Malaria in Ethiopia

Background context

- Caused by a tiny plasmodium parasite.
- 2 hosts: female anopheles mosquitoes + humans.
- World's most deadly disease: 2019 - 400,000 died (3/4 kids under 5.)
- Mosquitoes = vectors transmitting the disease.
- Parasites enter people through the bite of an infected mosquito.
- Africa = 94% of all malaria deaths (2018).

Incidence and patterns of malaria

- Endemic in 75% of Ethiopia.
- 2/3 population live in areas at risk (kills 70,000 per year.)
- Not evenly distributed: highest risk = western lowlands (Tigray + Gambella provinces.
- Transmission rates peak after rainy season (June-November).
- Midlands = altitude ranges from 1000-2000m, transmission = seasonal with occasional epidemics.
- Afar and Somali (eastern lowlands): arid climate confines malaria to river valleys.
- Central highlands (1/4 of the country) are malaria-free.

Environmental causes of malaria

- Most malarial mosquitoes thrive in warm, humid climates: stagnant water surfaces provide ideal breeding habitats.
- In Ethiopia, these are strongly influenced by altitude: disease endemic in the western lowlands where temperature and humidity are high all year.
- Absence of malaria in the highlands explained by low average temperatures - slow the development of mosquitoes and plasmodium parasites.

Human causes of malaria

- Population movements, urbanisation, irrigation schemes + misuse of malarial drugs encourage spread.
- At harvest + planting time, large-scale seasonal migration from highlands to agricultural lowlands.
- This time coincides with rainy season + peak malarial transmission period (June-September.)
- Harvesting can continue after sunset when mosquitoes are most active + most migrant workers sleep in fields overnight.
- Irrigation projects in Awash valley + Gambella province & rice cultivation have both expanded the mosquito breeding habitats.
- Urbanisation had similar effect: flooded excavations, garbage dumps + discarded containers = more breeding sites.
- Malarial parasites increasingly drug-resistant - last significant breakthroughs in anti-malarial drugs made 50 years ago.

Social impacts

- Hardest hit = poor: live in poorly built dwellings offering few barriers to mosquitoes.
- Ethiopians suffer 5 million cases of malaria /year + 70,000 die.
- Malaria affects food security + environment: western lowlands = resource-rich with considerable potential to raise food production BUT MALARIA IS ENDEMIC TO THE REGION so development is held back.
- Knock-on effect in highlands: region = malaria-free - supports unusually high population densities SO FARMING RESOURCES ARE OVEREXPLOITED for generations -> land degradation.
- Contributed to devastating famines in 1980s.

Economic impacts

- Debilitating effects: people absent from work which slows economic growth + reinforces the poverty cycle.
- Lost production due to malaria estimated at US$ 12 billion a year.
- Cost to health services = considerable - malaria absorbs 40% of national health expenditure & accounts for 10% of hospital admissions.
- Dealing with malaria epidemics can overwhelm the country's health services & damage tourism and inward investment.

Strategies to control and treat malaria: DRUGS

- Malaria can be treated but not always cured.
- Many antimalarials used in prevention & treatment have physical + psychological side-effects.
- EG: Chloroquine: causes pH in parasite's cell to increase, preventing important biochemical reactions.
o Excessive use of the drug can be toxic to humans.
o Growing resistance detected 70 years ago led to the development of alternatives (mefloquine) which has significant psychological effects on many who take it.

Strategies to control and treat malaria: Two parasites and ACT

- Two dominant parasites in Ethiopia = P.vivax (40%) and P.falciparum (60%).
- National malaria guidelines recommend ARTEMISININ-BASED COMBINATION THERAPIES (ACT) for the treatment of uncomplicated malaria caused by P.falciparum.
- For P.vivax, chloroquine remains the most efficient treatment in endemic areas.

Strategies to control and treat malaria: Prevention and control

- Prevention & control programme in Ethiopia outlined in the National Malaria Strategic Plan (NMSP) in line with WHO's global campaign to Roll Back Malaria (RBM.)
- Current methods of controlling malaria interventions = insecticide-treated mosquito nets (ITNs), indoor residual sprayers (IRS) and mosquito larval source reduction.
- 2015: malaria indicator survey (MIS) showed that over 70% households in endemic areas were protected by ITN or IRS.
- However rate of improved household protection has slowed in the past few years (eg. fishing nets.)

Strategies to control and treat malaria: Targets

- Recently targeted malaria elimination worldwide in 2030, aligned w/WHOs Global Technical Strategy through intensifying existing malarial control activities.
- 2019: Ethiopia on track to achieve 2020 milestone of reducing malaria by 40%.
- Emergence of insecticide resistance, migration population and emerging chloroquine resistance for P.vivax and difficulty in controlling and eliminating P/vivax = challenging factors for malaria elimination.