There are many diseases in the world. But among many others, there is the case of malaria. This disease is ravaging the world. What is a malaria disease? Malaria is a disease caused by a Plasmodium parasite, transmitted by the bite of an infected mosquito. Only the Anopheles genus of the mosquito transmits malaria. Symptoms of malaria may include fever, vomiting and/or a headache. The classic form of manifestation in the body is fever, sweating, and chills that appear 10 to 15 days after the mosquito bite. Blood samples are examined under a microscope to diagnose malaria, where the parasite is detected inside the red blood cells. Rapid diagnostic tests (RDTs) are used to diagnose malaria in remote areas where the microscope cannot be used.
I – Principal Facts About Malaria Disease and Population at Risk
Malaria is the most common tropical infectious disease in the world. About half of the world’s population is at risk of contracting malaria disease, especially those living in low-income countries.
It produces 2,700,000 annual deaths, of which more than one million occur in children under 5 years. About 50 million women living in endemic areas become pregnant each year.
In 2015, malaria disease was present in 91 countries and territories. As a result, 10,000 women and 200,000 children die from malaria acquisition during pregnancy. Malaria disease kills a child every 2 minutes.
The majority of cases and deaths are in sub-Saharan Africa. However, Asia, Latin America, the Middle East and parts of Europe are also affected. In the Americas, an estimated 132 million people live in areas at risk of contracting malaria. Those traveling from malaria-free areas to areas where the disease is prevalent are particularly vulnerable.
In addition to environmental conditions, other elements help to explain this geographical pattern. The distribution of the disease also coincides with the regions where the socio-economic situation and the health infrastructures are more precarious, which shows that today malaria disease is closely linked to poverty, being both cause and consequence of this disease. last.
In 2016, almost half of the world’s population – was at risk of contracting malaria. Most cases of malaria disease and deaths from the disease occur in sub-Saharan Africa. However, the WHO Regions of Southeast Asia, the Americas and the Eastern Mediterranean are also affected. In 2016, 91 countries were experiencing continued malaria transmission.
Some groups in the population are at much higher risk than others of getting malaria disease and being seriously ill: infants, children under 5, pregnant women, people living with HIV or AIDS, non-immune migrants, shifting populations and travelers. National malaria control programs should take special measures to protect these groups from malaria disease, taking into account their situation.
Malaria disease is a significant economic burden and can reduce the economic growth rates of countries where the disease is prevalent by 1.3%.
On November 19, 2018, the World Health Organization published this:
– Malaria is a life-threatening disease caused by parasites transmitted to humans by infected female mosquito bites.
– In 2016, there were an estimated 216 million cases of malaria in 91 countries, 5 million more than in 2015.
– Malaria resulted in 445,000 deaths in 2016, a figure similar to 2015 (446,000).
– The WHO African Region bears a disproportionate share of the global burden of malaria. In 2016, 90% of malaria cases and 91% of deaths from this disease occurred in this Region.
– In 2016, funding to fight and eliminate malaria was estimated at $ 2.7 billion (US $) in total. Government contributions from endemic countries reached $ 800 million (US $), or 31% of funding.
*** Malaria Disease in Children Can Be a Life-Threatening Disease.
Malaria is a disease that affects both children and adults. It is a life-threatening illness, but it can also be cured if it is treated the right way and at the right time.
The epicenter of the disease is located in Nigeria and the Democratic Republic of Congo in Africa, while in Asia, the most affected country is India. Malaria is the disease that causes the most deaths in children under 5, every day 3000 children die from this disease.
II – Symptoms of Malaria Disease – According to the WHO
Malaria is an acute febrile condition. In a non-immune subject, symptoms of malaria usually appear 10 to 15 days after the infective mosquito bite. The first symptoms of malaria – fever, headache, and chills – can be mild and difficult to attribute to malaria. If left untreated within 24 hours, Plasmodium falciparum malaria can progress to a severe and often fatal condition.
Highly affected children often develop one or more of the following symptoms of malaria: severe anemia, respiratory distress following metabolic acidosis or cerebral malaria.
In adults, we often observe a multi-organic attack. In endemic areas, people may sometimes be partially immunized, and there may be asymptomatic infections.
In children, the incubation process varies according to the person affected but usually lasts about 15 days. The mosquito stings and transmits the parasites to the infected child’s blood, they move and reproduce in the liver, then return to the bloodstream to kill the red blood cells.
It is a disease with a difficult diagnosis because the first symptoms of malaria, fever, which can reach 41º centigrade, and chills, are common to many diseases. It also typically presents with headaches, muscle, and joint pains and digestive disorders, such as flu or frequent diarrhea.
III – Transmission of Malaria – According to the WHO
In most cases, malaria disease is transmitted by biting female Anopheles. There are more than 400 different mosquito species of Anopheles mosquitoes, of which about thirty are very important vectors of malaria disease. All important species of malaria bite between dusk and dawn. The intensity of transmission depends on factors related to the parasite, the vector, the human host and the environment.
Anopheles lay their eggs in the water. These eggs hatch into larvae and become adult mosquitoes. Female mosquitoes look for a blood meal to feed their eggs. Each species has its preferences; some, for example, prefer shallow freshwater like that of puddles and that found in footprints left by animal hooves, which are abundant during the rainy season in tropical countries.
Transmission is more intense in places where mosquito species have a relatively long life span (allowing the parasite to complete its development cycle inside the mosquito) and bite humans rather than animals. The long lifespan and strong preference for African vector species in humans explain that nearly 90% of malaria cases occur in Africa.
Transmission also depends on climatic conditions that may affect mosquito abundance and survival, such as rainfall patterns, temperature, and humidity. In many places, transmission is seasonal with a peak during or just after the rainy season.
Malaria epidemics can occur when climate and other conditions suddenly promote transmission to areas where populations are low or not immunized. They can also occur when poorly immunized people move to areas of intense transmission, for example, to find work or as refugees.
Human immunity is another important factor, especially in adults in areas of moderate to severe transmission. Immunity develops after years of exposure and, while never giving full protection, it reduces the risk that malaria infection causes severe disorders.
This is why most malaria deaths in Africa occur in young children, whereas in low-transmission areas and where the population is poorly immunized, all age groups are exposed.
IV – Malaria Disease Prevention – According to the WHO
Vector control is the primary means of preventing and reducing malaria transmission. If coverage by vector control interventions is high enough in a given area, the entire community will be protected.
WHO recommends effective vector control to protect all populations at risk of contracting malaria disease. Two forms of vector control are effective in many situations: insecticide-treated mosquito nets and indoor spraying of residual insecticides.
*** Insecticide-Treated Mosquito Nets (ITNs)
Long-lasting insecticidal nets (LLINs) are the mosquito nets of choice for public health programs. WHO recommends that MIDs be distributed to all at-risk populations. The most efficient and cost-effective way to do this is to provide MIDs for free so that everyone has access to them under the same conditions. At the same time, effective communication strategies need to be in place so that everyone at risk of malaria disease sleeps every night under such a net.
*** Indoor Insecticide Spraying
Indoor residual insecticide spraying is a very effective way of rapidly reducing malaria transmission. For best results, insecticides should be sprayed in at least 80% of dwellings in the target areas.
This spray is effective for 3 to 6 months depending on the formulation of the insecticide used and the type of sprayed surface. In some places, the same homes must be sprayed several times to protect the population throughout the malaria transmission season.
The disease can also be prevented with antimalarials. Travelers can protect themselves with chemoprophylaxis, which removes the blood stage of malaria infection, which prevents the disease from occurring.
WHO also recommends intermittent preventive treatment with sulfadoxine-pyrimethamine for pregnant women living in areas with moderate to high transmission at each prenatal visit scheduled after the first trimester. Similarly, for infants living in areas of high transmission from Africa, 3 doses of sulfadoxine-pyrimethamine as an intermittent preventive treatment are recommended together with routine immunizations.
In 2012, WHO recommended seasonal chemoprevention of malaria as a complementary malaria prevention strategy for the Sahel sub-region of Africa. This strategy calls for a one-month treatment of amodiaquine and sulfadoxine-pyrimethamine for all children under 5 years of age during the high transmission season.
V – Diagnosis and Treatment – According to the WHO
Early diagnosis and treatment of malaria disease reduces the intensity of the disease and helps prevent death. They also help to reduce the transmission of malaria. The best available treatment, especially for P. falciparum malaria, is an artemisinin-based combination therapy (ACT).
WHO recommends that, in all suspected cases, malaria be confirmed by a diagnosis based on the search for parasites (by microscopy or rapid diagnostic test) before administering treatment. Parasitological confirmation can be obtained in 30 minutes or less. Treatment based on symptoms of malaria disease alone should only be considered if the parasitological diagnosis is not possible. More detailed guidance can be found in the Guidelines for the Treatment of Malaria (Third Edition), published in English in April 2015.
*** Vaccines Against Malaria
RTS, S / AS01 (RTS, S), also called MosquirixTM, is an injectable vaccine giving young children partial protection against malaria. This product is currently being evaluated in sub-Saharan Africa as a complementary tool for control that can be added (and not replaced) to the core set of prevention, diagnostic and treatment measures recommended by the WHO. WHO.
In July 2015, the European Medicines Agency, a stringent regulatory authority for pharmaceuticals, gave a favorable opinion on this vaccine. In October 2015, 2 WHO advisory groups recommended the implementation of RTS, S / ASO1 pilot projects in a limited number of African countries. WHO has adopted this recommendation and wholeheartedly supports the need to implement these pilot programs, towards the advent of the first malaria vaccine in the world.
In November 2016, WHO announced that the RTS vaccine will be deployed in pilot projects in 3 countries in sub-Saharan Africa: Ghana, Kenya, and Malawi. Funding for the initial phase of the program is now assured and vaccinations are due to start in 2018. These pilot projects could pave the way for a wider deployment of the vaccine if its safety and efficacy are deemed acceptable.
*** How to Protect Children from Malaria Disease?
Progress in finding the malaria vaccine is still ongoing. There is a vaccine that we work with, but it is not 100% effective.
Anopheles, the mosquito responsible for the spread of malaria disease, stings only at night, so precautions can be taken. The placement of a mosquito net with repellent has reduced by 55% deaths from malaria in the past two years.
In addition, if you are traveling with children in an area where the number of malaria cases is high, it is advisable to consult a pediatrician to prescribe an antimalarial drug as a preventive measure.
VI – For the Elimination of Malaria
Recent evidence suggests that large-scale implementation of WHO-recommended strategies could rapidly reduce malaria disease, particularly in areas of high transmissions, such as in Africa. WHO and the Member States have made significant progress in eliminating malaria. For example, recently the Maldives and Sri Lanka have been certified for eliminating malaria. The success of countries is due to intense national commitment and coordination of their efforts with partners.
Elimination is defined as the interruption of the local transmission of a well-specified Plasmodium species in a defined geographical area as a result of deliberate efforts. Continuous measures are required to prevent re-establishment of transmission. (Certification of malaria elimination in one country assumes that local transmission has been interrupted for all Plasmodium species parasitizing humans).
Malaria eradication is defined as the permanent reduction to zero of the global incidence of infection caused by human malaria parasites as a result of deliberate activities. There is no need for interventions once eradication has been achieved.
The pace of progress in a particular country depends on the strength of the national health system, the level of investment in malaria control, and a number of other factors, such as biological determinants, the environment, and social realities. demographic, political and economic aspects of the country in question.
In countries with moderate to severe malaria transmission, national malaria control programs aim to minimize the number of cases and deaths due to malaria disease.
As countries approach elimination, strengthened surveillance systems help ensure that each infection is detected, treated and reported to the national malaria registry. Patients diagnosed with symptoms of malaria disease should be treated promptly with effective antimalarial drugs to protect their own health, but also to prevent further transmission of the disease into the community.
Countries that have completed at least 3 consecutive years zero local malaria cases qualify for WHO certification of malaria elimination. In recent years, the Director-General of WHO has certified that eight countries have eliminated malaria: the United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016) and Kyrgyzstan (2016) and Paraguay (2018).
The WHO Framework for Malaria Elimination (2017) provides a comprehensive set of tools and strategies for achieving and maintaining elimination.
For the first time in many years, malaria disease is in decline, following deployment of unprecedented control tools. New diagnostic methods and available treatments have contributed to better identification of the burden of the real disease and fast treatment of cases.