Malaria: SocietyMalaria: SocietyBy: Senait GebrehiwotBy: Senait Gebrehiwot

Jennie XiongJennie Xiong

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Malaria StatisticsMalaria Statistics It is a leading cause of death and disease in It is a leading cause of death and disease in

many developing countries.many developing countries. Young children and pregnant women are the Young children and pregnant women are the

most affected group.most affected group. At the end of 2004, some 3.2 billion people lived At the end of 2004, some 3.2 billion people lived

in areas at risk of malaria transmission in 107 in areas at risk of malaria transmission in 107 countries and territories. countries and territories.

350-500 million infections per year. 350-500 million infections per year. 1 million deaths occur every year. 1 million deaths occur every year. About 60% of the cases of malaria and 80% of About 60% of the cases of malaria and 80% of

death due to malaria worldwide occur in Africa death due to malaria worldwide occur in Africa south of the Sahara. south of the Sahara.

Malaria Geography Malaria Geography It occurs mostly in poor, tropical and subtropical It occurs mostly in poor, tropical and subtropical

areas of the world.areas of the world. About 90% of deaths due to malaria occur in the About 90% of deaths due to malaria occur in the

sub-Saharan Africa. This is due to:sub-Saharan Africa. This is due to:• A very efficient mosquito vector (A very efficient mosquito vector (Anapheles gambiaeAnapheles gambiae) )

assuring high transmission. assuring high transmission. • The predominant parasite species is The predominant parasite species is Plasmodium Plasmodium

falciparum, falciparum, which causes severe malaria.which causes severe malaria.• Weather conditions allowing transmission to occur Weather conditions allowing transmission to occur

year round.year round.• Scarce resource and socio-economic instability hinder Scarce resource and socio-economic instability hinder

inefficient malaria control. inefficient malaria control. In South America and Southeast Asia, malaria In South America and Southeast Asia, malaria

causes substantial disease and incapacitation. causes substantial disease and incapacitation.

Who is Most VulnerableWho is Most Vulnerable

People with no or little protective People with no or little protective immunity against malaria including:immunity against malaria including:

• Young childrenYoung children• Pregnant women Pregnant women • HIV positive peopleHIV positive people• Travelers or migrants who lack Travelers or migrants who lack

immunity.immunity.

Social and Economic TollsSocial and Economic Tolls

Countries with malaria make 1.3% Countries with malaria make 1.3% lower economic growth per year than lower economic growth per year than countries without malariacountries without malaria

Direct CostDirect Cost Indirect CostIndirect Cost Social and Economical DecisionsSocial and Economical Decisions

Direct Costs of MalariaDirect Costs of Malaria

Personal ExpendituresPersonal Expenditures• Individual/Family spending on Individual/Family spending on

insecticide treated mosquito nets (ITNs)insecticide treated mosquito nets (ITNs)• Doctor feesDoctor fees• Anti-malarial drugsAnti-malarial drugs• Transport to health facilitiesTransport to health facilities• Household expenditures in and out of Household expenditures in and out of

the hospitalthe hospital

Reasons Why ITNs Aren’t EffectiveReasons Why ITNs Aren’t Effective Cost of ITNs plays a role in its availability Cost of ITNs plays a role in its availability

to familiesto families• Nets are about US $1.70 each (RBM)Nets are about US $1.70 each (RBM)• Insecticides for treatment range from US $0.30 Insecticides for treatment range from US $0.30

to $0.60 each (RBM)to $0.60 each (RBM) Families unfamiliar with ITNs must be Families unfamiliar with ITNs must be

convinced of their usefulnessconvinced of their usefulness Families need to be persuaded to re-Families need to be persuaded to re-

treatment of ITNs with insecticidal treatment of ITNs with insecticidal properties on a regular basisproperties on a regular basis• Less than 5% of nets are re-treated (RBM)Less than 5% of nets are re-treated (RBM)

If Used Properly ITNsIf Used Properly ITNs

20% reduction in young children 20% reduction in young children deaths (RBM)deaths (RBM)

25% fewer underweight or premature 25% fewer underweight or premature babies (RBM)babies (RBM)

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Doctor FeesDoctor Fees Average cost per outpatient visit ranged Average cost per outpatient visit ranged

from US $1.54 to $4.49 (Chima)from US $1.54 to $4.49 (Chima) Average cost per inpatient admission was Average cost per inpatient admission was

between US $3.05 and $21.29 (Chima)between US $3.05 and $21.29 (Chima)

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Antimalarial DrugsAntimalarial Drugs

Drug ResistanceDrug Resistance• Chloroquine – cheapest and most widely Chloroquine – cheapest and most widely

used antimalarialused antimalarial• Sulfadozine-pyrimethanime (SP) - Sulfadozine-pyrimethanime (SP) -

usually the first and least expensive usually the first and least expensive alternative to chloroquinealternative to chloroquine

Many countries need to change Many countries need to change treatment policies and use more treatment policies and use more expensive drugs making antimalarial expensive drugs making antimalarial drugs less affordabledrugs less affordable

Household ExpendituresHousehold Expenditures

Monthly per person for malaria-Monthly per person for malaria-related prevention methods range related prevention methods range between US $0.05 to $2.10 or US between US $0.05 to $2.10 or US $0.24 to $15 per household (Chima)$0.24 to $15 per household (Chima)

Monthly per person for malaria-Monthly per person for malaria-related treatment range between US related treatment range between US $0.41 to $3.88 or US $1.88 to $26 $0.41 to $3.88 or US $1.88 to $26 per household (Chima)per household (Chima)

Direct Costs of MalariaDirect Costs of Malaria

Public expendituresPublic expenditures• Spending by government on maintaining Spending by government on maintaining

health facilitieshealth facilities• Health care infrastructureHealth care infrastructure• Publicly managed vector controlPublicly managed vector control• EducationEducation• ResearchResearch

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Health Care InfrastructureHealth Care Infrastructure

Establish systems for ensuring Establish systems for ensuring adequate stocks of drugs and clinical adequate stocks of drugs and clinical consumablesconsumables

Provide health facility staff that are Provide health facility staff that are trained and supervised in rapid trained and supervised in rapid identification, resuscitation and identification, resuscitation and subsequent clinical caresubsequent clinical care

ResearchResearch

Development of long-lasting ITNs that will Development of long-lasting ITNs that will retain insecticidal properties for 4-5 years retain insecticidal properties for 4-5 years making retreatment unnecessarymaking retreatment unnecessary

Research of Antimalarial drug combination Research of Antimalarial drug combination therapy to improve on malaria resistancetherapy to improve on malaria resistance• Artemether/lumefantrineArtemether/lumefantrine• Artesunate plus amodiaquineArtesunate plus amodiaquine• Artesunate plus mefloquineArtesunate plus mefloquine• Artesunate plus sulfadozineArtesunate plus sulfadozine

Indirect Cost of MalariaIndirect Cost of Malaria

Lost of productivityLost of productivity Lost of income associated with illness Lost of income associated with illness

or deathor death Human pain and sufferingHuman pain and suffering Effects on children’s schooling and Effects on children’s schooling and

social developmentsocial development

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Lost of ProductivityLost of Productivity

2 to 6% loss of gross domestic 2 to 6% loss of gross domestic product annually (GDP) (Chima)product annually (GDP) (Chima)

50% loss in agricultural (Chima)50% loss in agricultural (Chima) 10% loss in industrial (Chima)10% loss in industrial (Chima)

Loss of IncomeLoss of Income

Average time lost per episode for a Average time lost per episode for a sick adult ranges from 1 to 5 days sick adult ranges from 1 to 5 days (Chima)(Chima)

Time lost by adults caring for sick Time lost by adults caring for sick children ranges from 1 to 5 days per children ranges from 1 to 5 days per episode (Chima)episode (Chima)

Schooling and DevelopmentSchooling and Development 7% of children who survive cerebral malaria have 7% of children who survive cerebral malaria have

permanent neurological problemspermanent neurological problems• Limited availability of specialized education provision Limited availability of specialized education provision

and equipment for these children effects learning and equipment for these children effects learning opportunitiesopportunities

Children who appear to have complete Children who appear to have complete neurological recovery from cerebral malaria can neurological recovery from cerebral malaria can still develop cognitive problems that affects their still develop cognitive problems that affects their school performanceschool performance• Attention deficitsAttention deficits• Difficulty with planning and initiating tasksDifficulty with planning and initiating tasks• Speech and language problemsSpeech and language problems

Domestic chores at home due to sick family Domestic chores at home due to sick family members results in absence from schoolmembers results in absence from school

Household Coping Methods For Household Coping Methods For Direct and Indirect CostsDirect and Indirect Costs

Mobilizing cash reserves and savingsMobilizing cash reserves and savings Selling livestockSelling livestock

• Jeopardizes household assetJeopardizes household asset Receiving gifts from other Receiving gifts from other

householdshouseholds• No livestock can result in not being able No livestock can result in not being able

to receive gifts resulting in taking out to receive gifts resulting in taking out loans and falling into debtloans and falling into debt

Effects on Social and Economical Effects on Social and Economical DecisionsDecisions

Undeveloped tourism of countryUndeveloped tourism of country• Reluctance of travelers to visit Reluctance of travelers to visit

malaria endemic areasmalaria endemic areas Undeveloped marketsUndeveloped markets

• Traders’ unwillingness to travel to Traders’ unwillingness to travel to and invest in malaria areasand invest in malaria areas

Less productive agriculture Less productive agriculture • Planting subsistence crops rather Planting subsistence crops rather

than more labor-intensive cash than more labor-intensive cash crops because of harvest seasonscrops because of harvest seasons

Aid for Economic ProblemsAid for Economic Problems

Private CompaniesPrivate Companies Abuja Summit: Roll Back Malaria Abuja Summit: Roll Back Malaria

(RBM) (RBM)

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Private CompaniesPrivate Companies Contribution to programsContribution to programs Assisting in research and development of Assisting in research and development of

new treatments and interventionsnew treatments and interventions Providing management and business Providing management and business

expertise to help market INTs and expertise to help market INTs and antimalarial drugsantimalarial drugs

Using their networks to distribute and Using their networks to distribute and carry life saving medicines and prevention carry life saving medicines and prevention measures to remote communitiesmeasures to remote communities

Using their marketing and PR expertise to Using their marketing and PR expertise to assist in public education campaignsassist in public education campaigns

Abuja Summit: Roll Back Malaria Abuja Summit: Roll Back Malaria (RBM)(RBM)

Social marketing schemesSocial marketing schemes Abuja DeclarationAbuja Declaration Development of local industriesDevelopment of local industries Further government involvementFurther government involvement WHO standards for ITNsWHO standards for ITNs Strategic Framework for Coordinated Strategic Framework for Coordinated

National Action for Scaling-up National Action for Scaling-up Insecticide-treated Netting Programs Insecticide-treated Netting Programs in Africain Africa

Results of RBMResults of RBM

Almost 20 African countries have Almost 20 African countries have reduced or eliminated taxes and reduced or eliminated taxes and tariffs on ITNs to make them more tariffs on ITNs to make them more affordable (RBM)affordable (RBM)

Half of African countries have Half of African countries have established County Strategic Plans to established County Strategic Plans to achieve RMB goals and targets (RBM)achieve RMB goals and targets (RBM)

Multiple ChoiceMultiple Choice

1) What is an indirect cost of Malaria?1) What is an indirect cost of Malaria?

a) Doctor feesa) Doctor fees

b) Human pain and sufferingb) Human pain and suffering

c) Publicly managed vector controlc) Publicly managed vector control

bb

Fill In the BlankFill In the Blank

2) ________ helps to promote health 2) ________ helps to promote health education campaigns. education campaigns.

Roll Back MalariaRoll Back Malaria

3) Time lost by adults caring for sick 3) Time lost by adults caring for sick children ranges from __ to __ dayschildren ranges from __ to __ days

1 to 51 to 5

Short AnswerShort Answer

4) Name one of the three household 4) Name one of the three household coping methodscoping methods

Mobilizing cash reserves and savingsMobilizing cash reserves and savings Selling livestockSelling livestock Receiving gifts from other Receiving gifts from other

householdshouseholds

True or FalseTrue or False

5) Agricultural irrigation promotes an 5) Agricultural irrigation promotes an increase in frequency and transmission increase in frequency and transmission of Malaria.of Malaria.

FalseFalse, In a couple studies on irrigation in , In a couple studies on irrigation in sub-Saharan Africa the introduction of sub-Saharan Africa the introduction of irrigated agriculture had little impact on irrigated agriculture had little impact on Malaria because with enhanced income Malaria because with enhanced income there were better protective measures there were better protective measures against itagainst it

ReferencesReferences 2001-2010 United Nations Decade to Roll 2001-2010 United Nations Decade to Roll

Back Malaria. Retrieved February 8, 2007: Back Malaria. Retrieved February 8, 2007: http://www.rbm.who.inthttp://www.rbm.who.int

Chima, R., Goodman, C., Mills, A. The Chima, R., Goodman, C., Mills, A. The Economic Impact of Malaria In Africa: A Economic Impact of Malaria In Africa: A Critical Review of The Evidence. Health Critical Review of The Evidence. Health Policy 2003;63:17-36Policy 2003;63:17-36

Gallup, J., Sachs, J. The Economic Burden Gallup, J., Sachs, J. The Economic Burden of Malaria. Am J Trop Hyg 2001;64 (1,2) of Malaria. Am J Trop Hyg 2001;64 (1,2) S:85-96.S:85-96.

The Impact of Malaria, a Leading Cause of The Impact of Malaria, a Leading Cause of Death Worldwide. Retrieved February 13, Death Worldwide. Retrieved February 13, 2007: 2007: http://www.cdc.gov/malaria/impact/index.hhttp://www.cdc.gov/malaria/impact/index.htmtm