Malaria case study

Question 1

Vector-borne

Answer 1

When a disease is biologically transmitted by a carrier

Question 2

Number of people living in areas at risk

Answer 2

3.6 billion

Question 3

Number of countries at risk

Answer 3

91

Question 4

Distribution of countries at risk

Answer 4

Sub-Saharan Africa carries a disproportionately high share of the global deaths caused by malaria.
The region was home to 93% of malaria cases and 94% of malaria deaths.

Question 5

Amount of deaths and cases in 2018 (according to the WHO)

Answer 5

228 million cases
405,000 deaths

Question 6

Most vulnerable people

Answer 6

Children under 5
67% of all malaria deaths (272,000)

Question 7

Prevalence in Africa

Answer 7

19 countries in Sub-Saharan Africa plus India carried almost 85% of the global malaria deaths.

Question 8

6 main countries for malaria cases

Answer 8

Nigeria - 25%
Democratic Republic of Congo - 12%
Uganda - 5%
Cote d’Ivore (Ivory Coast) - 4%
Mozambique - 4%
Niger - 4%

Question 9

Where do mosquitoes breed?

Answer 9

Stagnant water

Question 10

When is the best time for transmission?

Answer 10

Just after the rainy season - in Africa the length of the malaria transmission season is directly related to the length of the rainy season.

Question 11

Rain, altitude and Malaria

Answer 11

At altitudes above 1500m and where rainfall is below 1000mm, malaria transmissions fall.

Question 12

Temperature and Malaria

Answer 12

High temperature is also important. The parasites require temperatures of between 16 degrees C and 32 degrees C to develop inside the mosquito and this is why the disease is largely concentrated in the tropics.

Question 13

Symptoms of Malaria

Answer 13

• fever that comes and goes depending on the species of malaria
• initially feels like the flu: high fever, fatigue, body aches, hot and cold stages
• headache
  -nausea
• shaking chills (rigors)
• sweating
• weakness
  Anaemia is common in patients with malaria, in part due to the effects of the plasmodium parasite on the red cells

Question 14

Malaria in children

Answer 14

Signs and symptoms in children may be nonspecific, leading to delays in diagnosis.

Question 15

Plasmodium falciparum

Answer 15

Causes a particularly severe form of malaria:
In addition to fever patients may experience complications such as
- destruction of red blood cells
- yellow skin discoloration
- kidney failure
- fluid in the lungs
- cerebral malaria
- convulsions
- coma
- death

Question 16

Immunity

Answer 16

People who have lived for years in areas with malaria may develop a partial immunity to new infections.

Question 17

Land use

Answer 17

Studies in India show that people living in close proximity to a forest are more susceptible to infection.

Question 18

Housing quality

Answer 18

Homes with earth/sand floors using mud,bamboo or wooden trunks for walls and grass or palm leaves to provide a roof.

Question 19

High density occupancy

Answer 19

Densely clustered built up areas and overcrowded rooms affect increasing risk.

Question 20

Unsanitary conditions

Answer 20

Even though houses are usually clean surrounding areas that are dirty and polluted are associated with mosquitoes and increased risk.

Question 21

Occupation

Answer 21

Agricultural workers are more exposed to mosquitoes.

Question 22

Rural vs urban environments

Answer 22

Generally those in rural areas are seen to be at more risk. Urban contamination rates are high due to building density and unsanitary conditions.

Question 23

Age and Gender

Answer 23

These are not significantly associated with risk of infection though children under 5 are more likely to suffer. In Gambia and Tanzania the burden is more from ages 5-14.

Question 24

Income

Answer 24

strong positive correlation between income and the use of prevention methods. higher income is also associated with better nourishment.

Question 25

Education

Answer 25

Those with a clear understanding of malaria and the risks are less likely to be at a greater risk.

Question 26

Distance and accessibility

Answer 26

Greater distance to the nearest clinics or hospitals is associated with fewer seeking treatments for symptoms and less expenditure on prevention methods.

Question 27

Disease of poverty

Answer 27

most of the variables are proxies for poverty and evidence suggests malaria is strongly associated with low socio-economic status.

Question 28

Malaria killing kids

Answer 28

Malaria kills a child somewhere in the world every 2 mins.

Question 29

Costs to individuals and families

Answer 29

travel to and treatments at clinics, purchase of drugs to treat malaria, lost income from absence at work.

Question 30

Cost to government

Answer 30

building, staffing and maintaining healthcare facilities, purchase of drugs and of public health intervention.

Question 31

Direct and indirect costs

Answer 31

Direct costs of malaria resulting from the provision of healthcare are thought to be around $15 - 18 billion each year globally.

Question 32

Nets (ITN)

Answer 32

sleeping under a ITN is a particularly effective low cost barrier to mosquitoes.

Question 33

Treatments

Answer 33

• anti malarial drugs
• vaccines
• mosquito coils
• indoor residual spraying