This week PLOS Medicine publishes the following new articles:
Malaria in pregnancy is responsible for the deaths of about 200,000 newborn babies and 10,000 women every year and can cause miscarriage and preterm delivery, despite simple and inexpensive interventions. Jenny Hill and colleagues report that the main barriers to the access, delivery, and use of interventions are relatively consistent across sub-Saharan African countries, and more barriers hinder the use of intermittent preventative treatment in pregnancy (IPTp) with the drug SP (sulfadoxine-pyrimethamine) than the use of insecticide-treated bed nets. The barriers identified in this study may be helpful as a checklist for use by country malaria programmes and policy-makers to identify factors that influence the uptake of these interventions in their specific location or context.
Less than five percent of promising basic science discoveries that claim clinical relevance lead to approved drugs within a decade, partly because of flawed pre-clinical animal research. A number of recent initiatives seek to improve the quality of such studies, and Jonathan Kimmelman and colleagues identify key experimental procedures believed to increase clinical generalizability in the new STREAM (Studies of TRanslation, Ethics And Medicine) checklist. Preclinical animal research is a critical step in drug development; more rigorous attention to experimental procedures protects patients in subsequent clinical trials, redeems the use of animals, and promises to reduce the cost and delay in developing drugs.
While non-communicable diseases (NCDs) exact a heavy burden on populations and governments around the world, particularly in low- and middle-income countries (LMICs), it is not clear that they will be included or prioritized within the new development agenda to replace the Millennium Development Goal (MDG) programme that ends in 2015. Devi Sridhar and colleagues argue that, if non-communicable diseases are included in the new health goals, it is likely they will be included via the broad umbrella of healthy life expectancy, or the sector-specific target of universal health coverage. Healthy life expectancy or universal health coverage, as currently conceived, are unlikely to adequately incorporate NCDs that require alternative health system mechanisms and clear governmental intervention.
Access to drugs for NCDs represents the latest treatment-access crisis, and will require a transformation in global health much like the fight for access to patented HIV/AIDS medicines in developing countries did a decade ago. Thomas Bollyky argues a new fight over treatment access looms in areas like India, China, and other LMICs, which have taken measures to circumvent patents on medicines for diabetes, cancer, and cardiovascular and chronic respiratory illnesses, the NCDs increasing most rapidly in LMICs. The transformation should focus on low-cost interventions and patient-centered rather than country-focused strategies.