Ethiopia Case Study

What is malaria?

Caused by four species of Plasmodium, transmitted by bite of female Anopheles mosquito

Malaria classification

Noncommunicable, Infectious, Endemic

Global malaria deaths in 2019

405,000 (3/4 were under 5 years old)

Malaria symptoms

Muscle aches, fever, nausea, vomiting, diarrhoea, headaches, chills, seizures, mental confusion, kidney failure

Malaria prevalence definition

Number of people living with disease in a set time

Malaria incidence definition

Rate of new cases in a disease-free population within a time period

Prevalence of malaria in Ethiopia

5 million episodes yearly, 70,000 deaths

Malaria incidence in Ethiopia

High deaths under age 4, increase in older groups, 15–19 year olds have death rate of 1,000/100,000; 70–74 women 7,000/100,000, men 4,000/100,000

Malaria patterns in Ethiopia

High deaths in under 5s, prevalent below 2000m, seasonal, worst in western lowlands (Tigray, Amhara, Gambela)

Social causes of malaria (1)

Lack of nets (only 33% of under-5s use), population movement during rainy season, night harvesting, field sleeping

Social causes of malaria (2)

Stagnant water from irrigation, unsanitary and crowded living conditions, urbanization, marshes and swamps

Environmental causes of malaria

Warm, humid conditions, stagnant water, endemic in western lowlands, floods contaminate freshwater

Socio-economic impacts of malaria (1)

Children miss school, adults miss work, $12 billion/year lost, drug resistance, poor education affects medication adherence

Socio-economic impacts of malaria (2)

17% of outpatient visits, 15% of admissions, 27% of in-patient deaths, 40% of health spending, deters tourism and FDI

Population shift due to malaria

From western lowlands to central highlands, causing land overuse and degradation

Peak malaria transmission season in Ethiopia

September to December (after June-Sept rains)

Ideal breeding temperature for mosquitoes

24–28°C

Harvest season behaviour increasing risk

Field workers sleep outdoors during mosquito peak activity

Impact of urbanization on malaria

Creates waste dumps and stagnant water

Drug resistance issue

Chloroquine losing effectiveness, last major breakthrough 50 years ago

Lack of sanitation and water access

24% lack toilets, 93% lack basic toilets, 60 million lack clean water

Poor housing and malaria risk

Thatched/mud homes offer little mosquito protection

Stagnant water around infrastructure

Hydroelectric dams and irrigation areas create breeding grounds

Direct malaria control strategies

IRS, bed nets, breeding site reduction

Indirect malaria control strategies

Mass education, diagnosis and treatment, net distribution

PMI launch year

2008

PMI goal

Reduce malaria mortality by 50% in 15 African countries

Four PMI interventions

ITNs, IRS, ACTs, intermittent treatment of pregnant women

PMI coverage targets

100% ITN households, >80% net use, 100% household spraying, 100% habitat identification

PMI recent results

10.4 million nets, 2,600 IRS staff trained, 44 districts sprayed, support to 400 health centers

Bed net effectiveness belief

94% of people agree they prevent malaria

Bed net wear and tear

ITNs last two years, 72% experience wear

Misconceptions about malaria

Blame food, sugarcane, cold weather, witchcraft

Knowledge of symptoms

Only 35% know three or more symptoms

Improvement in malaria detection

From 64% to 98%

Misdiagnosis rate reduction

From 8% to 0%

Antenatal clinics managing malaria

Only 60% participation

IRS effectiveness in targeted areas

95% coverage, 1.3 million people benefited