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Malaria Leadership & Global Health. Malaria: Overview A febrile illness transmitted by Anopheles...
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Transcript of Malaria Leadership & Global Health. Malaria: Overview A febrile illness transmitted by Anopheles...
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