Casestudy: Malaria, Ethiopia

Question 1

In 2019, how many lives did malaria claim?

Answer 1

405,000 lives, with 3/4 being children under 5.

Question 2

What proportion of total malaria deaths did the African continent account for?

Answer 2

94%.

Question 3

How is malaria spatially distributed in Ethiopia?

Answer 3

• Malaria is endemic in 75% of Ethiopia’s land area
• 2/3 of the countries population live in areas at risk of the disease, killing around 70k per year.
• The areas of highest risk are the Western Lowlands, in Tigray, Amhara and Gambella Provinces.
• In Afar and Somali provinces, arid climates confine malaria to river valleys.
• The central highlands which host 1/4 of the country are malaria free.

Question 4

How is malaria seasonally affected in Ethiopia?

Answer 4

• Transmission of malaria peaks after rainy season between June and November.
• In the Midlands, where altitude ranges from 1000-2200m, transmission is also seasonal with occasional epidemics.

Question 5

What are the environmental causes of malaria in Ethiopia?

Answer 5

• Malarial mosquitoes thrive in warm, humid climates where stagnant surface waters provide breeding habitats.
• Ethiopia’s malarial mosquito distribution is heavily dependent on altitude - disease is endemic in the western lowlands where temperatures and humidity are high throughout the year.
• Altitude prevents malaria in the highlands due to low average temperatures, slowing the development of mosquitoes and the plasmodium parasite.

Question 6

List ways in which human factors can cause malaria

Answer 6

• Population movements
• Urbanization
• Irrigation schemes
• Misuse of anti-malarial drugs

Question 7

How does the human factor of population movements cause malaria in Ethiopia?

Answer 7

• At harvest in Ethiopia, large-scale seasonal population movements take place between the malaria-free highlands and agricultural low lands.
• The timing of this coincides with the rainy season, which is when malarial transmission is at it’s peak (June-Sep).
• There is a higher population for the malarial parasite to spread around.
• Migrant workers harvest past sunset when mosquitoes are most active, and most migrant workers sleep in the fields overnight.

Question 8

How does the human factor of irrigation schemes cause malaria in Ethiopia?

Answer 8

• Irrigation projects in the Gambella province, and cultivation of rice, have expanded breeding habitats for mosquitoes

Question 9

How does the human factor of urbanization cause malaria in Ethiopia?

Answer 9

• Urbanization creates ideal habitats for malaria through providing flooded excavations, garbage dumps, discarded containers and so forth.
• The accumulation of people in one area means malaria is likely to spread more easily between individuals in a high population density.

Question 10

How does the human factor of misusing anti-malarial drugs cause malaria in Ethiopia?

Answer 10

• Malarial parasites are becoming increasingly drug-resistant, with some experts pointing out that there have rarely been breakthrough in anti-malarial drugs in the last 50 years.

Question 11

What are the economic impacts of malaria in Ethiopia?

Answer 11

• Malaria has debilitating effects, causing absenteeism from work - slowing economic growth and perpetuating the cycle of poverty.
• Lost production in Sub-Saharan Africa due to malaria is $12 billion a year.
• In Ethiopia, the cost of malaria to health services is 40% of the national health expenditure and 10% of hospital admissions.
• Dealing with malaria epidemics overwhelms the countries health services, as well as damaging tourism and curtailing inward investment.

Question 12

What are the social impacts of malaria in Ethiopia?

Answer 12

• Ethiopians suffer approximately 5 million episodes of malaria yearly, and it kills around 70,000 in Ethiopia.
• Malaria also has implications for food security and the environment
• Western Lowlands are resource rich which can considerably raise food production, yet malaria intervenes with development due to being endemic here.
• The highlands experience a knock-on effect due to being malaria free, hosting high population densities. Meagre farming resources in the highlands have been overexploited for generations, creating widespread land degradation.

Question 13

What is the national strategy used in Ethiopia to control malaria?

Answer 13

• The National Malaria Strategic Plan (NMSP).
• The NMSP implements interventions in Ethiopia such as…
• Insecticide treated mosquito nets
• Indoor residual spraying
• The relative success of this was seen in the 2015 Malaria indicator survey: more than 70% of households in malaria endemic areas were protected by either ITNs or IRS, however the improved household protection has slowed in the last few years.

Question 14

What is a direct strategy to deal with malaria?

Answer 14

• Anti-malarial drug distribution
• For example: chloroquine and artemisinin.
• This is limited by increasing resistance of malarial parasites to anti-malarial drugs, and toxicity to humans that cause side effects.
• The National Malaria Guidelines reccomend Artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated malaria caused by P. Falciparum, whilst for P. vivax chloroquine remains the most efficient treatment in endemic areas.