Frugal Engineering Design Solutions in the Fight to Eradicate Malaria

By the time you finish reading this, another child will have died from malaria, a disease that kills approximately 600,000 people each year. Ninety-six percent of these victims live in Africa, and eighty percent are children younger than five years old (WHO, 2021). Malaria’s cause, a parasite transmitted by the bite of the Anopheles mosquito, has been known for over a century; but, this ancient killer continues to evade humanity’s best efforts to eradicate it. Today, brilliant engineers are on the frontlines, working to develop sustainable, cost-effective solutions that may finally put us in position to defeat this enduring adversary.

In the twentieth century, scientists made strong headway against malaria. The widespread use of insecticides like DDT, insecticide-treated bed nets, and anti-malarial drugs like chloroquine saved millions of lives. But each of these solutions had shortcomings. DDT was detrimental to human health. Mosquitoes became resistant to insecticide-treated bednets and chloroquine. Progress against malaria slowed, and then plateaued.

The world’s malaria rate has not only failed to decline since 2013, it is even increasing in some countries such as Nigeria, which reported an increase of 1.3 million cases in 2017 (McNeil, 2018). In 2021, the World Health Organization heralded a major advance, the first malaria vaccine, Mosquirix. But the vaccine is only thirty percent effective at preventing severe malaria (D’Souza, 2021). It is not a panacea and does not overcome one of the most basic fundamental challenges to malaria care: rapid and inexpensive diagnosis of the disease.

To achieve a cost-effective and sustainable solution to the scourge of malaria, quick and easy diagnosis is essential (WHO, 2021). Patients, especially those infected with the most deadly parasitic species, Plasmodium falciparum, are much more likely to survive if their malaria is identified and treated promptly. But definitively diagnosing malaria is not easy because it requires separating out the plasma and red blood cell components of a patient’s blood. Doing so requires a centrifuge, a heavy, expensive piece of equipment that requires electricity to run. Many African villages lack not only centrifuges, but also electricity.

Luckily, a team of engineers has begun to solve this problem.

A Stanford engineer named Manu Prakash once visited a rural clinic in Uganda. There he noticed that a centrifuge was being used as a doorstop because there was no electricity to run it (Newby, 2017). He became inspired to collaborate with healthcare professionals and devote his career to what is termed “frugal design”. In 2017, he and his team developed a handheld centrifuge based on the physics of a child’s toy—the whirligig. Composed of a cardboard disc that spins by the pulling of coiled strings passing through holes in its center, Prakash’s “paperfuge” achieves 125,000 rpm, a rate even higher than some electric centrifuges (Bhamla, 2017). Each one costs only twenty cents and can be operated by anyone, with little to no training. Using tiny plastic capillary straws to hold blood specimens, it takes only 1.5 minutes to separate pure plasma from red blood cells, and malarial parasites can be identified under a microscope within fifteen minutes. The paperfuge was perfectly complemented by another invention developed by Prakash’s team, the “foldoscope,” a paper microscope that costs only ninety-seven cents to make (Cybulski, 2014). It provides 2,000-fold magnification, weighs only eight grams, and can run for over fifty hours on a single battery. Together, the paperfuge and foldoscope are giving healthcare workers the tools they need to rapidly diagnose and treat malaria in even the most remote parts of Africa.

In order to find sustainable solutions to humanity’s greatest problems, engineers like Prakash are needed to develop new, cost-effective solutions. On a global scale, there are few more valuable and virtuous goals than the eradication of malaria. By giving hundreds of millions of children the chance to live healthy, productive lives, we not only improve worldwide health, but also take a positive step toward economic progress and global stability.

Annotated Bibliography

Bhamla, M.S., Benson, B., Chai, C., et al. (2017, January 10). Hand-powered ultralow-cost paper centrifuge. Nature Biomedical Engineering, 1, 1-6. Retrieved from https://www.nature.com/articles/s41551-016-0009.
This is the original scientific article that introduced the inexpensive paper centrifuge. It comprehensively describes the physics, efficacy, and efficiency of the paperfuge. The paperfuge can be mass-produced and widely distributed with ease—a godsend for technicians who no longer need to lug heavy, expensive, electric-powered centrifuges to rural areas in Africa. It is amazing to see that this game-changing innovation was inspired by a child’s toy, demonstrating how engineering draws on all aspects of life.

Cybulski, J.S., Clements, J., Prakash, M. (2014, June 18). Foldscope: Origami-Based Paper Microscope. PLoS ONE, 9(6), 1-3. Retrieved from https://doi.org/10.1371/journal.pone.0098781.
This is the scientific article that described the foldoscope, a paper microscope that offers 2000-fold magnification at a cost of only ninety-seven cents. The paper highlights the wide application of microscopy in medicine, science, and education. Coupled with the paperfuge, these products of “frugal science” can be used to efficiently diagnose malaria, especially in areas where impoverished people struggle to gain access to malaria prevention tools.

D’Souza, J., Nderitu, D. (2021, December). Ethical considerations for introducing RTS,S/AS01 in countries with moderate to high Plasmodium falciparum malaria transmission. Lancet, 9, e1642-e1643. Retrieved from https://doi.org/10.1016/S2214-109X(21)00498-8.
This journal article considers ethical factors that nations should consider when deciding whether to adopt the new 2021 Mosquirix vaccine, which is only thirty percent effective at reducing cases of severe malaria. This level fails to reach the WHO’s usual requirement of seventy-five percent efficacy. But, the authors conclude that, even though the Mosquirix vaccine is only modestly effective, and superior vaccines in the pipeline may be close at hand, Mosquirix’s use is ethical because the need to address health inequities affecting impoverished African populations is so urgent.

McNeil, D. (2018, November 19). The Fight Against Malaria Has Reached a Standstill. New York Times. Retrieved from https://www.nytimes.com/2018/11/19/health/malaria-deaths-who.html.
This article highlights our stalled progress in the effort to eradicate malaria. Despite tools like bednets and drugs, as well as generous government funding, we are losing ground and malaria remains a critical problem. As insecticide and drug resistance (and annual malaria cases) increase, the need for sustainable solutions continues to grow.

Newby, K. (2017, January 10). Inspired by a whirligig toy, Stanford bioengineers develop a 20-cent, hand-powered blood centrifuge. Stanford News. Retrieved from https://news.stanford.edu/2017/01/10/whirligig-toy-bioengineers-develop-20-cent-hand-powered-blood-centrifuge/.
This article describes the exciting story of Manu Prakash and his engineering team that invented the paperfuge. The philosophy of “frugal design” is highlighted. The paperfuge’s engineers sought to make their product cheap, transportable, and available in remote regions of Africa. The description of an expensive centrifuge being used as a doorstop was a powerful way to illustrate the struggles of villages that lack electricity.

World Health Organization. (2021, December 6). Malaria. Retrieved from https://www.who.int/news-room/fact-sheets/detail/malaria.
This article on malaria provides current and accurate information on the disease, and our efforts to combat it. It was enlightening to learn about the life-saving benefits of early diagnosis. The report’s statistics about mortality rates, and the vulnerability of women and young children, put the grim reality of malaria’s toll into perspective. Even though we now have the new RTS,S/AS01 vaccine (Mosquirix), these numbers make clear the ongoing need for more efficient, cost-effective solutions.