2.A. - Case study of Malaria in Ethiopia

Question 1

what are the environmental causes of malaria in Ethiopia?

Answer 1

• mosquitos need specific conditions to survive:
  > warm humid climates (parasite needs 21-28C to develop)
  > need stagnant water for breeding
  > altitude
• rainfall can affect breeding ground. drought = stagnant water areas dry up. wet season/flooding = breeding grounds
• altitude. temps drop 1C per 100m climbed. at high elevations there is no Malaria - temps become too low at 2000m+
• lower temps in Ethiopian highlands = no malaria
• in western lowlands, the temperature and humidity is high throughout the year = over 100,000 cases/yr.
• its an endemic disease in the lowlands

Question 2

what are the human causes of malaria in Ethiopia?

Answer 2

• agricultural settlements lead to changes in water use/changes in the concentration of domesticated and wild animals/causes deforestation.
• this all boosts larval sites and increases human-mosquito contact
• seasonal population movement. every year at harvesting and planting time, large scale population movement between malaria free highlands and agricultural lowlands.
• timing coincides with rainy season which best for farming but also peak malaria transmission
• harvesting continues after sunset when mosquitoes are most active. migrant workers sleep in fields overnight = higher risk of being bitten and infected
• irrigation channels expand breeding habitats
• urbanisation has a similar effect - flooded excavations/garbage dumps/discarded plastic containers provide countless breeding sites

Question 3

what are the social impacts of Malaria in Ethiopia?

Answer 3

• 70% of the population is at risk of contracting
• Malaria is most dangerous to pregnant women and children
• the disease means the role of women is held back and slows gender equality.
• the role of women becomes more focused on having/looking after lots of children due to higher infant mortality. takes away choice and freedom
• contributors to it spending are lack of education, lack of insecticide treated bed nets and rural population being more easily bitten.
• responsible for 40% of hospital admissions annually

Question 4

what are the economic impacts of Malaria in Ethiopia?

Answer 4

• PFL - areas that are hardest hit are poorer in the first place as they have limited barriers to disease.
• leads to more people unable to work which limits economic growth
• malaria is estimated to cost Ethiopia $12 billion/yr.
• healthcare is expensive which the poorer are unable to access
• in the lowlands, agriculture could be responsible for economic growth but this is limited by malaria
• the average cost of malaria nets are $3 but avg hourly wage is $1.5. arguably affordable but not easy to access.
• with Malaria taking 40% of national health expenditures, other sectors can’t be invested in
• **2.9 million cases*g reported in 2019. 4700 died (shows success of strategies)
• SPATIAL INEQUALITY - TNCs invest in highlands but not lowlands.
• Addis Ababa = 2200m = malaria free. people migrate out of lowlands.

Question 5

are strategies successful?

Answer 5

2.9 million cases reported in 2019. 4700 died (shows success of strategies

Question 6

malaria nets statistic

Answer 6

the average cost of malaria nets are $3 but avg hourly wage is $1.5. arguably affordable but not easy to access.

Question 7

what INDIRECT strategies are used by the GOVERNMENT to tackle malaria?

Answer 7

• the indoor residual spraying for malaria control project. implements best practices on indoor residual spraying to reduce malaria transmission
• the Malaria diagnosis and treatment activity. strengthens malaria laboratory diagnosis/treatment.
• coordinates monitoring and evaluation of strategies.
• US govt:
  > USAID partners with Ethiopia’s National Malaria Elimination Program to improve malaria prevention and treatment activities with an aim to substantially decrease malaria morbidity. LT goal of elimination

Question 8

what INDIRECT strategies are used by the NGOs to tackle malaria?

Answer 8

• indirect strategies focus on mass publicity campaigns to minimise potential mosquito breeding sites
• providing early diagnosis and treatment (within 24hrs of the onset of fever)
• and distributing insecticide-treated bed nets to all households in infected areas

Question 9

what INDIRECT strategies are used by THE GLOBAL FUND to tackle malaria?

Answer 9

• a malaria grant of up to $105 million was signed for Ethiopia for 2021-24
• the investment supports interventions designed to reduce malaria mortality and morbidity by 50% by 2025
• since 2002, deaths have almost halved and annual case numbers have fallen by 57%

Question 10

what are some barriers to eradicating malaria?

Answer 10

• mosquito resistance to insecticides
• the emergence of new vectors
• the potential side effects of irrigation and HEP (Ethiopia is expanding irrigation/hydropower dams, infrastructure found to intensify malaria transmission)
• climate change/variability (temperature suitability is climbing into the highlands
• strategies are only making a dent and not resolving the situation on the scale its needed

Question 11

what INDIRECT strategies are used by the BILL AND MELINDA GATES FOUNDATION to tackle malaria?

Answer 11

• concentrate their resources in areas where their efforts can be catalytic
• they take on risks that would be more challenging for others to take
• and focus on LT objectives
• “eradication is the only sustainable approach to addressing malaria. by using existing tools effectively to save lives and advancing innovative approaches to eradication, we can rid the world of this preventable, treatable disease.”
• they are investing in organisations that are working to map the malaria burden down to the community level

Question 12

how effective are indirect strategies?

Answer 12

• as a result of these efforts death rates from malaria halved between 2000 and 2010
• in the past, cycles of malaria have occurred every 5-8yrs. since 2003, however, there have been no malaria epidemics in the country
• vector management tools such as insecticides, environmental modification and benders have contributed greatly to successful malaria control efforts historically, but have faced setbacks in recent years due to factors such as the emergence of insecticide resistance.
• whilst vector management might be the most effective strategy, in Ethiopia the rural nature of communities means that either people can’t get access to the management tools or can’t afford them, so the effectiveness is limited by development.
• remote locations also make publicity campaigns difficult. hard to educate the population

Question 13

what DIRECT strategies are used by the GOVERNMENT to tackle malaria?

Answer 13

• In 2011 the Ethiopian govt also implemented a 5 yr plan for malaria prevention and control
• the plan operates in partnership with a number of agencies like UNICEF, the World Bank and WHO
• direct action involves measures to eradicate mosquitos including periodic spraying of dwellings with insecticides and managing the environment to destroy breeding sites
• the US has invested over $445 million to combat malaria in Ethiopia.
• has contributed to improved prevention methods, including distribution of over 40 mill long lasting insecticide treated bed nets as well as enhanced diagnostic/treatment capacity
• helped cut malaria incidence and death by 50% between 2015-18

Question 14

are direct strategies effective?

Answer 14

• very effective at preventing or dealing with malaria directly seeing as breeding grounds are destroyed, therefore cases will decline
• despite the strategies themselves being very effective, Ethiopia as an LIDC does not have the economy to fund them
• this means they’ve built up a dependency on this aid from investments and NGOs, so if these were to stop, the cases in Ethiopia would increase again as they wouldn’t have the means to deal with it.

Question 15

what DIRECT strategies are used by THE GLOBAL FUND to tackle malaria?

Answer 15

• since 2002 the Global Fund have provided 230 million bed nets to families
• has 4 core grants active in Ethiopia, with funding totalling $453 million for 2021-2024
• since 2004 the global fund has been rolling out large-scale interventions such as mass distribution of long lasting insecticidal nets/indoor residual spraying
• also introduced additional diagnosis and treatment mechanism such as rapid diagnostic tests

Question 16

direct strategies

Answer 16

• destroying habitats
• spraying homes/insecticides
• ACTs (drugs)
• passenger screening (Mauritius)