3.a. case study malaria

location and background of malaria

landlocked country in horn of africa with diverse landscapes- highlands and rift valley. borders kenya, somalia and south sudan. varies from temperate in highlands with 2 rainy seasons to hot in lowlands very prone to droughts. 140 mil pop, density 135 per km². mountains and blue nile flowing from lake tana. malaria caused by tiny plasmodium parasite= worlds most deadly disease. parasite has 2 hosts: anopheles mosquitoes and humans. mosquitoes act as vectors, transmitting the disease from person to person. they enter through a bite. 2024 worldwide= 600,000 deaths. 95% african region, 75% account for children under 5

prevalence, incidence and patterns of the disease

malaria is endemic in 75% of the land area. 70% of countrys pop live in areas at risk from the disease, especially below 2000m. 2024= 7 mil cases woth 1,200 deaths, a rise compared to previous years. however malaria is not evenly distributed within the country. the areas of highest risk are the western lowlands, in Tigray, Amhara and Gambella provinces. there transmission rates oeak after the rainy season so typically sept to dec after rain in june to sept. in midlands where altitudes ranges from 1000 to 2200m transmission is also seasonal and unstable, with occasional epidemics every 5-8 years. in Afar and somali provinces in the eastern lowlands the arid climate confines malaria to river valleys and wetter areas. the central highlands, comprising around ¼ of the country are malaria free

environmental and human causes

environmental= malaria thrives in warm humid climates and where stagnant surface water provides ideal breeding habitats for mosquitoes. these are strongly influenced by altitute. the disease is endemic in the western lowlands below 2000m where temps and humidity are high, 20^oc, throughout the year. the absence of malaria in the highlands 2500m is explained by low average temps, below 16^oc= slower development of mosquitoes and the parasite

human= population movements, urbanisation, irrigation schemes and the misuse of antimalarial drugs have encouraged the spread of malaria in ethiopia. every year over 1 mil seasonal migrant workers move at harvest and planting time from malaria free highland areas ti agricutural lowlands. timing of this migration coincides wit the main rainy season june to sept, which is the peak malaria transmission period in the lowlands. infection rates increase further because harvesting often continues after sunset when anopheles mosquitoes are most active, and many migrant workers sleep outdoor or in temporary shelters with limited access to insecticide-treated bed nets. irrigation projects particularly in the awash valley and gambella province have increased malaria risk through the construction of canals, micro dams, ponds and rice paddies which create areas of stagnant water ideal for mosquito breeding. in gambella malaria accounts for over 40% of outpatient visits in some years. rapid urbanisation has had a similar effect as poor drainage, flooded construction sites, rubbish dumps and discarded containers provid numerous breeding sites in expanding informal settlements. meanwhile parasites becoming increasingly drug resistance, particularly to older treatments such as chloroquine, which reduce the effectiveness of treatment and increases the likelihood of ongoing transmission

socio economic impacts of the disease

significant social and economic impacts= hardest hit are the poor often living in crudely built dwellings that offer few barriers to mosquitoes. ethiopians suffer around 5 mil episodes of malaria a year, malaria also has debilitating effects causing absence from work, slowing economic growth and reinforcing the cycle of poverty and affecting education- school missed in peak periods. lost productions in sub saharan africa due to malaria is estimated to be $12 bil a year. said that 12% of patients are spending more than 10% of their monthly income on treatment. the cost to health services is also considerable: in ethiopia malaria absorbs 15% of national health expenditure and accounts for 10% of hospital admissions and 12% of health clinic visits. dealing with malaria epidemics can overwhelm the country’s health service as well as damaging tourism and curtailing inwards investment. also has implications for food security and the environment. the western lowlands for example are resource rich woth considerable potential to raise food production. however malaria which is endemic to the region holds back development with $200 mil spent annually for direct and indirect costs for diagnosis, treatment and productivty losses.

this problem has a knock on effect in the highlands. because this region is malaria free, it supports unusually high populations densities. as a result its meagre farming resources have been overexploited for generations, resulting in widespread land degradation. this situation contributed to devasting famines in 1980s. there has been efforts to reduce mortality rates, rising case numbers, health system issues and funding gaps continue to threaten development gains

direct and indirect strategies used by gov and international agencies to mitigate against malaria and respond to outbreaks

since 2005 ethiopia has benedited from the president’s malaria initiative and the global health initiative to scale up malaria prevention and treatment throughout sub saharan africa. between 2008-13 ethiopia received grants of on average $30 mil a year from malaria control. in 2011 the gov also implemented a 5 year plan for malaria prevention and control. the plan operates in partnership with a number of agencies, including UNICEF, world bank and WHO, non gov organisations and OECD donor countries. its strategy is both direct and indirect

direct

measures to eradicate mosquitoes, including periodic spraying of dwellings with insecticides to control vectors and managing the environment to destroy breeding sites for mosquitoes. R21 vaccine introduced in 2025, 90,000 children targeted. providing early diagnosis and treatment of malaria (within 24 hours of the onset of fever) such as artemisinin based combination therapy to eliminate the malaria parasite from infected people therefore reducing the transmission potential

indirect

mass publicity campaigns to minimise potential mosquito breeding sites and distributing insecticide-treated bed nets to all households in infected areas especially children and pregnant women. over 3 bil insecticide treated nets have been distributed. 75% of households owned at least 1 in 2023. strengthening healthcare services and targeting high risk groups like seasonal migrant workers, with mobile clinics and net distribution. local volunteers and health workers often help with net distribution, campaigns and referrals for treatment. programs including WHO, UNICEF, global fund and local govs scale up interventions, ensure supplies and target high risk populations. WHOs global strategy aims to reduce malaria incidence and deaths by 90% by 2030 compared to 2015 baselines

R21 vaccine

newest, successful human trial. 70-80% reducing cases the vaccine for the trial. Ghana approved malaria vaccine first, richer ones in africa could have before WHO approved. WHO will fund if approved for poorer countries. less than $4 a dose. 2nd oct 2023 approved by WHO, funded now