to be successful,
transfer of technology requires more than just the moving of high tech equipment
to developing communities. After the donated nets arrive, Bestnet will work with
MPF and the locals by sharing its know-how and expertise with regards to the
production and quality control of mosquito nets. They will also aid MPF in
enabling the local community to find a location for the future erection of a
production plant, purchase the necessary equipment and implement the
production process. They will help us make the Assam community self-sufficient;
Assam will eventually be able to make nets in India, by Indians, and for Indians
(Bestnet). Proper prevention is a main goal of MPF and Bestnet can help us
achieve it by providing us with the proper tools and expertise needed.
4.5 PATH
PATH is an international nonprofit
organization determined to transform
global health by developing high-
impact, low-cost solutions. At PATH,
they understand that finding a solution to the worldʼs biggest heatlh problems
requires innovation and collaboration to ensure that health is within reach for
everyone (PATH). One of PATHʼs main focuses is finding solutions for emerging
epidemic diseases like malaria. Similar to MPFʼs goal, PATHʼs “mission is to
improve the health of people around the world by advancing technologies,
strengthening systems, and encouraging healthy behaviors” (PATH). By
collaborating with PATH, MPF will have access to their expertise in developing
solutions for the malaria endemic in Assam.


33

4.5.1 PATHʼS MALARIA VACCINE INITIATIVE
Over the last decade, global efforts have contributed to dramatic declines in
malaria outbreaks around the world and progress is continually being made
through scientific research; new tools for controlling and preventing malaria are
constantly being tested. Despite these efforts, drug resistant malaria in
Southeast Asia could put millions at risk if it is allowed to spread. By partnering
with PATHʼs Malaria Vaccine Initiative, MPF will have access to the most up to
date malaria drug research and malaria-control programs, which will help us
move closer to our long-term goal of eradicating the disease in the Assam
community.
As a subset of the nonprofit PATH, the Malaria Vaccine Initiative (MVI) works to
accelerate the development of malaria vaccines to get them to the communities
that need them most. They identify potential malaria vaccines approaches and
systemically move them through the development process while ensuring that a
successful malaria vaccine will be widely available and accessible in these
countries.
4.6 MEDICINES FOR MALARIA VENTURE
Medicines for Malaria Venture (MMV) is a
not-for-profit public-private partnership whoʼs
missions is to reduce the burden of malaria
in disease-endemic countries by
discovering, developing and facilitating the
delivery of new, effective and affordable anti-
malaria drugs. Similar to MPFʼs vision,
MMV works toward creating a world in which innovative medicines will cure and
protect underprivileged communities at high risk of malaria, ultimately eradicating
this terrible disease (MMV).
By partnering with MMV, MPF will be able to provide medication and treatment to
the locals of Assam who are inflicted with malaria. Our clinic will not only have
access to essential medicines and treatments, but it will also have the advice and
expertise of the experienced managements team of MMV. We will also be able
to administer Artemisini-based combination therapies (ACTs), which are currently
recommended as first-line treatment for uncomplicated P. falciparum malaria by
the WHO, and will allow us to stop malaria before it even begins (MMV).


34

4.7 NATIONAL INSTITUTE OF MALARIA
RESEARCH
The NIMR is a research institution that provides
cutting edge research in both field and lab-
oriented topics. The field-oriented research is
mainly conducted at the 10 established units
located in different malaria endemic places in the
country. A Partnership with the National Institute
of Malaria Research will provide the Malaria
Relief Foundation Clinic with consultancies for
preparing a malaria action plan and delimiting
high-risk areas for prioritizing interventions.
NIMR is an institution of the Indian Council of Medicine (an autonomous body
under Department of Health Research, Ministry of Health & Family Welfare, Govt.
of India) and its primary task is to find short and long-term solutions to the
problems cause by malaria through basic, applied and operational field research.
It also plays a key role in providing man power resource development through
trainings/workshops and transfer of technology.
The major areas of research carried out over the years are on mosquito fauna
surveys, development of genetic and molecular markers for important malaria
vectors and parasites, cytotaxonomic studies identifying major vectors as species
complexes and laboratory and field studies to examine the biological variations
among sibling species. Field evaluation of new insecticides, biolarvicides,
insecticide-impregnated bed nets, drugs and parasite diagnostic kits have
provided new armament to malaria control and many of these have found place
in national malaria control program (Singh, 2010).
Through a partnership with the National Institute of Malaria Research MPF will
not only have access to the most recent research on malaria, it will also allow us
to develop good relations with the Indian government which is essential to giving
us leverage for easy access for building the clinic.


35

4.8 CENTER FOR DISEASE CONTROL
(CDC)
The Center for Disease Control and
Prevention is a U.S. federal agency under
the Department of Health and Human
Services. CDC works to protect public
health and safety by providing information
to enhance health decisions and by
promoting health through partnerships with state health departments and other
organizations. The CDC focuses on developing and applying disease prevention
and control. CDC laboratories (augmented by state-of-the-art insectaries and
animal facilities) conduct basic and applied studies and their findings can later be
verified or expanded during field investigations and will eventually lead to
improved, or new, interventions for control and prevention.
Malaria Prevention Foundation plans to partner with the CDC to gain access to
their malaria laboratories and the research conducted there. This will allow MPF
to work with CDC to develop molecular tools and networks in the field in the
north-eastern region of India that will monitor the emergence of the drug-resistant
malaria in Assam.
The laboratories will collect and maintain malaria parasite isolates with a wide
array of defined drug-resistant properties in order to identify and characterize the
molecular and biological markers of drug resistance and, also, the mechanisms
by which drug resistance develops in these malaria parasites. MPFʼs malaria
clinic will offer training to investigators in Assam on proper use of the molecular
markers to detect and track drug-resistant parasites as well as training for in vitro
methods of testing parasites for drug susceptibility.
4.8.1 CDC FOUNDATION
The CDC Foundation was established by congress as an independent, nonprofit
organization that connects the Center for Disease Control and Prevention (CDC)
with private-sector organizations and individuals in order to build public health
programs. Since 1995, the CDC Foundation has provided millions of dollars to
support CDCʼs work, launched more than 60 programs around the world and built
a network of individuals and organizations committed to improving public health.
By working with the CDC through the CDC Foundation, MPF will be better able to
accomplish its public health goals. Their partnership will provide our foundation


36

with collaborative efforts with world-renowned CDC scientists, access to research
facilities and scientific expertise (CDC).
4.9 PARTNERSHIP WITH THE LOCALS
In addition to partnering with the aforementioned organizations, Malaria
Prevention Foundation will engage the local community to promote proper
prevention and encourage those with symptoms to seek treatment at the clinic.
Not only will we provide educational materials and information sessions at the
MPF clinic, but we will also send volunteers and MPF personnel into local
schools to educate Assamʼs youth about malaria and what can be done to stay
safe and healthy. We will also oversee Global Brigadesʼ community health
trainings, and once they leave Assam, we will supervise the healthcare in the
community by working with local doctors and leaders. Thus, MPFʼs goal is not
only to provide a health care and educational facility, but we also aim to empower
the locals to eventually take their health into their own hands.


37

FINANCE
HAO-TING SUN


38

5.1 OVERVIEW OF MPFʼS FINANCES
In order to prevent and educate local residents living at Assam, India, about
malaria, we need to provide them with insecticide nets and artemisinin-based
combination therapies (ACTs). We would also need to provide them with Rapid
Diagnostic Test (RDTs) in order to diagnose local residents more accurately, a
clinic to treat the local patients, and doctors and pamphlets to educate people
about malaria and how to prevent it.
Money is essential to our operation and we cannot reach our goals to prevent
Malaria in India with money. Since we are a nongovernmental organization, we
rely on partnership and grants to fuel our operation.
In 2011, Assam encountered approximately 47,400 cases. Therefore, for our
project, we are providing 50,000 amounts of ACTs, RDTs, antimalarial drugs,
insecticide nets, and pamphlets. According to the National Center for
Biotechnology Information, each unit of ACT, RDT, and antimalarial drugs costs
$0.95, $0.75, and $5, respectively. The cost of an insecticide net and insecticide
spray for a year is $2.20 and $6.70, respectively, and we calculated the cost of
printing a pamphlet is about $0.50
Above: Chart of all costs of items per unit and total cost of each item.


39

Above: Total cost of each item in comparison with others.
Since we have a limited amount of medications and preventative measures, we
are focusing our help in rural and high-risk areas in Assam to the people that
needed the most.
We also need to build a clinic to shelter patients for treatment and for people to
come in and ask questions about Malaria. Building a simple clinic with two rooms
in India is estimated around $150,000 and the costs of hiring two doctors would
be around $160,000 for both. The total cost of everything added would $310,000.
Above: Total costs of resources.
But since we do not have any funds, we plan to work with different organizations
to help us with various items. For example, the Architecture for Humanity will
build the clinic for us while the Global Brigade will supply us with the two doctors
that we need for our operation. The Medicines for Malaria Venture, the Bestnet,
and the PATH Malaria Vaccine Initiative will provide us with insecticide nets,
residual insecticide spray, ACTs, RDTs, and antimalarial drugs. By having these
partnerships, we can greatly cut our expenses for our operation.
Insec&cide
Nets,

$
110000

Residual

Insec&cide

Spray,
$
335000

An&malarial

Drugs,
$

250000

ACTs,
$
47500

RDTs,
$
37500

Pamphlets,
$

25000


40

There would also be equipment, travel, and communication costs. Equipment
costs would include the purchase of new computers and software, tables, chairs,
desks, and tools. Travel cost would include plane tickets while the
communication cost would include the cost of cell phone and Internet.
By having cellphones for our group members, we can contact our partnerships to
keep up with current, up-to-date donations and medicine information. By having
computers, we can organize information about our clinics as well as local
patients.
Above: Total costs of equipment and necessities.
Above: Pie chart of total costs of equipment and necessities.
Tables,
Chairs,

Desks,
$
750

Tools,
$
1500

Plane
Ticket,
$

8500

Phone,
$

4880

Internet,
$
600

Food,
$
15000


41

5.2 Grants
We also ask grants from Bill and Melinda Gates Foundation in order to fund our
operational and equipment needs. The Bill and Melinda Gates Foundation
required us to submit a Letter of Inquiry (LOI). The LOI describes the purpose of
the project, summarizes the projectʼs goals, and includes financial information for
the project. The Bill and Melinda Gates Foundation provides funding priorities for
organizations for developing improved methods for mosquito control and develop
public awareness about malaria. For our operation, we received $35,000 in
grants from Bill and Melinda Gates Foundation per year.
Above: Total expense pie chart: Donation takes up most of our monetary needs.
As you can tell, our operation depends heavily on donations, such as
medications, from various organizations or company-related to the items that we
need. Without all these donations and grants, our operation would not be
successful. It is our duty and goal to put these donations and grants to good and
efficient use in order to prevent, educate, and treat Malaria.
Dona&on
Value

98%

Grants

2%
Total
Expense


42

Conclusions
Jennifer Quach


43

Malaria Prevention Foundation
believes that with the help from all our
partners, and us we will be able to
assist in reducing the cases of malaria
in India. With the clinic we will be able
to not only treat and prevent malaria
upon the locals, but also educate
them on how to protect themselves
and their loved ones from getting
malaria.
Assam, India is one of the highest risk
areas for malaria; however, with the help of MPF, we hope to eradicate malaria
from Assam, India one day. With our assistance, and our clinic as a resource,
Assam, India will have a brighter future.


44

Works Cited


45

An Overview Of Who Guidelines On The Management Of Malaria Dr. Anupama
Yerra & Dr. Pritesh Nagar
http://www.pedicon2010.org/uploads/Recent%20Advances%20Malaria.pdf
Architecture for Humanity (2010) San Francisco, CA. Web. 1 Aug. 2012
http://architectureforhumanity.org/about
Bestnet (2010) Denmark. Web. 1 Aug. 2012
Http://www.bestneteurope.com/newsmedia-
2.aspx?PID=1947&M=newsv2&Action=1&newsid=138
Center for Disease Control and Prevention (CDC). (2012) Atlanta, Georgia. Web.
1 Aug, 2012
Http://www.cdcfoundation.org/contact
Foster, S.D. “Pricing, Distribution, and Use of Antimalarial Drugs.” (National
Center for Biotechnology Information). Bethesda, MD. Web. 31 July 2012
http://www.ncbi.nlm.nih.gov/pubmed/1893512
Garten, Jeffrey E. “Really Old School” New York Times, 9 December 2006. New
York. Web. 1 August 2012
http://www.nytimes.com/2006/12/09/opinion/09garten.html?_r=1&scp=1&sq=Nal
anda&st=cse
Global Brigades (2011) Fresno, CA. Web. 1 Aug. 2012
Http://www.globalbrigades.org/about/vision-and-mission/
Guidelines for Diagnosis of Treatment on Malaria in India, 2009
http://www.mrcindia.org/Guidelines_for_Diagnosis___Treatment.pdf
Healthwise. “Malaria Prevention” (webmd). 20 April 2011 Web. 30 July 2012
Http://www.webmd.com/a-to-z-guides/malaria-prevention
Lacy, Deborah. “Investing in Malaria Pays Off” (Bill & Melinda Gates Foundation).
Web. 31 July 2012 http://www.impatientoptimists.org/en/Posts/2012/06/Investing-
in-Malaria-Pays-Off


46

Malaria parasite burden and treatment seeking behavior in ethnic communities of
Assam, Northeastern India Dev, V; Phookan, S; Sharma, VP; Dash, AP; Anand,
SP. JOURNAL OF INFECTION Volume: 52 Issue: 2 Pages: 131-139
Feb 2006
Http://apps.webofknowledge.com.proxy.library.ucsb.edu:2048/full_record.do?Pro
duct=WOS&search_mode=generalsearch&qid=1&SID=4EC45fJnJ2M97eoiBAO
&page=1&doc=8
Medicines For Malaria Venture (MMV) (2012) Geneva, Switzerland. Web. 1 Aug.
2012
Http://www.mmv.org/about-us/malaria-and-medicines
PATH (2012) Seattle, Washington. Web. 1 Aug. 2012
Http://www.path.org/about/index.php
Http://www.malariavaccine.org/
Prasad, Hardev. “Evaluation of Malaria Control Programme in Three Selected
Districts of Assam, India” December 2009 Web. 30 July 2012
Http://www.mrcindia.org/journal/issues/464280.pdf
Singh, O.P. “About National Institute of Malaria Research”. National Institute of
Malaria Research (Indian Council of Medical Research). 2010. Delhi, India. Web.
1 Aug. 2012 http://www.mrcindia.org/about.htm
Therapeutic efficacies of antimalarial drugs in the treatment of uncomplicated,
Plasmodium falciparummalaria in Assam, north-eastern India
Dev, V; Phookan, S; Barman, K , DEC 2003
Annals Of Tropical Medicine And Parasitology
Volume: 97 Issue: 8 Pages: 783-791
Http://apps.webofknowledge.com.proxy.library.ucsb.edu:2048/full_record.do?Pro
duct=WOS&search_mode=generalsearch&qid=1&SID=3CD3dihiBp1MKp3aGMi
&page=2&doc=12
World Bank. “Education in India” 2012. Web. 1 August 2012
http://www.worldbank.org/en/country/india

MPF Proposal

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (15)

Semelhante a MPF Proposal

Semelhante a MPF Proposal (20)

MPF Proposal