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Question:

Discuss about the Malaria Incidence.
 
 

Answer:

According to World Health Organization report on December, 2016 malaria is one of the life-threatening diseases that are caused by parasites transmitted through bites of female Anopheles mosquitoes through people (Cullen 2016). In the year 2015, around 91 countries had malaria transmission (Who 2014). Between the years 2010 to 2015, the global malaria incidence among the population with new cases rate fell by 21% and the mortality rates also fell by 29% among the populations at risk among the age groups and 35% among the children below the age of five (Barber et al. 2017). Malaria is caused by Plasmodium falciparum most prevalent in African continent with maximum number of malaria-related death and P. vivax being dominant in most countries causing malaria in humans. The symptoms include acute febrile illness, fever, chills, headache and vomiting appearing seven days after the mosquito bite. According to WHO report, half of the world’s population was at malaria risk with major mortality rates in sub-Saharan Africa (Bhatt et al. 2015). There are some population groups who are at high risk for contracting malaria like children below the age of five, patients with AIDS/HIV, pregnant women, non-immune migrants, travellers and mobile populations. During the year 2015, there were 212 million malaria cases and 429,000 malaria-related deaths (Ménard et al. 2016). Vector control intervention is the best way to prevent and control the malaria transmission with insecticide-treated mosquito nets and indoor residual spraying that are effective in many circumstances. The early diagnosis and treatment of malaria reduces the burden of disease and mortality rates. This shows that malaria is a public health concern and therefore, the following essay involves the control and eradication or elimination of malaria to ensure evidence-based public health practice.

According to WHO, the malaria transmission majorly occurs in five regions. On a global basis, approximately 3.2 billion in 95 countries are at risk for malaria infection and developing the disease being 1.2 billion people (Agarwal et al. 2015). According to World Malaria Report 2015, globally there were 214 million malaria cases and 438,000 malaria deaths which indicate that there was a decrease in the malaria cases and deaths with 37% and 60%, respectively since 2000. The burden of the disease was heaviest in the African Region, where there were around 90% malarial cases and malaria related deaths in children below the age of five accounting for more than two thirds of deaths worldwide (Griffin, Ferguson and Ghani 2014).

 


The prevalence of malaria worldwide shows that it majorly contributes to the burden of disease and has a major impact on the health of the people. Malaria takes a heavy toll of human life and imposes substantial costs to the government, being the burden of disease. It is one of the biggest health problems that grossly affect the health, morbidity and mortality rates and economy of the developing countries. According to Global Malaria Action Plan 2014, malaria is one of the most severe health concerns among the public being the leading cause of death in the developing countries (Hemingway et al. 2016). It is also imposing economic burden that includes maintenance and supply of staffs for health facilities, drugs purchase and supplies and public health interventions in order to prevent and control malaria. The direct costs like treatment and premature death pose serious implications on the economic growth in terms of growth and productivity. According to Centres for Disease Control and Prevention (CDC) the people who have no or little immunity against malaria are the most vulnerable groups where pregnant women and young children are then most affected groups (Centers for Disease Control and Prevention 2013). Apart from health and economic burden, the policy makers are aggressively trying to control malaria because of its high morbidity and mortality rates reaching at an alarming stage. Despite of tremendous progress made in order to prevent and control malaria transmission, it is still an acute public health issue. It contributes to anaemic condition in children below the age of five and pregnant women resulting in low birth weight of the newborns. The existing strategies are trying to reach the people and communities who are at risk for malaria with core interventions to save lives suffered with malaria.

According to WHO, new strategies are being adopted to prevent and control malaria. The most promising approach is the ‘integrated vector management’ (IVM) that reinforces and links the public health and environment providing optimum benefits to both the elements (Chanda et al. 2017). The IVM strategies provide greatest control over the disease in an effective way that minimizes the negative impacts on the environment and the adverse effects on the public health. The WHO Global Strategic Framework defines the IVM strategy as an effective multi-disease control that stresses on understanding of ecology of the local vector and local patterns in transmission of disease and finally choosing of the appropriate vector control tools for the vector control. It also encompasses environmental management strategies that aim to eliminate or reduce the vector breeding grounds through operation of water development projects through improved design. The biological controls like larvivorous fish or bacterial larvicides that targets and kills the larvae vector without causing any harm on the environment due to chemical use (World Health Organization 2014). This framework also comprises of improved prevention or personal protection strategies that combine the environmental tools with chemical tools like insecticide-treated nets (ITNs) with accessible and affordable diagnosis and treatment of malaria.

 


In order to control malaria, WHO has provided the IVM approach that is effective in controlling the malarial vector and in linking the public health and environment. It is a dynamic method that is still evolving and encourages controlling the vector via a single method. It is a cost-effective method that significantly co-benefits the local economies and linking health with better economic outcomes. IVM framework for vector control is highly dependent on local malarial vector behaviour, environmental conditions and patterns of disease transmission. The better designing of irrigation schemes, dams that allow alterations and flow and level of water with better flushing of reservoirs that would help to reduce the vector habitats. The irrigation schemes permit intermittent field irrigation and alternation between non-irrigated and irrigated crops proves successful in controlling the Anopheles mosquitoes in many regions that grows rice like India, China and parts of Asia. It disrupts the breeding cycles of the vectors and environmental modification helps to control the malarial vector (Tesfazghi et al. 2015).

The environmental manipulation like shade, drainage patterns and time-limited local vegetation changes proves an effective way to reduce the malarial vector habitats. The formation of shades over the breeding habitats of vectors which prefers sunlight can help to reduce the propagation of the vector. Conversely, the malarial vectors that thrive in shades, removal of weeds, overgrowth would significantly reduce the potential of breeding and vector abundance (Benelli and Mehlhorn 2016).

The human settlement away from the breeding areas of malaria can reduce transmission as the vectors do not travel much away from their breeding zones. The better control and management of man-made sites where mosquitoes reproduce like bore holes and water wells helps in reducing the breeding that is close to the human settlements (Killeen et al. 2016). Apart from environmental malarial management, biological controls also kill the larvae or the mosquitoes in a targeted manner. Among the controls, the application and maintenance of stocks of biolarvicides like Bacillus sphaericus and Bacillus thuringiensis israelensis that feed on the mosquito larvae helsp to control the malarial vector (Kumar et al. 2014). The Neem oil is also a successful biolarvicide that is extracted from the seeds in controlling the malarial vector. Along with these controls, chemical tools are also important in the areas of dense vector densities and intense disease transmission that have an impact on the disease incidence. The methods include space spraying; indoor residual spraying reduces the transmission of the disease by interrupting or shortening the adult vector lifespan as proposed by The Health and Environment Linkages Initiative (HELI). It also helps to keep the population of the vectors down through the application of chemicals over the breeding places and use of ITNs like covering beds, protective nets impregnated with insecticides, water container and living quarters.

 


The role of public in malaria control fails due to market and information failure, externalities, monopoly that implies a role for public action. However, there is a need for community participation where the communities in collaboration with public should work towards the control of malaria by creating awareness through programs and campaigns (Mnzava et al. 2014).

In the recent years, early diagnosis and prompt treatment is the key to control malaria and radical treatment necessary for preventing the malarial transmission. The anti-malarial drug like chloroquine is effective for uncomplicated malaria. The Fever Treatment Depots (FTDs) and Drug Distribution Centres (DDCs) established in rural areas serves to provide the anti-malarial drugs to the public and community. There are strategies and policies for controlling malaria that are recommended by WHO which focus on malaria control and prevention. The strategic malaria control emphasizes on two domains; prevention and management. They work to stop the transmission of parasite from the vector to humans and in the development and severity of the disease (Peters 2013).

The Malaria Policy Advisory Committee (MPAC) along with WHO recommended policy development to control and eliminate malaria through identification of the priority areas and challenges for the achievement of global malaria goals. The vaccine development is also an effective and safe way to control malaria. However, the complexity of the parasite’s nature with understanding of the critical processes like disease pathogenesis and host immune protection is difficult and so the vaccine development is hampered. Moreover, currently there is no licensed vaccine against malaria or any vaccine for parasitic disease. The anti-malarial drugs development resulted in controlling and reducing the endemic malaria worldwide. However, the emergence of drug resistance in parasites poses a critical priority in the agenda of malarial research. The improved and new diagnostics are effective for malarial control. The labour intensive methods like analyzing blood smears with better diagnostic tools and highly trained technicians pose challenges in the diagnostics in terms of drug resistance (WHO, M.P.A.C 2016).

According to Malaria Foundation International, the malaria control cannot programs and interventions cannot be achieved until there is decentralization, capacity building through community participation in public health practice. By adopting ‘evolutionary operation’ where there is constant adaptation and tuning of management approaches and harnessing of local knowledge in the key to control and prevent malaria (Kobayashi et al. 2015).  

For the elimination or eradication of malaria, the anti-malarial drug and vaccine development, surveillance and diagnostics are some of the novel malarial tools that accelerate eradication. The WHO’s Malaria Policy Advisory Committee adopted the goal for eliminating the P. falciparum in the subregions by 2030. It has developed the malaria elimination plans that help to eliminate or eradicate the malaria from the developing countries. Effective surveillance is important for tracking the disease and in developing the programmatic responses. High surveillance systems help to assess the disease trends and distribution in the developing countries that are greatly affected by malaria.  It is required at every point in the malaria elimination path by empowering effective programs. The advocating for investment, allocation of resources to the populations at risk, assessment of the interventions, impact of funding and evaluation of programs for the efficient elimination of malaria (World Health Organization 2014).

The malarial elimination is defined as the local transmission interruption in a geographical area. The elimination program depends on the health system of a particular country with level of investment in the control and other factors like environmental, social, biological determinants, political, demographic and economic status of a particular country. The elimination approach through surveillance ensures that every malaria infection is detected, treated and registered in national malaria registry. The effective diagnosis and treatment of malaria along with anti-malarial medicines helps to prevent and control disease transmission in the community. In May 2015, The WHO Global Technical Strategy for Malaria 2016-2030 adopted by the World Health Assembly provides a technical framework for the endemic malaria that is intended to support and guide the control and elimination of malaria (Ramsay, Olliaro and Reeder 2016).

 


The elimination of malaria is interruption of transmission at local level that is reduction of the incidence to zero in indigenous cases of a specific malaria parasite in a particular geographical area. By enhancing and optimising the prevention and treatment of malaria measures and by strengthening the surveillance system, the high burden countries can eliminate malaria. In some developing countries, there is high prevalence of malaria among the mobile populations and travellers who are beyond the reach of the international borders. The infections are imported by these migrants and visitors which also required strict surveillance for the timely diagnosis and treatment (Griffin et al. 2016).

The digital epidemiology modelling called geospatial mapping and reporting of malarial cases through mobile phones and tracking of patient status helps in the surveillance of malaria for effective elimination. The identification of the threats to the control and elimination of malaria serves for the new areas for action plan. The drug development that involves transmission blocking vaccine is an innovative method that might help in the malaria elimination post 2025. A transparent, credible and responsive policy for malaria elimination also serves to provide technical input and strategic advice for malaria elimination (Brady et al. 2015).

There are some proposed innovative technologies like development of new drugs that targets the molecular markers of resistance like artemisinin resistance, single dose drug like Tafenoquine, OZ439 and OZ Ferroquine may be helpful in the path to malaria elimination in the future by 2030. The vector control through indoor residual spraying of Chlorfenapyr, pyrethroid long lasting insecticide-treated net (LLIN) and crop protection are some novel vector control methods (Tanner et al. 2015). The addition of new active ingredients from the agrochemicals with spatial repellents, insecticidal paints and toxic barrier screens and sugar baits can serve as vector control vaccines in the elimination of malaria. The diagnostic tools like hyper-sensitive diagnostic test (IDT) for the identification of asymptomatic carriers along with non-invasive diagnostic methods for the screening of mass population might aid in eradication of malaria worldwide (Britton, Cheng and McCarthy 2016). Behavioural resistance is less compared as physiological resistance where the mosquito contact the insecticide, however not killed and it is a challenge for the government to control and eliminate malaria. In instances where behavioural resistance is detected, there is a need to target the bionomic vulnerabilities that may exist during mating, larval stages, sugar feeding or any other aspect in the vector’s lie cycle can drive toward elimination.  

For the elimination of malaria, the most important challenge is to link the public and private sector activity. On one hand, the private delivery of drugs and ITNs provides an opportunity to extend coverage and primarily focus on the needs of the public sector and at the same time, there are many deficiencies in the private sector like quality and outreaching of the resources through networks that must be recognized. The funding and delivery of resources through public sector channels would help to eliminate malaria through binding of public and private sectors (Liu et al. 2013).

Malaria is one of the life-threatening disease that has taken a toll over the human life and is high prevalent in many countries. It has contributed to the burden of disease and has an impact on the human life. There are many existing strategies like vector control management, biological controls in which larvivorous fish or bacterial larvicides target the larvae of the vector, environmental manipulation and human settlement away from breeding areas are the strategies adopted by WHO. For the eradication of malaria, vaccines, anti-malarial drugs and many innovative technologies can help in the near future. In addition, the collaboration of government with public and private sector ca n help to control and eradicate malaria from the countries.

 

References

Agarwal, K., Alonso, P., Chico, R.M., Coleman, J., Dellicour, S., Hill, J., Majeres-Lugand, M., Mangiaterra, V., Menendez, C., Mitchell, K. and Roman, E., 2015. Global Call to Action to scale-up coverage of intermittent preventive treatment of malaria in pregnancy: seminar report. Malaria journal, 14(1), p.206.

Barber, B.E., Rajahram, G.S., Grigg, M.J., William, T. and Anstey, N.M., 2017. World Malaria Report: time to acknowledge Plasmodium knowlesi malaria. Malaria Journal, 16(1), p.135.

Benelli, G. and Mehlhorn, H., 2016. Declining malaria, rising of dengue and Zika virus: insights for mosquito vector control. Parasitology research, 115(5), pp.1747-1754.

Bhatt, S., Weiss, D.J., Cameron, E., Bisanzio, D., Mappin, B., Dalrymple, U., Battle, K.E., Moyes, C.L., Henry, A., Eckhoff, P.A. and Wenger, E.A., 2015. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature, 526(7572), pp.207-211.

Brady, O.J., Godfray, H.C.J., Tatem, A.J., Gething, P.W., Cohen, J.M., McKenzie, F.E., Perkins, T.A., Reiner, R.C., Tusting, L.S., Scott, T.W. and Lindsay, S.W., 2015. Adult vector control, mosquito ecology and malaria transmission. International health, 7(2), pp.121-129.

Britton, S., Cheng, Q. and McCarthy, J.S., 2016. Novel molecular diagnostic tools for malaria elimination: a review of options from the point of view of high-throughput and applicability in resource limited settings. Malaria journal, 15(1), p.88.

Centers for Disease Control and Prevention, 2013. CDC Health Information for International Travel 2014: The Yellow Book. Oxford University Press.

Chanda, E., Ameneshewa, B., Bagayoko, M., Govere, J.M. and Macdonald, M.B., 2017. Harnessing Integrated Vector Management for Enhanced Disease Prevention. Trends in Parasitology, 33(1), pp.30-41.

Cullen, K.A., 2016. Malaria surveillance—United States, 2013. MMWR. Surveillance Summaries, 65.

Griffin, J.T., Bhatt, S., Sinka, M.E., Gething, P.W., Lynch, M., Patouillard, E., Shutes, E., Newman, R.D., Alonso, P., Cibulskis, R.E. and Ghani, A.C., 2016. Potential for reduction of burden and local elimination of malaria by reducing Plasmodium falciparum malaria transmission: a mathematical modelling study. The Lancet Infectious Diseases, 16(4), pp.465-472.

Griffin, J.T., Ferguson, N.M. and Ghani, A.C., 2014. Estimates of the changing age-burden of Plasmodium falciparum malaria disease in sub-Saharan Africa. Nature communications, 5.

Hemingway, J., Ranson, H., Magill, A., Kolaczinski, J., Fornadel, C., Gimnig, J., Coetzee, M., Simard, F., Roch, D.K., Hinzoumbe, C.K. and Pickett, J., 2016. Averting a malaria disaster: will insecticide resistance derail malaria control?. The Lancet, 387(10029), pp.1785-1788.

Killeen, G., Marshall, J.M., Kiware, S.S., South, A.B., Tusting, L.S., Chaki, P.P. and Govella, N.J., 2016. Measuring, manipulating and exploiting behaviours of adult mosquitoes to optimize malaria vector control impact. BMJ Global Health.

Kobayashi, T., Gamboa, D., Ndiaye, D., Cui, L., Sutton, P.L. and Vinetz, J.M., 2015. Malaria diagnosis across the International Centers of Excellence for Malaria Research: platforms, performance, and standardization. The American journal of tropical medicine and hygiene, 93(3 Suppl), pp.99-109.

Kumar, P.M., Murugan, K., Kovendan, K., Subramaniam, J., Panneerselvam, C. and Amerasan, D., 2014. Larvicidal and Pupicidal Activity of Orthosiphon thymiflorus and Spinosad for the Control of Malarial Vector, Anopheles Stephensi. Advances in Biotechnology and Patenting, p.259.

Liu, J., Modrek, S., Gosling, R.D. and Feachem, R.G., 2013. Malaria eradication: is it possible? Is it worth it? Should we do it?. The Lancet Global Health, 1(1), pp.e2-e3.

Ménard, D., Khim, N., Beghain, J., Adegnika, A.A., Shafiul-Alam, M., Amodu, O., Rahim-Awab, G., Barnadas, C., Berry, A., Boum, Y. and Bustos, M.D., 2016. A worldwide map of Plasmodium falciparum K13-propeller polymorphisms. New England Journal of Medicine, 374(25), pp.2453-2464.

Mnzava, A.P., Macdonald, M.B., Knox, T.B., Temu, E.A. and Shiff, C.J., 2014. Malaria vector control at crossroads: public health entomology and the drive to elimination. Transactions of The Royal Society of Tropical Medicine and Hygiene, p.tru101.

Peters, W. ed., 2013. Antimalarial Drugs I: Biological Background, Experimental Methods, and Drug Resistance (Vol. 68). Springer.

Ramsay, A., Olliaro, P. and Reeder, J.C., 2016. The need for operational research and capacity-building in support of the Global Technical Strategy for Malaria 2016–2030. Malaria journal, 15(1), p.235.

Tanner, M., Greenwood, B., Whitty, C.J., Ansah, E.K., Price, R.N., Dondorp, A.M., von Seidlein, L., Baird, J.K., Beeson, J.G., Fowkes, F.J. and Hemingway, J., 2015. Malaria eradication and elimination: views on how to translate a vision into reality. BMC medicine, 13(1), p.167.

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