MALARIA: ETHIOPIA

What is malaria?

• Caused by a tiny plasmodium parasite

• World’s deadliest disease

What are the 2 hosts of the malaria plasmodium parasite?

1. Anopheles mosquito

2. Humans

Anopheles mosquito role in malaria?

• Vector

• Transmits disease from person to person.

• Parasites enter humans through bite of infected mosquito.

Cases in 2019?

• 2019: 405,000 deaths from malaria.

• 3/4 = children under 5 years.

Malaria deaths 2018?

Africa accounted for 94% of all malaria deaths (2018).

Malaria patterns in Ethiopia?

• Endemic in 75% of Ethiopia’s land area.

• 2/3 of pop. are at risk.

How many people die per year from malaria in Ethiopia?

70,000

Distribution of malaria in Ethiopia?

• Uneven

• Western lowlands = highest risk

• Provinces include:

  • Tigray

  • Amhara

  • Gambella

Transmission of malaria: seasonal variations?

• Transmission rates peak after rainy season.

• June - November.

• Midlands: Seasonal transmission with occasional epidemics, altitudes range from 1000-2200m.

How are the eastern lowlands impacted?

• In Afar & Somali provinces.

• Arid climate confines malaria to river valleys.

How are the central highlands impacted?

• Central Highlands: comprise around 1/4 of country.

• Malaria-free.

How does Ethiopia’s altitude strongly influence malaria mosquito’s?

• Most thrive in warm, humid climates.

• Stagnant surface water = ideal breeding habitats for mosquitos.

• Strongly influenced by altitude.

How are the western-lowlands influenced by this?

• Endemic in western lowlands.

• Temps & humidity are high throughout year.

How do highlands contrast this?

• Absence of malaria is explained by low average temps.

• Slows development of mosquitos & the plasmodium parasite.

How do human factors play a role in malaria’s epidemiology?

Spread of disease encouraged by:

• Population movements

• Urbanisation

• Irrigation schemes

• Misuse of malarial drugs

How do human & seasonal factors coincide with spread of malaria?

• Every year at harvest & planting time - large-scale seasonal population movements between malaria-free highlands & agricultural lowlands.

• Timing of migration coincides with rainy season & peak malaria transmission in lowlands (June-November).

How does harvest increase infection?

• Harvesting often continues after sunset - mosquitoes are most active.

• Most migrant workers sleep in fields overnight.

How do irrigation projects increase spread of malaria?

• Irrigation projects in Awash Valley & Gambella province & cultivation of rice.

• Expanded breeding habitats for mosquitoes.

How has urbanisation increase spread of malaria?

• Flood excavations, garbage dumps & discarded containers etc.

• Provide countless breeding sites.

How does the misuse of malarial drugs influence incidence rates?

• Malarial parasites becoming increasingly drug-resistance.

• Some experts suggest the last significant breakthroughs in anti-malarial drugs - made nearly 50 years ago.

Who has been most effected by the socio-economic impacts of malaria?

• Hardest hit = the poor.

• Often live in crudely built dwellings

• Few barriers to mosquitoes.

How many episodes of malaria does Ethiopia suffer a year?

5 million episodes

What are the effects of malaria on the individual?

• Debilitating effects

• Causes absenteeism from work.

• Slows economic growth

• Reinforces cycle of poverty.

How much is lost in production in Sub-Saharan Africa due to malaria a year?

US$12 billion per year

Impacts on health in Ethiopia?

Considerable cost to health services:

• Malaria absorbs 40% of national health expenditure.

• Accounts for 10% of hospital admissions.

• 12% of health clinic visits.

What economic impacts does malaria cause? (3)

• Overwhelms health services

• Damages toursim

• Curtails inward investment

What 2 things does malaria have implications for?

1. Food security

2. Environment

How do these 2 factors impact the western lowlands?

• Resource-rice with considerable potential to raise food production.

• Malaria holds back development.

How does this problem have knock-on effects?

• Knock-on effects in highlands.

• Highlands = malaria free, thus supports unusually high population densities.

• Thus, maegre farming resources are overexploited for generations - results in widespread land degradation.

What is an example of this issue in the past?

This situation contributed to devastating famines in 1980s.

What are the challenges with treating malaria?

• Can be treated but not always cured.

• Many preventative drugs/treatment have side-effects - both physical & psychological.

Example of malaria treatment?

• Chloroquine - used for long time.

• Causes pH in certain parts of parasites cell to increase & prevents important biochemical reactions.

• Excessive use of drug = toxic

What is another issue of chloroquine?

• Growing resistance - first detected 70 years ago in Thailand.

• Led to development of alternatives e.g. Mefloquine.

Issues with Mefloquine?

Psychological impacts on significant % of patients.

What are the 2 dominant malaria parasites in Ethiopia?

1. P. flaciparum = 60% of cases

2. P. vivax = 40% of cases.

What do the national malaria guidelines recommend?

• Artemisinin-based Combination Therapies (ACT).

• Treatment of uncomplicated malaria caused by P. falciparum.

• P. vivax = cholorquine is most efficient treatment.

Prevention and control programme in Ethiopia?

Outlined in National Malaria Strategic Plan (NMSP).

What is this plan in line with?

WHO’s global campaign to Roll Back Malaria (RBM)

What are the current methods of controlling malaria interventions implemented in Ethiopia?

• Insecticide-treated mosquito nets (ITNs)

• Indoor residual spraying (IRS)

• Mosquito larval source reduction.

Figures to suggest evidence of these control methods?

• By 2015: Malaria Indicator Survey (MIS):

• >70% of households in malaria-endemic areas, were protected by either ITN or IRS.

• BUT, rate of improved household protection as slowed in past few years.

What are the global strategies to reduce malaria in Ethiopia?

• Targeted in Malaria Elimination Nationwide in 2030.

• Aligned with WHO’s Global Technical Strategy (GTS).

• By intensifying existing malaria control activities.

How has Ethiopia shown improvements/success?

• Ethiopia was on track to achieve the 2020 milestone.

• By reducing the incidence of malaria by 40%.

However, what are the challenges around this?

Emergence of:

• Insecticide resistance

• Migrant population

• Emerging chloroquine resistance for P. vivax

• Difficulty controlling & eliminating P. vivax