Malaria: disease characteristics, transmission, and control strategies

Malaria

PUBLIC HEALTH ISSUES

The objective of this work is to discuss Malaria as a public health issue and to examine this issue in the country or countries where Malaria is prevalent. This work will examine the affected populations, the existing programs for dealing with this disease. This work will discuss the barriers to treating this health issues and identify resources available for dealing with malaria. Finally, this work will answer the question of what the future holds regarding Malaria.

Malaria is stated by the Center for Disease Control and Prevention to be "...a leading cause of death and illness worldwide." (2001) the majority of deaths from malaria are children in Africa who are below the age of five years old. The Harvard School of Public Health reported in a 2001 press release that there are "...three key programs in malaria prevention" which have been on the receiving end of grants to fight what is termed "one of the world's most serious diseases. The three stated are those follows:

the Harvard Malaria Initiative;

Medicines for Malaria Venture; and Roll Back Malaria. (Harvard School of Public Health, 2001)

Malaria has been identified by the World Health Organization (WHO) as "one of the three major disease of poverty along with HIV / AIDS and tuberculosis." (Harvard School of Public Health, 2001) According to the press report malaria is curable however only "if promptly diagnosed and adequately treated." (Harvard School of Public Health, 2001) Presently "there are more cases of malaria...than at any time in history." (Harvard School of Public Health, 2001)

I. POPULATION AFFECTED by MALARIA

Forty percent of the world's population is stated to be at risk of Malaria with ninety percent of deaths from malaria occurring in the country of Africa, south of the Sahara desert. (Harvard School of Public Health, 2001; paraphrased) Malaria is reported by the Harvard School of Public Health to have been "eradicated in many countries, including the U.S., in 1950s..."(Harvard School of Public Health, 2001) However the malaria parasite has become extremely resistant to drug therapy. Furthermore, malaria not only causes terrible sickness but also has a potential to cripple "developing economies through the enormous cost in medical expenses and days of labor lost." (Harvard School of Public Health, 2001)

II. HISTORY of MALARIA

The work of DeAngelis and Zuccotti (2006) states that "Malaria is an ancient disease, with description of a disease resembling malaria that date back more than 4000 years." (DeAngelis and Zuccotti, 2006) in 1880, Laveran identified the parasite responsible for malaria and was awarded the 1904 Nobel Peace Prize. Measures for control of mosquitoes that are responsible for transmitting malaria as well as the antimalaria drug, chloroquine being discover in 1934 by Andersag have assisted in controlling the disease to come extent as well as has the use of dichlorodiphenyltrichlorethan (DDT) as an insecticidal agent, which started in 1939.

III. CONTEMPORARY CONTROLS

In recent years, less toxic forms of insecticide have been used for controlling malaria. Furthermore discovered has been "...other antimalarial drugs and drug combinations, including sulfadoxine-pyrimethamine, mefloquine, atovaquone-proguanic, quinine, and doxycycline." (DeAngelis and Zuccotti, 2006) Even though these advances have been made in this area, of health treatment and prevention millions of lives are lost each year and "3 billion people in 107 countries or territories are at risk... [with] more than 80% of deaths from malaria occur[ing] in Africa, 15% in Asia and Eastern Europe, and only a small fraction in the Americas." (DeAngelis and Zuccotti, 2006)

June 2008 report published by the 'Malaria Matters' foundation states that according to the press release of the United National "Malaria cases are dropping..." (Brieger, 2008) Brieger states that the Malaria Matters fund has "delivered 50 million bed nets impregnated with insecticide to families at risk of catching malaria, almost double the number that were issued a year ago." (2008) in fact, according to the executive direction, Michel Kazatchkine "there is now clear evidence that mortality rates from the disease among children younger than five years of age had fallen sharply in 10 sub-Sahara countries, and, in Zanzibar, malaria had been almost eradicated as a public health problem." (Breiger, 2008)

Four key components of success have been identified as follows:

1) a catalytic moment;

2) Demand for universal coverage;

3) Pragmatic donor response, and 4) Innovative problem-solving. (Breiger, 2008)

Brieger (2008) further reports in the work entitled: "IRS in Uganda - a Call for Monitoring Resistance" that it has been reported by the National Academy of Sciences that the government in Uganda "recently started spraying insecticides in homes and settlements to combat mosquitoes that spread malaria, the country's leading cause of death." (Brieger, 2008) it is reported that the committee which met for identifying best practices in malaria vector resistance to insecticides used for indoor residual spraying in Uganda toward maximizing the effectiveness of DDT and for identifying "contextual issues that would have a bearing on successful implementation of the 'best practices'.

IV. MEDICINES for MALARIA VENTURE (MMV)

The "Comment by the Medicines for Malaria Venture:- for Web-Based Public Hearing of World Health Organization in View of Meeting of Intergovernmental Working Group on Public Health, Innovation and Intellectual Property" states that it welcomed "the work of Intergovernmental Working Group on Public Health, Innovation and Intellectual Property" and states that the Medicines for Malaria Venture (MMV) has as its' mission the discovery, development and delivery of "new antimalarial drugs through effective public-private partnerships." (Medicines for Malaria Venture, 2008)

MMV is a public-private partnership which was created by the World Health Organization (WHO) in 1999 with the World Bank, as well as leading foundations, bi-lateral donor governments and representatives of the research branch of the pharmaceutical industry for replenishing and sustaining the "global pipeline of new antimalarial drugs." (Medicines for Malaria Venture, 2008) the following statement of the MMV relates critical information about the goals of the MMV:

For MMV, the public health goal does not end at the development of new antimalarial drugs. MMV's responsibility extends to the delivery of those drugs, which means ensuring access to them by people that need them in malaria-endemic countries. This means that MMV has to consider the analytical, policy, funding (including drug pricing issues) and organizational issues that comprise delivery. This requires detailed planning for registration, launch and roll-out of the new drugs and the development of individual, product specific global access plans to ensure that the drugs we develop will achieve maximum health impact." (Medicines for Malaria Venture, 2008)

The threat that is identified as the greatest to these public-private partnerships and the "pipeline of vaccines, microbicides and drugs for neglected diseases currently under development" is the lack of funding that is "sufficient and sustainable." (Medicines for Malaria Venture, 2008)

The work of Azarian, Kay and Smith entitled: "Malaria Among Recently Arrived Burundian Refugees: A Public Health Response" states that the Duval County Health Department (DCHD) was notified on July 6, 2007 and provided information regarding an EP-X report sent out by the "Centers for Disease Control and Prevention (CDC) regarding undocumented and/or insufficient pre-departure therapy for malaria among East African refugees resettling in the United States. In addition, these refugees came from a region in Africa where chloroquine resistance is common. This posting was intended to inform local health authorities of the potential public health risk and suggest recommendations for presumptive treatment of refugees who had recently emigrated from East Africa." (Azarian, Kay and Smith, 2008)

V. POINTS of ENTRY and DEPARTURE

Monitoring at country borders is of primary importance in fighting Malaria health issues. One example of how this is being addressed is reported in the state of Florida in an area where Burmese individuals enter the country and Malaria is a public health issue that is closely monitored as individuals enter the United States. The work of Azarian, Kay and Smith entitled: "Malaria Among Recently Arrived Burundian Refugees: A Public Health Response" states that the Duval County Health Department (DCHD) was notified on July 6, 2007 and provided information regarding an EP-X report sent out by the "Centers for Disease Control and Prevention (CDC) regarding undocumented and/or insufficient pre-departure therapy for malaria among East African refugees resettling in the United States. In addition, these refugees came from a region in Africa where chloroquine resistance is common. This posting was intended to inform local health authorities of the potential public health risk and suggest recommendations for presumptive treatment of refugees who had recently emigrated from East Africa." (Azarian, Kay and Smith, 2008) a meeting was held for members of both the DCHD Epidemiology Program and the Department of Communicable Disease, which identified issues that were critical as follows:

specimen collection;

Initial refugee follow-up health visits;

Contacts for agencies sponsoring refugees in Jacksonville;

The availability of a Kirundi (interpreter);

Documentation of pre-departure antimalaria; and the availability of Malarone, which is the preferred treatment for people who have acquired malarial infections due to Plasmodium falciparum in areas where chloroquine resistance has been documented." (Epi Update, 2008)

Additionally the decision that was made that incoming refugees would be screened for 'active parasitemia' in addition to presumptive therapy. Challenges in the response of public health in this area includes the following:

1) a lack of medical records or documentation of predeparture therapy;

2) Limited Medicaid reimbursement for therapy and follow-up care due to the lack of documentation;

3) Difficulty in securing the appropriate treatment since Malarone is not on the FDOH.

A formulary; and 4) Initial difficulty in locating a Kirundi interpreter for the interviews. (Epi Update, 2008)

VI. BARRIERS and MISCONCEPTIONS

Barriers to funding and focus on prevention, treatment and eradication efforts are identified to be those as follows:

Malaria no longer 'king of diseases' in the tropics and hardly any threat to the industrialized countries of the North

Malariologists no longer in charge - new breed of 'managers' have taken command

Basic research dominates and the little applied research that is funded has little operational links with control programs

More complex international infrastructure; countries need to invest heavily to figure out how to seek funds

Funding biased towards 'big' projects rather than towards smaller efforts whose aim is steady, long-term growth from 'below'." (Malaria and International Health Organizations, nd)

Stated to be a strategy that is of a viable nature for future malaria control will include the following features:

Active involvement of communities, especially children, in public projects;

Strengthening of local 'managerial' capacities;

Use of graduate students to support local efforts; and Making 'local' information available to the community. (Malaria and International Health Organizations, nd)

VII. REQUIREMENTS to STRENGTHEN INTERNATIONAL COMMUNITY'S ROLE

The requirements for strengthening the role of the international community would likely include those as follows:

carry-out demonstration projects aimed at enhancing local capacity to control malaria;

develop prototype approaches for local capacity building using adaptive management workshop protocols;

integrate such projects within wider efforts to strengthen national public health functions;

extrapolate the information needed concerning malaria to other situations of the world and make that information readily and easily available on the web;

encourage national governments to adopt information policies that are supportive of local public health initiatives;

encourage and support, technically and financially, national governments in their effort to reform their educational systems to provide needed support to local public health initiatives;

invite the global applied research community, including historians, to be 'on-call' when specific skills are in short supply, locally and nationally; ensure that a representative sample of local initiatives are well evaluated. (Malaria and International Health Organizations, nd)

VIII. MALARIA a 'PUBLIC' and a 'HEALTH' ISSUE

S. Price James, stated in the report entitled: "Principles and Methods of Antimalarial Measures in Europe" in 1927 as follows: "Malaria control cannot be death with as an isolated problem separate from other social, medical and public health affairs." Indeed as noted by Rockefeller Foundation Vice President in 1937, "Malaria is a health and social problem; it must be attacked simultaneously from both these angles."

IX. VACCINES for MALARIA

On October 17, 2007 New Scientist Magazine reported that a vaccine "against malaria would save hundreds of thousands of lives each year. Now it seems we're much closer to finding one." The report states that in Mozambique, infants injected "with the experimental vaccine RTS, S/AS02 were 65 per cent less likely to be infected with Plasmodium falciparum - the mosquito-borne parasite that causes malaria - than infants injected with a control vaccine, according to the first major trial of a malaria vaccine in 210 infants. Recipients were also 35 per cent less likely than controls to develop malaria itself." (New Scientist, 2007) According to Pedro Alonson of Spain's University of Barcelona "Effectively it represents the first proof of concept that you can immunize infants against malaria." (New Scientist, 2007) the vaccine is stated to mimic: