Malaria
In collaboration with Cesvi 
According to the World Health Organization (Report 2008), malaria affects more than 250 million people every year in all the world, posing a risk for 40% of the world population living in the countries of the south of the world (3 billion people in jeopardy in 109 countries, especially the children under the age of 5). Most of the cases of infection and diseases (about 90%) occur in sub-Saharan Africa, although also Asia, Latin America, the Middle East and some European areas are considered at risk. In Africa malaria is the most severe threat to life, especially children’s, and about 1 million deaths are recorded every year. The geographic distribution of malaria depends on climatic factors mainly, such as temperature, humidity and rain. The ideal areas for malaria are the tropical and sub-tropical regions, where mosquitoes proliferate.
Map of malaria in the world (source: Roll Back Malaria Partnership) (apre una nuova finestra)
Malaria: cure, projects and prevention (intervenes Doct. Roberto Moretti, epidemiologist expert in communitarian, public and tropical health and Cesvi adviser for health projects)
Myanmar project(Doct. May Aung Lin, Mattia Cristofoli - Cesvi)
Malaria in the Democratic Republic of Congo (Maria Agata Messina - Cesvi, Doct. Luwasa -provincial coordinator of the programmefor combating malaria in Congo)
- The practices for combating malaria
- Malaria in the Asian-European region
- Imported malaria
- World Malaria Day
- Malaria action plan
- Useful Links
1. What is malaria?
Malaria is a life-threatening parasitic disease transmitted by mosquitoes.
The real cause of malaria is a one-cell parasite called plasmodium. the parasite is transmitted from person to person through the bite of a female Anopheles mosquito.
There are four types of human malaria Plasmodium vivax,
P. malariae, P. ovale and P. falciparum. P. vivax and P. falciparum are the most common and falciparum the most deadly type of malaria infection.
The malaria parasite enters the human host when an infected Anopheles mosquito takes a blood meal. Inside the human host, the parasite undergoes a series of changes as part of its complex life-cycle.
Its various stages allow plasmodia to evade the immune system, infect the liver and red blood cells, and finally develop into a form that is able to infect a mosquito again when it bites an infected person.
Typically, malaria produces fever, headache, vomiting and other flu-like symptoms.
Malaria can kill by infecting and destroying red blood cells (anaemia) and by clogging the capillaries that carry blood to the brain (cerebral malaria) or other vital organs.
2. Why is it so widespread?
Malaria is the most widespread of all the parasitical illnesses and it is particularly sensitive to the climate changes, above all the increase of temperature and humidity. It is widespread in the hottest areas of the world and it reaches the peak during the rain seasons.
Malaria is widespread for two reasons: above all the easy transmission, caused by 60 different species of mosquitoes that live everywhere (inside houses, in water containers used to cook and wash, in wells) and that, biting the man, transmit the parasite.
The second reason is the lack of prevention and treatment measures in the most jeopardized countries.
3. A bit of history
Today malaria predates the poorest countries of Africa above all, but until 50 years ago it afflicted also Europe and United States (in Italy the epidemic was spreading in the Agro Pontino area, along the River Po and in Sardinia).
Its defeat in the industrialized countries and, in the same years, in some tropical countries, was possible thanks to the extensive use of the insect-repellent Ddt, together with the administration of anti-malarian drugs.
The success of Ddt did not last long: it was banned from the market and the resistance of malaria to drugs provoked, especially in the hottest and poorest areas a quick rise in the infection and death toll. Although there have been no international programs of disinfection so far to delete the mosquito and the parasite, the genetic research has studied the mosquito and the parasite responsible for the infection.
Up to today there are 1,400 genes of the mosquito Anopheles , whereas 14 chromosomes and 5,300 genes of the parasite have been identified – a step forward to most effective drugs and vaccines.
4. Social and economic impacts of malaria
Malaria causes significant economic losses, and can decrease gross domestic product (GDP) by as much as 1.3% in countries with high levels of transmission. Over the long term, these aggregated annual losses have resulted in substantial differences in GDP between countries with and without malaria, particularly in Africa.
The health costs of malaria include both personal and public expenditures on prevention and treatment.
In some heavy-burden countries, the disease accounts for: up to 40% of public health expenditures; 30% to 50% of inpatient hospital admissions; up to 60% of outpatient health clinic visits.
Malaria disproportionately affects poor people who cannot afford treatment or have limited access to health care, trapping families and communities in a downward spiral of poverty.
5. Malaria in Africa
The WHO World Malaria Report 2008 confirms the severity of the situation, especially in sub-Saharan Africa: about 90% of the cases and diseases for malaria occur in Africa, being Nigeria, the Democratic Republic of Congo, Ethiopia, Tanzania and Kenya the most afflicted.
According to the Africa Malaria Report 2006 (published by the regional office of the WHO for Africa and east-Mediterranean), over the 60% of the cases of malaria and over 90% of diseases attributed to malaria – the figure amounts to one million deaths (variable from 700 thousand and 1,3 million), are recorded in sub-Saharan Africa. 75% of the dead are children under the age of 5.
Lots of the estimations given do not consider the side effects of malaria, such as anaemia, hypoglycemia, breath problems, under-weight new born babies and other complications. More recent estimations reveal that about 75,000-200,000 children die every year in Africa due to these side effects; anaemia and under-weight cause the 50% of child death under the age of 5.
6. The practices for combating malaria
The practices to monitor malaria on a large scale comprise at present: Long lasting insecticide-treated nets; "Artemisinin-based combination therapy");indoor spraying ("Insecticide residual spraying"); "Intermittent preventive treatment").
According to the WHO, in spite of the increased distribution of mosquito-nets, in most of the sub-Saharan African countries their number in 2006 resulted inferior than the quantity needed.
The same for anti-malarian drugs available in the public surgeries: the access to the treatment in inappropriate, according to the WHO, in most of the countries examined, even though the doses of drugs administrated have increased from 6 million in 2005 to 49 million in 2006, of which 45 million for Africa alone. In 2006 the mosquito-nets available were enough to protect 26% of the population in 37 African countries.
In 18 countries examined, it emerged that 34% of the families owned a mosquito-net; 23% of the children and 27% of pregnant women used to sleep under a bed-cloth; 38% of the children with fever were treated with anti-malarian drugs, but only 3% had been administrated a combined therapy with drugs derived from artemisinin (currently the most effective); 18% of the women had been administrated a preventive treatment during the pregnancy.
Only 5 African countries had effective insecticidal, enough to protect 70% of the population in jeopardy.
Although it always seems difficult to establish a clear connection between interventions and expected impact – the WHO says – it has been observed that in 7 out of 45 African countries examined, with a good surveillance system and a full coverage of interventions, the infections and the death toll by malaria have been reduced by over 50% between 2000 and 2007.
7. Malaria in the Asian-European region
Between 1995 and 2005, according to the WHO, the cases of malaria in the European region decreased from 90,712 to 5,072.
With a population of 873.457.500 living in the same area, it has been estimated that 35-40 million live in areas at variable risk of malaria.
Currently malaria represents a public health problem in 8 out of 53 countries in the region: Armenia, Azerbaijan, Georgia, Kyrgyzstan, Tajikistan, Turkey, Turkmenistan, Uzbekistan.
8. Imported malaria
Every year within the European Union (especially in France, UK, Germany and Italy), 10 to 12 thousand cases of imported malaria are recorded.
An analysis of the TropNetEurop surveillance system (that covers about 12% of all the cases of imported malaria in Europe) show 453 cases of imported malaria in 2007, 442 of which caused by the most dangerous parasite, Plasmodium falciparum (97,6%). The total figures show a decrease compared with the peak in 2003 with 928 cases of malaria by Plasmodium falciparum.
According to the TropNetEurop 2007, the majority of patients affected by malaria are male, average age 37 and they have travelled 30 days on average. Among those who have been infected, there are immigrants and tourists: 32% were Europeans in 2007, where the term “European” referred to people born in Europe.
Among the reasons for the infection there are travels, visits to families and friends (the main reason of the infection among immigrants, 76.4%). A notably high numb
er of European patients were on a business trip (10.4%), 25.7% on a visit to families and friends and 11.8% on a charity trip.
9. World Malaria Day
World Malaria Day, which was instituted in May 2007 and promoted by the partnership of Roll Back Malaria, is celebrated on April 25th: it is a day for recognizing the global effort to provide effective control of malaria and contributing to Millennium Development Goals.
WHO on World Malaria Day 2009 http://www.who.int/mediacentre/events/annual/malaria/en/index.html
10. Malaria action plan
Already in 2005 the World Health Assembly had demanded to the member states to create action plans aimed at guaranteeing preventive and curative treatments to 80% of the population affected by malaria o at risk of infection, in order to reduce the illness incidence by at least 50% by 2010 and 75% by 2015. These objectives have been included in the Global Strategic Plan 2005-2015 of Roll Back Malaria Partnership.
Also the Millennium Declaration by United Nations has established that the objective to tackle or to start reducing the global incidence of malaria by 2015. In 2008 Roll Back Malaria partnership, that comprises Governments, International organizations, research institutes, foundations, non-profit and private, elaborated the Global Malaria Action Plan: it establishes the efforts needed to reach the eradication of malaria by 2010.
The programme , started in 2008 and lasting 2 years, aims at intensify the efforts to reinforce the health systems in the countries where the illness is endemic. The initiative also aims at reaching, through prevention campaigns, 100% of the population at risk of malaria by 2010 and bringing the death toll up to a value close to zero by 2015. in order to reach these objectives, by 2010 more than 700 million insecticide-treated mosquito-nets, more than 200 million anti-malarial drug doses and about 200 million indoor sprays every year will be needed.
In terms of money the costs will be: 5,3 billion dollars for 2009; 6,2 billion dollars for 2010; 5 billion dollars per year from 2011 to 2020; about a billion dollar per year for the research and development of new prevention and treatment technologies.
World Malaria Day by Roll Back Malaria
www.rollbackmalaria.org/
www.rollbackmalaria.org/worldmalariaday/index.html
Global Malaria Action Plan
www.rollbackmalaria.org/gmap/index.html
10. Malaria action plan
http://malaria.who.int/wmr2008/malaria2008.pdf
Unicef Report: "Malaria and Children"
www.unicef.it/flex/cm/pages/ServeBLOB.php/L/IT/IDPagina/3752
Ministry of Health and for combating malaria
www.ministerosalute.it/dettaglio/phPrimoPiano.jsp?id=170
Iss and malaria
www.iss.it/mipi/index.php?lang=1
Italian Tropical Medicine Society
www.simetweb.eu/index.htm
Epicetro - National Epidemiology, Health Surveillance and Promotion Centre
www.epicentro.iss.it/problemi/malaria/malaria.asp
European Network on Imported Infectious Disease Surveillance (TropNetEurop)
www.tropnet.net/
WHO Europe and malaria
www.euro.who.int/eprise/main/WHO/Progs/MAL/Home
European Centre for disease control and prevention
http://ecdc.europa.eu/
The European Malaria Vaccine Initiative
www.emvi.org/
WHO andmmalaria
www.who.int/topics/malaria/en/
Global Malaria Program
http://malaria.who.int/
Roll Back Malaria Partnership
http://rbm.who.int/
Malaria. Special programme for Research and Training in Tropical disease (Tdr)
http://apps.who.int/tdr/
National Institutes of Health e malaria
http://health.nih.gov/result.asp?disease_id=417
National Institute of allergy and infectious disease (Niaid)
www3.niaid.nih.gov/topics/Malaria/default.htm
PanAmerican Health Organization e malaria
www.paho.org/english/hcp/hct/mal/malaria.htm
The global fund to fight Aids, Tubercolosis and malaria
www.theglobalfund.org/en/