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In the earlier times, malaria was a big issue in the North America, Europe and some areas of northern Asia. The geographic distribution could still be offset by the shift in population mobility and climatic changes. Plasmodium falciparum is the most dominant species in the world while the P. Ovale dominating the sub-Saharan region of Africa, and P. vivax found in the other remaining regions according to Parasites and Health.12. However, the last two have a tendency of overlapping in their geographic distribution and they are at times very difficult to distinguish.
(2). Regional (within U.S.)
In the U.S.A. The malaria predominance is along the border points and the entry points into the U.S.A. As earlier noted. These are cases that are detected among the travelers returning from the malaria prone areas like Africa and South Asia as the Morbidity and Mortality Weekly Report10 noted. However, most of the cases are handled immediately and are not fatal as along as the patients follow the prescription.
(3). Rural vs. Urban
C. Gardiner et.al.13, 608-9, in their research based in Ghana found out that the malaria distribution among the rural and urban was so distinct. The research found out that the rural population was more predisposed to the malaria parasite and infection than the urban population. This, the research says was due to a higher usage of preventive medication in the urban areas than the rural areas, as well as the breeding conditions that were favorable for the vectors in the rural areas than the urban regions.
C. Risk Factors
These are the conditions under which the parson can be more prone to malaria attack. There are various groups that are more exposed to the malarial attack and can easily succumb to the infection due to medical factors that will be discussed.
(1). Known malaria risk factors
One of the most predominant risk factors in malarial attack is the age. The young kids from the age of zero to 18 years are known to be more exposed to malarial attack than any other age. They are the ones who report the highest mortality rate every year as per CDC2 statistics.
The other risk factor is pregnancy. George J. Gilson14 indicates that pregnant women are prone to infection by malarial and may be fatal to the unborn child as there is a high risk of contracting placental malaria which eventually causes Fetal Growth Restriction (FGR).
Another risk factor that is widely considered is the sociobehavioural risk factor. This is the place of residence and the sanitation around the place as well as the activities that the locals engage in. For instance among the communities that go out for fishing sprees at night and engage in nocturnal activities, they are more prone to malarial infection if they don't use protection sprays or drugs as indicated by Marry Ann, et.al.15, 257-265.
(2). Distribution of risk factors among subpopulations
It is estimated that 1-2.8 million people die of malaria in the Sub-Saharan region of Africa and most of them are children who succumb to Plasmodium falciparum malaria. An estimated 2% of malarial attacks among the children in Africa are severe and fatal as noted by D. Modiano et.al.16, 539. Indeed it estimated that among the deaths from malaria, 75% of the deaths are among the children and young adults.
The above is a graph obtained from the South African case which is agood sample to work from since it is one of the regions that have high malaria prevalence.
In terms of pregnancy and risks from malaria, it is estimated that 2-15% of maternal anemia is from malaria, 5-14% of low birth weight newborns, 30% of "preventable" low birth weight newborns and 3-5% of newborn deaths are due to malaria infections. The World Health Organization, 17, puts the P. falciparum infection among the pregnant women to be up to 60% and the maternal death rate at between 10%-15%.
Section III. Prevention and Control
A. Disease Prevention
This is considered to be the best and most cost effective and safest health wise in malaria prevention. It is the control of the vector (mosquito) and reduction to the possible minimum of the contact between the vector and human beings. It also involves reduction of the vector population density and changing the longevity of the malaria parasite vector; these are the two most effective primary measures as observed by International Petroleum Industry Environmental Conservation Association.18
This stage involves prevention by controlling and the reduction of individual risks and exposure to malaria. This is normally achieved at four levels given the acronym ABCD as outlined by International Petroleum Industry Environmental Conservation Association.18
A-Awareness and education; patients and physicians must understand the prevention strategies, pre-travel and post travel caution and awareness.
B-Bites; where personal protection against vector bites, understanding the behavior of the anopheles mosquito, proper clothing and protection, use of permethrin on clothes and nets among others.
C- Compliance; with the prescription of the Chemoprophylaxis prior to travelling to malaria prone areas.
D-Diagnosis; should be done promptly immediately there is suspicion of malaria in the patient so that early treatment can be obtained for the patient.
This is the bid to manage and reduce the negative impacts on the patient of malaria by restoring the prior functions and reducing to a possible minimum the malaria related complications. The International Petroleum Industry Environmental Conservation Association18
suggests that it involves administration of the above mentioned curative drugs to the patient and prescribed by the physical handling the patient.
B. Public Health Intervention
(1). Policy Development
The WHO, 17 has several mandates among them being the constant monitoring of antimalarial drug resistance, and in the same effort works with the susceptible nations to strengthen their work on the same field.
The WHO, 16 is also running a Global Malaria Program which is responsible fro formulating policy based on evidence as well as technical assistance, strategy formulation, capacity building, monitoring and evaluation, as well as coordinating the global effort to fight malaria.
WHO, 17 is also a significant partner and a host to the well-known global framework aimed at implementing a well coordinated action against malaria known as Roll Back Malaria (RBM). The RBM partnership is solely entrusted with mobilization of action and resources and to aid bring agreement among partners. The RBM partnership has a membership of more than 500 partners among them being the malaria endemic countries, private sector, foundations, bilateral as well as multilateral development partners to endemic countries, NGOs and community-based organizations, academic and research institutions as noted by Malis S.8.
(2). Intervention Program
The WHO17 has the duty of propagating the effective control measures among the malaria endemic countries so as to curb the spread of the lethal disease. Some of the most predominant intervention programs are:
i. Insecticide-treated mosquito nets (ITNs)- where the use of Long Lasting Insecticide Impregnated Nets (LLINs) is the preferred by WHO mode of vector bite prevention. These are distributed via the public health sectors and everyone in the high transmission areas should sleep under the LLIN each night as C. Gardiner13 found out.
ii. Indoor residual spraying-this is done using residual insecticides and has been noted to be one of the most powerful and rapid ways of transmission reduction. It is more effective if, according to WHO, 80% of the houses in the area under treatment are sprayed and the effect lasts for 3-6 months, period relies on the insecticide used and the sprayed surface. DDT has been however found to be effective between 9-12 months.
There are other intervention programs that are bearing fruits like the Millennium Development Goals and Abuja intervention in Kenya (East Africa) has indicated an improvement in the reduction rate of number of infections as shown in the below graph by Division of Malaria Control (Kenya)19.
Fig1.1. The trend in spread of malaria in 2005 and 2006
Among the travelling population from and to countries of high malarial endemic, drugs can be used to prevent malaria. These drugs include chemoprophylaxis which basically suppresses the blood stage of the malarial infections hence averting malaria.
C. Current Research
The war against malaria in some regions is almost won, yet in many more regions the war is still far from being won hence putting the safe areas in risk again as Ranjitkar7 notes. There are several researches that have been conducted both widely publicized some not known on malaria.
There is a quest to get a malaria vaccine that will be more effective than the current preventive drugs. The specialists in molecular biology, immunology, and cell biology are currently busy trying to see if there can be an interruption of the life cycle of malaria as each stage is quite distinct from the other.
On the other hand, C. Gardiner13 says that there is still an intense quest to find longer lasting options of the Indoor Residual Spraying (IRS) insecticides; these are aimed at…[continue]
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