1. Leadership & Global Health
Malaria
Leadership & Global Health

2. 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

3. 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

6. 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.

7. 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

8. 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

9. Malaria: Adverse Events
Death
Severe anemia/blood transfusions
Neurologic problems
Behavioral problems
Seizures
Mental delay
Paralysis, cortical blindness

10. Malaria Prevention Malaria can be prevented Bed nets Education
Environmental changes
Prophylaxis for pregnant women
Insecticide spraying

11. 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

13. 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

14. 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

15. 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

16. 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

17. 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.

18. 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.

19. Malaria Life-Cycle