Although, according to the most recent World Malaria report, there were still an estimated 655,000 deaths from the disease in 2010, the majority occurring in African children, major investments in malaria control by the international community in the past decade have yielded excellent returns, with mortality rates falling by more than 25% globally. However as we approach this year’s World Malaria Day (25th April), it may be prudent to consider widening the focus of these international control efforts.
Of the five distinct species of Plasmodium causing human malaria, two species, namely P. malariae and P. ovale, have low prevalence and normally only cause mild disease. The thrust of global control efforts has been directed at P. falciparum, one of the two highly prevalent species, because it causes the highest mortality. However the former name of ‘benign tertian malaria’ given to P. vivax, the other highly prevalent species that is also the most widely distributed, is certainly a misnomer; infection with P. vivax is anything but mild. It has been estimated that this species, endemic in South and Central America, the Middle East, Africa and Asia, and found in temperate as well as tropical areas, causes over two hundred million cases of malaria per year. While fatal infections, usually resulting from a ruptured spleen, are infrequent, P. vivax is harder to diagnose than P. falciparum as it infects immature red blood cells and parasitaemias are thus lower. It is also harder to treat because the life cycle includes dormant liver stages (hypnozoites) that cause periodic relapse infections, accompanied by severe anaemia, respiratory distress and poor obstetric outcomes. And it affects all age groups rather than predominantly children, so as well as the human suffering endured, the economic impact is huge.
The fifth species of Plasmodium that can cause human malaria, P. knowlesi, was previously only thought to infect certain species of macaque monkeys, but has now been recognised as a clinically significant zoonosis. It has been reported from several South East Asian countries, including Thailand, Malaysia, Vietnam, Myanmar, Singapore, Indonesia and the Philippines, and causes up to 70% of the malaria cases in some of these areas. As with P. falciparum, infection with P. knowlesi is potentially fatal if it is not diagnosed and treated promptly; unfortunately microscopically it is very similar to the much less serious P. malariae and is frequently misdiagnosed. And a major concern is that deforestation and increasing human settlement in P. knowlesi endemic areas may result in humans, rather than macaques, becoming the preferred host, and thus the dissemination of P. knowlesi to neighbouring countries where there are no suitable simian hosts, but where the vector mosquitoes (predominantly Anopheles leucophyrus group) breed.
International investment and efforts to control malaria in the last decade have been truly laudable, but it is now time to look outside the P. falciparum box.
Like much in healthcare IT, the development of Laboratory Information Management Systems (LIMS) has been an uneven mix of technology-push and user-pull, coupled with regulatory efforts at streamlining the two. Today, the new vista of cloud computing is rapidly opening up new LIMS opportunities, especially for smaller labs.
The demand for LIMS began in the late 1970s after the proliferation of electronic lab equipment and an explosion in data. The then-emerging technology of ‘minicomputers’ offered LIMS the first realistic alternative to expensive/inaccessible mainframes. Minicomputers, however, were only a brief interlude in computing technology, before the advent of personal computers. Most minicomputer vendors (e.g Data General, Wang, Norsk Data etc.) have since disappeared. By the late 1980s, personal computers enabled LIMS users to leverage relational databases. The arrival of client/server architecture and the Internet in the 1990s expanded the reach of LIMS outside laboratories, providing novelties such as 24×7 analysis from offshore locations. The past decade has expanded the footprint of LIMS further via Wi-Fi, mobile access and standards like XML.
However, much of this has been a mixed blessing. As the LIMS community proliferated, so too did concerns about data security and systems complexity. Competition among LIMS vendors led to a blizzard of new features, ranging from those required to comply with regulations, to a swathe of pureplay ‘business’ applications such as inventory and personnel management, workflow sequencing etc. The result: an escalation in user expectations, and in entry-level costs.
In spite of the recent centralisation of healthcare, most labs are still relatively small. In the US, the largest 50 account for one-third of the industry’s total revenues of about 40 billion dollars; over 7,500 labs share the rest. With commercial LIMS systems beyond their budgets, several labs have sought to develop their own, but almost always ended up with huge cost-overruns, and performance problems. One reason lies in the very essence of information technology, namely the steady fall in unit costs of processing power, with savings harnessed by commercial vendors to bundle additional features. The second reason: any mission-critical IT system needs to handle peak load requirements, often several multiples of the median; healthcare is no exception.
Cloud computing technology may answer both the above challenges, and LIMS seems an especially promising area. At its most basic, cloud computing is akin to an electricity grid, pooling computing horsepower across locations to enable scale-up on demand; the parallel is particularly close in terms of load balancing – the ability to adjust database, server and networking capacity to fluctuating demand.
In May 2010, a headline feature by the American Chemical Society titled ‘LIMS in the Cloud’ emphasised how cloud computing was opening up LIMS to small labs, which had ‘not been particularly well served’ by vendors. Indeed, cloud-based LIMS pioneers such as LabLynx have acquired over 1,000 customers in less than two years of launch. The recent entry of IT giants such as Microsoft, Oracle and Google into cloud computing promises to galvanise the industry further, with LIMS applications likely to remain at the forefront.
March 2026
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