Module 2
IRS involves coating the walls and other surfaces of a house with a residual insecticide. For several months, the insecticide will kill mosquitoes and other insects that come in contact with these surfaces.
indoor residual spraying
who does malaria affect
infants and young children pregnant women non0immune (tourist)
Because the malaria parasite is found in red blood cells of an infected person, malaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her unborn infant before or during delivery ("congenital" malaria).
malaria
seen as a consequence of poverty, is also a major cause of poverty and its prevention is an important part of poverty alleviation
malaria
A malaria-stricken family spends an average of over one quarter of its income on malaria treatment, as well as paying prevention costs and suffering loss of income.
malaria cost
In Thailand, malaria patients pay nine times their average daily wage for care.
malaria cost
Malaria-afflicted families on average can only harvest 40% of the crops harvested by healthy families
malaria cost
Workers suffering a malaria bout can be incapacitated for at least 5 days.
malaria cost
The Global Strategy consists of three components
1) Controlling malaria, 2) Eliminating malaria and 3) Research into new tools and approaches.
In this context, the purpose of the Regional Strategies chapters is to translate the global strategy into regionally-specific approaches for controlling and eliminating malaria, taking into account the differences between regions:
African strategy: Build human resource and managerial capacity; Improve monitoring and evaluation systems; expand research and development and operational and implementation research; optimize procurement and supply chain management (PSM) systems; streamline burdensome financing and reporting processes; improve emergency response mechanisms.
how to present malaria infection
Bednets, repellents (Don't get bit!) Insecticides (Kill mosquitoes) Drugs (Kill the parasite) Vaccines (Block infection Kill the parasite)
Few time is cause of death - relapses are common Early symptoms (Irregular fever Spleen enlargement: 10-14 days) P. ovale: less severe
Beningn Tercian Malaria
Major gains have been made in controlling malaria in developing nations. In the past decade, malaria incidence has fallen by at least 50 percent in one-third of the countries where the disease is endemic.
Bill and Melinda Gates Foundation
Sustained research and development (R&D) is needed to create a diverse array of treatment and prevention tools and thus avoid overreliance on a small set of anti-malaria tools, which has proven risky for effective malaria control.
Bill and Melinda Gates Foundation
The Global Malaria Action Plan, the World Health Organization (WHO) and the Roll Back Malaria Partnership are coordinating international efforts. But more effective policies and increased funding are sill needed to secure lasting gains.
Bill and Melinda Gates Foundation
These gains have been made through a combination of interventions, including timely diagnosis and treatment using reliable tests and anti-malarial drugs; indoor spraying with safe insecticides; and the use of long-lasting, insecticide-treated bed nets to protect people from mosquito bites at night.
Bill and Melinda Gates Foundation
Plasmodium falciparum
Cerebral malaria-
Whereas 80% of adults have opening pressures at LP that are in the normal range (<200 mm CSF), 80% of children have elevated opening pressures (>100 mm CSF; the normal range is lower in children), and intracranial pressure may rise transiently to very high levels. Some patients with cerebral malaria die of acute respiratory arrest with neurologic signs that are compatible with brainstem compression. However, these signs are also common and may persist for many hours in survivors.
Cerebral malaria- Plasmodium falciparum
Hidden Consequences of severe Malaria
Children experiencing cerebral malaria and malaria accompanied by complex seizures
Classically (but infrequently observed) the attacks occur every second day with the "tertian" parasites (P. falciparum, P. vivax, and P. ovale) and every third day with the "quartan" parasite (P. malariae).
Classically (but infrequently observed) the attacks occur every second day with the "tertian" parasites (P. falciparum, P. vivax, and P. ovale) and every third day with the "quartan" parasite (P. malariae).
Climatic suitability for stable malaria transmission, where 0 = unsuitable, hence transmission very unstable or absent, 1 = highly suitable, hence transmission stable, and fractions between 0 and 1 = decreasing suitability, therefore more and more unstable transmission
Climatic suitability for stable malaria transmission, where 0 = unsuitable, hence transmission very unstable or absent, 1 = highly suitable, hence transmission stable, and fractions between 0 and 1 = decreasing suitability, therefore more and more unstable transmission
Different species of mosquitoes have Intra-specific genetic ,behavior, and adaptation to
Different species of mosquitoes have Intra-specific genetic ,behavior, and adaptation to
Differently from the human host, the mosquito host does not suffer noticeably from the presence of the parasites.
Differently from the human host, the mosquito host does not suffer noticeably from the presence of the parasites.
why is malaria getting worse?
Drug resistance Insecticide resistance Deterioration of public health services Environmental changes No vaccine
Created by the Roll Back Malaria (RBM) Partnership, the global coordinating body for fighting malaria.
Global Malaria action Plan
The RBM Partnership comprises all malaria-endemic countries, bilateral and multilateral development partners, the private sector, nongovernmental organizations, community-based organizations, foundations, and research and academic institutions involved in malaria control as well as the RBM Secretariat, Working Groups, and Sub-Regional Networks
Global Malaria action Plan
The plan will maximize the impact of the malaria community's work by guiding the prioritization of resources and by strengthening the alignment across and effectiveness of various initiatives.
Global Malaria action Plan
he purpose of the Global Malaria Action Plan is to foster agreement among all partners around the goals, strategy, and activities required to control malaria transmission.
Global Malaria action Plan
24% of children in both malaria groups had significant cognitive impairment. Crude estimates: 128,000 children a year develop epilepsy following malaria. 250,000 develop significant cognitive impairment
Hidden Consequences of severe Malaria
In countries where cases of malaria are infrequent, these symptoms may be attributed to influenza, a cold, or other common infections, especially if malaria is not suspected. Conversely, in countries where malaria is frequent, residents often recognize the symptoms as malaria and treat themselves without seeking diagnostic confirmation ("presumptive treatment").
In countries where cases of malaria are infrequent, these symptoms may be attributed to influenza, a cold, or other common infections, especially if malaria is not suspected. Conversely, in countries where malaria is frequent, residents often recognize the symptoms as malaria and treat themselves without seeking diagnostic confirmation ("presumptive treatment").
In high-income countries, aggressive prevention measures and more effective monitoring and treatment gradually brought the disease under control and then led to elimination—which the World Health Organization defines as the complete interruption of mosquito transmission of the disease for three or more years
In high-income countries, aggressive prevention measures and more effective monitoring and treatment gradually brought the disease under control and then led to elimination—which the World Health Organization defines as the complete interruption of mosquito transmission of the disease for three or more years
A form of personal protection that has been shown to reduce malaria illness, severe disease, and death due to malaria in endemic regions. In community-wide trials in several African settings, ITNs have been shown to reduce the death of children under 5 years from all causes by about 20%. Bed nets form a protective barrier around people sleeping under them. However, bed nets treated with an insecticide are much more protective than untreated nets.
Insecticide-treated bed nets (ITNs)
Severe anaemia, jaundice, hyperventilation, malfunctioning of central nervous system
Malaria caused by P. falciparum (malignant tertian Malaria)
Malaria is transmitted among humans by female mosquitoes of the genus Anopheles.
Malaria is transmitted among humans by female mosquitoes of the genus Anopheles.
Malaria parasites are micro-organisms that belong to the genus Plasmodium. There are more than 100 species of Plasmodium, which can infect many animal species such as reptiles, birds, and various mammals. Four species of Plasmodium have long been recognized to infect humans in nature. In addition there is one species that naturally infects macaques which has recently been recognized to be a cause of zoonotic malaria in humans.
Malaria parasites are micro-organisms that belong to the genus Plasmodium. There are more than 100 species of Plasmodium, which can infect many animal species such as reptiles, birds, and various mammals. Four species of Plasmodium have long been recognized to infect humans in nature. In addition there is one species that naturally infects macaques which has recently been recognized to be a cause of zoonotic malaria in humans.
which is found worldwide in tropical and subtropical areas. It is estimated that every year approximately 1 million people are killed by P. falciparum, especially in Africa where this species predominates. P. falciparum can cause severe malaria because it multiples rapidly in the blood, and can thus cause severe blood loss (anemia). In addition, the infected parasites can clog small blood vessels. When this occurs in the brain, cerebral malaria results, a complication that can be fatal.
P. falciparum
is found throughout Southeast Asia as a natural pathogen of long-tailed and pig-tailed macaques. It has recently been shown to be a significant cause of zoonotic malaria in that region, particularly in Malaysia. P. knowlesi has a 24-hour replication cycle and so can rapidly progress from an uncomplicated to a severe infection; fatal cases have been reported.
P. knowlesi
found worldwide, is the only human malaria parasite species that has a quartan cycle (three-day cycle). (The three other species have a tertian, two-day cycle.) If untreated, P. malariae causes a long-lasting, chronic infection that in some cases can last a lifetime. In some chronically infected patients P. malariae can cause serious complications such as the nephrotic syndrome.
P. malariae
is found mostly in Africa (especially West Africa) and the islands of the western Pacific. It is biologically and morphologically very similar to P. vivax. However, differently fromP. vivax, it can infect individuals who are negative for the Duffy blood group, which is the case for many residents of sub-Saharan Africa. This explains the greater prevalence of P. ovale(rather than P. vivax ) in most of Africa.
P. ovale
which is found mostly in Asia, Latin America, and in some parts of Africa. Because of the population densities especially in Asia it is probably the most prevalent human malaria parasite. P. vivax (as well as P. ovale) has dormant liver stages ("hypnozoites") that can activate and invade the blood ("relapse") several months or years after the infecting mosquito bite.
P. vivax
has stages of dormancy on the liver that can cause relapses
Plasmodium vivax
Where is malaria?
Primarily in the tropics
Paroxysms every 3 days Mildest form of Malaria Chronic Neuropathic
Quaternary Malaria P. malariae
Since malaria cannot be diagnosed clinically, blood must be examined either by microscopy, after staining thick and thin films (Giemsa at pH 7.2 is preferred; Wright's, Field's, or Leishman's can also be used), or by rapid antigen detection tests (RDTs). In many endemic areas, a high percentage of individuals (often 95% of children and 50% of adults) have low densities of P. falciparumin their blood during transmission seasons.
Since malaria cannot be diagnosed clinically, blood must be examined either by microscopy, after staining thick and thin films (Giemsa at pH 7.2 is preferred; Wright's, Field's, or Leishman's can also be used), or by rapid antigen detection tests (RDTs). In many endemic areas, a high percentage of individuals (often 95% of children and 50% of adults) have low densities of P. falciparumin their blood during transmission seasons.
The classical (but rarely observed) malaria attack lasts 6-10 hours. It consists of a cold stage (sensation of cold, shivering) a hot stage (fever, headaches, vomiting; seizures in young children) and finally a sweating stage (sweats, return to normal temperature, tiredness).
The classical (but rarely observed) malaria attack lasts 6-10 hours. It consists of a cold stage (sensation of cold, shivering) a hot stage (fever, headaches, vomiting; seizures in young children) and finally a sweating stage (sweats, return to normal temperature, tiredness).
Keep malaria high on the political and development agendas Advocate strongly for adequate and predictable long-term financing for malaria control Sustain national financial commitments for malaria control Developing strategic and operational plans for achieving and maintaining universal access and coverage of malaria interventions. Recommend vector-control operations for all people at risk, and maintenance of effective coverage particularly through (i) replacement and continuous provision of long-lasting insecticide-treated bed nets, and (ii) regular application of indoor residual spraying with insecticides, in accordance with WHO regulations
WHA resolution 64.17
Prompt diagnostic testing of all suspected cases of malaria and effective treatment with artemisinin-based combination therapy Use the expansion of interventions for malaria prevention and control as an entry point for strengthening health systems, including laboratory services, maternal and child health services at peripheral health facilities, integrated management of illnesses at the community level, and timely and accurate surveillance Increase funding for research and development in malaria prevention, control and treatment Support initiatives for the discovery and development of new medicines and insecticides to replace those whose usefulness is being lost through resistance Support both basic research on innovative tools for control and elimination of malaria (including vaccines) and operational research to overcome constraints limiting the expansion and practical effectiveness of existing interventions
WHA resolution 64.17
In most areas several vector species transmit malaria and the control of only a few may not necessarily be followed by a decrease of the morbidity or mortality rates. (Centers for Disease Control, CDC)
anopheles mosquitoes
Respect in-country variations; build managerial capacity; monitor, prevent, and contain anti-malarial drug resistance; monitor insecticide resistance; improve quality of anti-malarial treatments and other commodities; and focus on forest malaria and migrant populations.
asia (global malaria action plan)
Hepatoplenomegaly: 10-15% patients die
cerebral malaria
P. malariae quarten nephrosis
cerebral malaria
results from an increase in cerebral capillary permeability, which leads to brain swelling, coma, and death. There is evidence of a mild generalized increase in systemic vascular permeability in severe malaria, but it is now clear from imaging studies that the majority of adults and children with cerebral malaria show no evidence of cerebral edema. However, the role of raised intracranial pressure in cerebral malaria remains unclear
cerebral malaria
Although ITNs at present cost only about $2, these require regular re-treatment every 6 to 12 months with insecticide, which costs an additional $0.50 per treatment. The new technology of "long-lasting insecticidal nets" or LLINs cost $5-$6 at the present time.
challenges
The universal use of insecticide-treated bed-nets can reduce episodes of illness by 50 % in areas of high transmission, yet fewer than 2 % of African children sleep under a net
challenges
The majority of malaria-endemic countries can make a substantial impact on their malaria burden by controlling it with existing tools. By first scaling up appropriate interventions for all populations at risk and then sustaining control over time, malaria will cease to be a major source of deaths world-wide.
control (global malaria action plan)
Reducing to zero all locally-acquired infections within a country will bring the world closer to the ambitious goal of global eradication. Some countries are currently engaging in elimination and more will transition to elimination after achieving control provided there is strong rationale for this move. In high transmission settings, complete interruption of malaria transmission will require additional, new control tools.
elimination (global malaria action plan)
take blood meals to carry out egg production, and such blood meals are the link between the human and the mosquito hosts in the parasite life cycle.
female mosquitoes
basic symptoms of malaria
fever headache body pain chills cyclic symptoms
disease remains leading disability during war
impact on military
RS does not directly prevent people from being bitten by mosquitoes. Rather, it usually kills mosquitoes after they have fed if they come to rest on the sprayed surface. IRS thus prevents transmission of infection to other persons. To be effective, IRS must be applied to a very high proportion of households in an area (usually >80%).
indoor residual spraying
Over one million people die from malaria each year, mostly children under five years of age, with 90 per cent of malaria cases occurring in Africa, south of the Sahara.
malaria
Species are morphologically distinct Differences in development stages present for P. falciparum Polymerase Chain Reaction (PCR) can distinguish species and detect at much lower parasitemias
malaria
Usually diagnosed by observing parasite-infected red blood cells (RBCs)
malaria
Usually, people get malaria by being bitten by an infective female Anopheles mosquito. OnlyAnopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken from an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito's saliva and are injected into the person being bitten.
malaria
a medical emergency and should be treated urgently and aggressively.
malaria
can be suspected based on the patient's travel history, symptoms, and the physical findings at examination. However, for a definitive diagnosis to be made, laboratory tests must demonstrate the malaria parasites or their components.
malaria
hampers children's schooling and social development. Many children who survive a serious attack of malaria develop physical and mental impairment. 40 % of the world's population live in areas with malaria risk
malaria
kills one child every 30 seconds, about 3,000 children everyday
malaria
must be recognized promptly in order to treat the patient in time and to prevent further spread of infection in the community via local mosquitoes. It should be considered a potential medical emergency and should be treated accordingly. Delay in diagnosis and treatment is a leading cause of death in malaria patients in the United States.
malaria
preventable and treatable, and history shows that it can be eliminated.
malaria
•Fever •Chills •Sweats •Headaches •Nausea and vomiting •Body aches •General malaise
malaria
Local factors that have a direct impact on breeding sites include farming methods, house structure and rubbish disposal.
malaria challenges
More breeding sites are created by human manipulation of the environment, mostly for necessary endeavors such as agriculture and settlement, building dams for power generation and irrigation.
malaria challenges
Of these, intervention from communities could work at the level of improving house structures to decrease the number of mosquitoes entering, and rubbish disposal.
malaria challenges
Potential mosquito breeding sites, comprising small, temporary, freshwater pools (man-made or natural) that are exposed to sunlight, abound in countries in which malaria is endemic.
malaria challenges
Africa's GDP today would be up to 32 percent greater if malaria had been eliminated 35 years ago. Malaria-endemic countries are among the world's most impoverished.
malaria cost
A number of studies conducted in the last decade, especially on children aged less that 10 years, have highlighted the fact that recognition/definition of malaria-like illness is based on a people's belief system, as it relates to the etiology of illness.
malaria crisis challenges
As with other illnesses, a significant percentage of malaria-like illness is first recognized and defined at home.
malaria crisis challenges
Health systems' failure Drug resistance Population movement Deteriorating sanitation, Climatic changes Unplanned development activities The use of scarce hard currency on drugs, nets and insecticides for malaria control and treatment puts additional burden in the already fragile economies of most African countries*.
malaria crisis challenges
Sustained communication aimed at promoting behavior change Including gender as a prominent variable in health promotion interventions. Community involvement in prevention actions Document and collect information on prevention efforts.
malaria general challenges
Preventing large scale epidemics; migrant populations and cross-border coordination; adapting to changing agricultural behaviors; sustain political and financial commitment
middle east and eurasia (global malaria action plan)
Nonetheless, clinicians should not withhold antimalarial treatment from a patient with clinical symptoms and signs and any level of
parasitemia
•Elevated temperatures •Perspiration •Weakness •Enlarged spleen •Mild jaundice •Enlargement of the liver
physical findings (malaria) may include:
Malaria produces serious complications during pregnancy Intense sequestration of P. falciparum-infected erythrocytes in the placenta Local activation of proinflammatory production Maternal anemia. Leads to placental insufficiency and fetal growth retardation.
pregnancy
Malaria control and elimination efforts will require continued research to be successful. International research is needed to create new tools, as well as inform policy and improve operational implementation of strategies. Then, national and local health systems must focus on how to use the tools and sustain the gains.
research (global malaria action plan)
Cerebral malaria, with abnormal behavior, impairment of consciousness, seizures, coma, or other neurologic abnormalities Severe anemia due to hemolysis (destruction of the red blood cells) Hemoglobinuria (hemoglobin in the urine) due to hemolysis Acute respiratory distress syndrome (ARDS), Abnormalities in blood coagulation Low blood pressure caused by cardiovascular collapse Acute kidney failure
severe malaria
occurs when infections are complicated by serious organ failures or abnormalities in the patient's blood or metabolism. The manifestations of severe malaria include:
severe malaria
•particularly critical. For example, at temperatures below 20°C (68°F),Plasmodium falciparum (which causes severe malaria) cannot complete its growth cycle in theAnopheles mosquito, and thus cannot be transmitted.
temperature
Increase access to health services in isolated populations; improve adherence to treatment and proper use of interventions; monitor drug and insecticide resistance; build managerial capacity; foster cross-country coordination; and expand research.
the americas (global malaria action plan)
the presence of parasites in a blood smear does not ensure that clinical symptoms and signs such as elevated temperature are due to malaria. Furthermore, in high-transmission areas, parasitemias of up to 10 000 parasites/µL may be tolerated without symptoms or signs in partially immune individuals. In these cases, an absolute density of parasites in the blood (often 5000-20 000 parasites/µL blood) is used to make the clinical diagnosis of malaria, and patients with lower levels of parasitemia must be investigated for other causes of their symptoms and signs.
the presence of parasites in a blood smear does not ensure that clinical symptoms and signs such as elevated temperature are due to malaria. Furthermore, in high-transmission areas, parasitemias of up to 10 000 parasites/µL may be tolerated without symptoms or signs in partially immune individuals. In these cases, an absolute density of parasites in the blood (often 5000-20 000 parasites/µL blood) is used to make the clinical diagnosis of malaria, and patients with lower levels of parasitemia must be investigated for other causes of their symptoms and signs.
•In many malaria-endemic countries, malaria transmission does not occur in all parts of the country. Even within tropical and subtropical areas, transmission will not occur
•At very high altitudes •During colder seasons in some areas •In deserts (excluding the oases) •In some countries where transmission has been interrupted through successful control/elimination programs. •Generally, in warmer regions closer to the equator •Transmission will be more intense •Malaria is transmitted year-round. •The highest transmission is found in Africa South of the Sahara and in parts of Oceania such as Papua New Guinea. •CDC Malaria Map Application - is an interactive map which provides information on malaria endemicity throughout the world.
severe malaria symptoms
•Hyperparasitemia, where more than 5% of the red blood cells are infected by malaria parasites •Metabolic acidosis (excessive acidity in the blood and tissue fluids), often in association with hypoglycemia •Hypoglycemia (low blood glucose). Hypoglycemia may also occur in pregnant women with uncomplicated malaria, or after treatment with quinine.
•In some malaria-endemic areas, malaria transmission is so intense that a large proportion of the population is infected but not made ill by the parasites. Such carriers have developed just enough immunity to protect them from malarial illness but not from malarial infection. In that situation, finding malaria parasites in an ill person does not necessarily mean that the illness is caused by the parasites.
•In some malaria-endemic areas, malaria transmission is so intense that a large proportion of the population is infected but not made ill by the parasites. Such carriers have developed just enough immunity to protect them from malarial illness but not from malarial infection. In that situation, finding malaria parasites in an ill person does not necessarily mean that the illness is caused by the parasites.
•Malaria parasites can complete their growth cycle in the mosquitoes ("extrinsic incubation period").
•Malaria parasites can complete their growth cycle in the mosquitoes ("extrinsic incubation period").
•Where malaria is found depends mainly on climatic factors such as temperature, humidity, and rainfall. Malaria is transmitted in tropical and subtropical areas, where Anopheles mosquitoes can survive and multiply
•Where malaria is found depends mainly on climatic factors such as temperature, humidity, and rainfall. Malaria is transmitted in tropical and subtropical areas, where Anopheles mosquitoes can survive and multiply
•Where malaria is not endemic any more (such as in the United States), health-care providers may not be familiar with the disease. Clinicians seeing a malaria patient may forget to consider malaria among the potential diagnoses and not order the needed diagnostic tests. Laboratorians may lack experience with malaria and fail to detect parasites when examining blood smears under the microscope.
•Where malaria is not endemic any more (such as in the United States), health-care providers may not be familiar with the disease. Clinicians seeing a malaria patient may forget to consider malaria among the potential diagnoses and not order the needed diagnostic tests. Laboratorians may lack experience with malaria and fail to detect parasites when examining blood smears under the microscope.
What transmits malaria?
Anopheles mosquitoes
vector control
Indoor Residual Spraying
if mortality rate was still at historic levels, then there would be 500,000 deaths per year in US
Malaria Mortality Rates
Is the cause of most malaria deaths (Non synchronic cycles Unstable fever Fast development of symptoms)
Malaria caused by P. falciparum (malignant tertian Malaria)
What causes malaria?
Plasmodium parasites (protozoan) P. falciparum P. vivax
how to control or eliminate malaria
Vectors' control Treatment and chemical prophylaxis Vaccines development
how are the effects of the disease?
anemia sticks to capillary walls (cerebral malaria) sticks to placenta (maternal malaria)
Bill and Melinda Gates Foundation
provides bed nets to Zambia to control the spread of malaria
