Malaria Leadership & Global Health. Malaria: Overview A febrile illness transmitted by Anopheles mosquitoes Caused by parasites called plasmodia –P. falciparum.

Malaria

Leadership & Global Health

Malaria: Overview

• A febrile illness transmitted by Anopheles mosquitoes

• Caused by parasites called plasmodia– P. falciparum is by far the most dangerous type of

parasite

• Malaria causes much sickness and death• Malaria is preventable, treatable, and curable

Clinical Manifestations of Malaria

Infected Mosquito

Infected Human

Chronic effects

Anemia

Neurologic/ cognitive

Developmental

Impaired growth and development

Malnutrition

Acute febrile illness

Severe illness

Hypoglycemia

Anemia

Cerebral malaria

DeathRespiratory distress

Pregnancy

Fetus

MaternalAcute illness

AnemiaImpaired productivity

Low birth weight Infantmortality

Malaria: Epidemiology

• A disease of inequality: poor countries and poor people most affected– More than 90% of total cases and deaths

are in Sub-Saharan Africa– Over 3000 children die of malaria every

day in Sub-Saharan Africa.– Malaria is also common in places like Haiti.

Malaria: At-Risk Populations

• Some people are much more likely to become seriously ill or die from malaria– Pregnant women– Children under 5– People with HIV

• Prevention and early treatment should focus on these groups

Malaria: Treatment

• Depends on local resistance patterns– Haiti: chloroquine– Rwanda: Co-Artem or fansidar-amodiaquine– Malawi:

• For Simple malaria-can take oral medication as outpatient treatment

• Severe malaria requires IV treatment in a hospital or health center– Quinine, artemether

Malaria: Adverse Events

• Death

• Severe anemia/blood transfusions

• Neurologic problems

– Behavioral problems

– Seizures

– Mental delay

– Paralysis, cortical blindness

Malaria Prevention

• Malaria can be prevented– Bed nets– Education– Environmental changes– Prophylaxis for pregnant women– Insecticide spraying

Prevention: Bed Nets

• Bed nets can significantly reduce malaria

• Bed nets must be used consistently• Bed nets with insecticide help everyone

in the house, not just the people sleeping under the net

• Bed nets must be used properly and be maintained well

Estimated Cost of Malaria Control in an Endemic Area: One Million People, One Round

of Residual House Spraying

Insecticide

One application (tons) Price/ton Total cost

Cost per capita

DDT 147 $3,950 $580,650 $0.58

Malathion 220 $4,300 $946,000 $0.95

Deltamethrin 110 $20,000 $2,200,000 $2.20

Pyrimiphos-methyl

220 $16,000 $3,520,000 $3.52

Estimated Cost of Malaria Control: One Million People, One Full-dose Treatment, 1999

Drug

Tablets in millions (dose)

Price/ 1000 tabs Total cost

Cost per

capita

Chloroquine (3 days)

11.25 (100 mg)

$6.05 $68,063 $0.08

Sulfadoxine-pyrimethamine (one dose)

2.5 (500 mgS/

25 mgP)

$47.00 $117,500 $0.12

Quinine (7 d) 31.5 (300 mg) $41.25 $1,299,375 $1.30

Artesunate (5 d) 13.5 (50 mg) $365.00 $4,927,500 $4.93

Malaria and Ecology and Burden

Intrinsic and Extrinsic Factors

Controland prevention

measuresHuman

Parasite Mosquito

Social, behavioral, economic and

political factors

Environmental conditions

Malaria and HIV Co-infection

• Interactions exist between malaria and HIV– 40 million people have HIV– 500 million malaria infections occur per

year• People with advanced HIV (low CD4) are

more likely to become very sick or die from malaria

Impact of HIV on Malaria

• It is estimated that as a result of joint infection by malaria & HIV each year, – 3 million additional cases of malaria and – 65,000 more avoidable malaria deaths occur.

• These impacts are likely to be much larger in areas with high rates of HIV and unstable malaria transmission.

Summary• Conditions that contribute to the risk for

becoming infected with a Tropical Disease like malaria include environmental factors, nutritional status, climate and socioeconomic circumstances.

• Illness and death due to infection remain too and too frequent in the tropics. – Every minute three children die of malaria alone.

• The burden imposed by these diseases extends beyond the sad story of young lives being lost.– They impede the capacity of children to grow and learn,

and of young adults to work and raise a family. – They stifle efforts for individual, community and

national advancement. – They sap resources which would otherwise be utilized

for improving the human condition.

Malaria Life-Cycle