Leadership & Global Health 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 Acute febrile illness Severe illness Hypoglycemia Anemia Cerebral malaria Death Respiratory distress Chronic effects Anemia Neurologic/ cognitive Developmental Impaired growth and development Malnutrition Pregnancy Fetus Maternal Acute illness Anemia Impaired productivity Low birth weight Infant mortality

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 Bed nets also protect against other diseases, such as filariasis and leishmaniasis

One application (tons) 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 $16,000 $3,520,000 $3.52 PF Beales and HM Gilles in Essential Malariology (DA Warrell and HM Giles, eds), 2002

Tablets in millions (dose) 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 PF Beales and HM Gilles in Essential Malariology (DA Warrell and HM Giles, eds), 2002

Malaria and Ecology and Burden Intrinsic and Extrinsic Factors Control and prevention measures Social, behavioral, economic and political factors Human Conditions that contribute to the risk for becoming infected with a Tropical Disease like malaria include environmental factors, nutritional status, climate and socioeconomic circumstances. Parasite Mosquito 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. Disease, like poverty, is not distributed uniformly among people and countries. In the developing world, the chance of dying is almost 30 times greater for an infant, at least 40 times greater for a child and more than a 1000 times greater for a pregnant woman compared to their counterparts living in an industrialized nation. Infectious diseases account for approximately one half of all deaths in the tropical areas of the world. Nearly all of these deaths occur in children under the age of five. Those infectious diseases that are primarily found in the developing world or profoundly impact the health of people living in the tropics are frequently referred to as tropical diseases.

Malaria Life-Cycle