When asked what the world’s deadliest animal is, people often think of sharks, snakes or for the more cynical amongst us, humans. The world’s deadliest animal is none of these - it is the humble mosquito.
For many of us in developed countries, mosquitoes cause nothing more than an itchy rash. But for the unfortunate individuals who live within 95 malaria-endemic countries today, a bite from a female Anopheles mosquito might be deadly.
Currently, half of the world’s population are at risk of infection and 214 million people contract malaria every year. The World Health Organization estimates 438 000 deaths in 2015, with the majority of these in children under five. 9 out of 10 malaria cases are in Subsaharan Africa with the worst outbreaks during rainy season.
The symptoms of malaria are not a walk in the park. One salient description of the symptoms was highlighted by Bill Gates in his blog:
“I awoke to what felt like lightning going through my legs, and then spreading through my body and in my head. Probably the worst headache, body aches, and chills you could possibly imagine. It felt like I was being stung repeatedly by an electric shock gun and could barely control my movements. The pain was so intense; I actually believed I was dying, literally crying out in pain so bad that I was taken to a 24 hour clinic that night at 3am.”
For those fortunate enough to survive, malaria can have lasting impacts on an individual’s ability to function, preventing them from working or earning money to live; a terrifying thought.
Malaria is a fully diagnosable and treatable disease. The test with the highest accuracy or the gold standard is a test known as the thick and thin blood film. Two drops of blood are collected from the patient’s finger onto glass slides. One drop is spread thinly to create a thin blood film and the other is not spread to create a thick blood film. The drops of blood are then examined under the microscope to identify the exact malaria parasite and count the number of parasites in the blood.
This is important as one parasite known as Plasmodium Falciparum requires stronger and longer treatment than the other strains. Counting the number of parasites in the blood is crucial to determining disease severity, the treatment regime and knowing when a patient is improving.
Unfortunately, neither of these tasks are easy or fast. Accurate identification of the malaria parasite is difficult and counting the number of parasites is time-consuming, taking 20-30 minutes per patient. The difference in accuracy between doctors or interoperator variability is high. Malaria experts are extremely accurate (97-99%) whilst doctors who have received formal training are expected to have 70% accuracy.
In a malaria-endemic country with an already burdened health system, accurately diagnosing malaria for everyone is simply not possible. Doctors will cut corners to save time, insufficient staff will be trained and in some communities, any patient with fever is treated with drugs, even if it is just the simple flu. Wrongly treating patients is leading to malarial parasites becoming resistant to antimalarial drugs. In a number of countries, the problem is becoming more serious, with many patients dying because medications are no longer effective.
Between 2000 and 2015, the rates of malaria have decreased by 37% and mortality rates have dropped by 60%. Although this is promising, the fight is far from over. When we look to smallpox, the only other disease we have eradicated, it took 10-12 years to bring 10 million cases down to 0. With malaria, we are still sitting at 214 million. As the incidence of malaria drops, diagnosis becomes more difficult as cases become rarer.
The fight to eradicate malaria is gaining speed with increased investment from Governments, Philantropic Foundations and Public Health Organizations. Malaria funding has increased 10-fold between 2000 and 2012. Significant backing for the fight has been received from the Global Fund to Fight AIDS, TB and Malaria, the Bill and Melinda Gates Foundation, the World Bank, the Wellcome Trust and the United States, UK, Australia and Japan. Endemic countries’ commitments to the malaria fight are growing.
Africa is undergoing a technological gold rush. Over the last 2 years, smartphone usage has doubled to 226 million and over a quarter are connected to the internet. Microsoft, Google and Facebook have all invested hundreds of millions of dollars into technology infrastructure and entrepreneurship hubs are developing in countries such as Kenya, Ivory Coast, Nigeria, Ghana and South Africa.
A colleague of mine recently described a teleconferencing session between doctors in Kenya with doctors from a metropolitan hospital in London. Whilst the Kenyan doctors had access to a powerful computer with Windows 10, doctors in London were confined to a Windows 95 desktop.
The time is ripe for an effective, reliable and fast malaria solution that relies on existing infrastructure. We plan to develop an artificial intelligence solution that can accurately diagnose the strain of malaria and rapidly count the number of parasites. The solution will leverage onto existing systems and allow hospitals to process blood films at significantly faster speeds with minimal human effort. This will provide hospitals with the opportunity to earn revenue by processing films from other hospitals and medical clinics.
The solution we develop will be field-tested, and clinically validated with expert diagnosis. Our research will be published in peer-reviewed medical journals once sufficient data has been collected. We will be working closely with field partners from a number of countries (both African and non-African) and our experiences will be documented on this website. Our depersonalised surveillance data will be shared with any interested parties, such as United Nations bodies, public health organizations, Governments and teaching institutions. Our platform will provide a foundation to automate other diseases requiring microscopic diagnosis.
We hope to change the medical field in developing countries with technology in a socially conscious, economically viable and significantly impactful way.