Ogyantanaa the well known fetish gave them a herbal preparation to be applying on the child's body and no false spirit will dare to harm her again.
The child later became more weak and fitted again and died before the parents could reach her to the hospital.
Did you know that a child dies of Malaria every two minutes? Most of this are normally among children under age five.
Key facts
- Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.
- In 2017, there were an estimated 219 million cases of malaria in 90 countries.
- Malaria deaths reached 435 000 in 2017.
- The WHO African Region carries a disproportionately high share of the global malaria burden. In 2017, the region was home to 92% of malaria cases and 93% of malaria deaths.
- Total funding for malaria control and elimination reached an estimated US$ 3.1 billion in 2017. Contributions from governments of endemic countries amounted to US$ 900 million, representing 28% of total funding.
Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called "malaria vectors." There are 5 parasite species that cause malaria in humans, and 2 of these species – P. falciparum and P. vivax – pose the greatest threat.
- In 2017, P. falciparum accounted for 99.7% of estimated malaria cases in the WHO African Region, as well as in the majority of cases in the WHO regions of South-East Asia (62.8%), the Eastern Mediterranean (69%) and the Western Pacific (71.9%).
- P. vivax is the predominant parasite in the WHO Region of the Americas, representing 74.1% of malaria cases.
Symptoms
Malaria is an acute febrile illness. In a non-immune individual, symptoms usually appear 10–15 days after the infective mosquito bite. The first symptoms – fever, headache, and chills – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness, often leading to death.
Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ involvement is also frequent. In malaria endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur.
Who is at risk?
In 2017, nearly half of the world's population was at risk of malaria. Most malaria cases and deaths occur in sub-Saharan Africa. However, the WHO regions of South-East Asia, Eastern Mediterranean, Western Pacific, and the Americas are also at risk. In 2017, 90 countries and areas had ongoing malaria transmission.
Some population groups are at considerably higher risk of contracting malaria, and developing severe disease, than others. These include infants, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers. National malaria control programmes need to take special measures to protect these population groups from malaria infection, taking into consideration their specific circumstances.
Disease burden
According to the latest World malaria report, released in November 2018, there were 219 million cases of malaria in 2017, up from 217 million cases in 2016. The estimated number of malaria deaths stood at 435 000 in 2017.
The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2017, the region was home to 92% of malaria cases and 93% of malaria deaths.
In 2017, five countries accounted for nearly half of all malaria cases worldwide: Nigeria (25%), the Democratic Republic of the Congo (11%), Mozambique (5%), India (4%) and Uganda (4%).
In areas with high transmission of malaria, children under 5 are particularly susceptible to infection, illness and death; more than two thirds (70%) of all malaria deaths occur in this age group. The number of under-5 malaria deaths has declined from 440 000 in 2010 to 285 000 in 2016. However, malaria remains a major killer of children under five years old, taking the life of a child every two minutes.
Transmission
In most cases, malaria is transmitted through the bites of female Anopheles mosquitoes. There are more than 400 different species of Anopheles mosquito; around 30 are malaria vectors of major importance. All of the important vector species 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 mosquitoes lay their eggs in water, which hatch into larvae, eventually emerging as adult mosquitoes. The female mosquitoes seek a blood meal to nurture their eggs. Each species of Anopheles mosquito has its own preferred aquatic habitat; for example, some prefer small, shallow collections of fresh water, such as puddles and hoof prints, which are abundant during the rainy season in tropical countries.
Transmission is more intense in places where the mosquito lifespan is longer (so that the parasite has time to complete its development inside the mosquito) and where it prefers to bite humans rather than other animals. The long lifespan and strong human-biting habit of the African vector species is the main reason why nearly 90% of the world's malaria cases are in Africa.
Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.
Human immunity is another important factor, especially among adults in areas of moderate or intense transmission conditions. Partial immunity is developed over years of exposure, and while it never provides complete protection, it does reduce the risk that malaria infection will cause severe disease. For this reason, most malaria deaths in Africa occur in young children, whereas in areas with less transmission and low immunity, all age groups are at risk.
Prevention
Vector control is the main way to prevent and reduce malaria transmission. If coverage of vector control interventions within a specific area is high enough, then a measure of protection will be conferred across the community.
WHO recommends protection for all people at risk of malaria with effective malaria vector control. Two forms of vector control – insecticide-treated mosquito nets and indoor residual spraying – are effective in a wide range of circumstances.
Insecticide-treated mosquito nets
Long-lasting insecticidal nets (LLINs) are the preferred form of insecticide-treated mosquito nets (ITNs) for public health programmes. In most settings, WHO recommends LLIN coverage for all people at risk of malaria. The most cost-effective way to achieve this is by providing LLINs free of charge, to ensure equal access for all. In parallel, effective behaviour change communication strategies are required to ensure that all people at risk of malaria sleep under a LLIN every night, and that the net is properly maintained.
Indoor spraying with residual insecticides
Indoor residual spraying (IRS) with insecticides is a powerful way to rapidly reduce malaria transmission. Its potential is realized when at least 80% of houses in targeted areas are sprayed. Indoor spraying is effective for 3–6 months, depending on the insecticide formulation used and the type of surface on which it is sprayed. In some settings, multiple spray rounds are needed to protect the population for the entire malaria season.
Antimalarial drugs
Antimalarial medicines can also be used to prevent malaria. For travellers, malaria can be prevented through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby preventing malaria disease. For pregnant women living in moderate-to-high transmission areas, WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine, at each scheduled antenatal visit after the first trimester. Similarly, for infants living in high-transmission areas of Africa, 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine are recommended, delivered alongside routine vaccinations.
In 2012, WHO recommended Seasonal Malaria Chemoprevention as an additional malaria prevention strategy for areas of the Sahel sub-region of Africa. The strategy involves the administration of monthly courses of amodiaquine plus sulfadoxine-pyrimethamine to all children under 5 years of age during the high transmission season.
Insecticide resistance
Much of the success in controlling malaria is due to vector control. Vector control is continues to be highly dependent on the use of pyrethroids, which are the only class of insecticides currently recommended for use in ITNs or LLINs.
In recent years, mosquito resistance to pyrethroids has emerged evolved in Anopheles mosquitoes. Since 2010, 66many malaria-endemic countries have confirmed resistance to this class of insecticide. Resistance to organochlorines, carbamates and organophosphates, used for IRS, is also widespread. So far, 22 countries have confirmed In some areas, resistance to all 4 out of 5 classes of insecticides used for public health and 57 countries have reported resistance to 2 or more classes. No reports has been detected of resistance to neonicotinoids – a fifth class of insecticide – have been received so far. More information on the global status of insecticide resistance can be found in the Global Report on insecticide resistance in malaria vectors http://www.who.int/malaria/publications/atoz/9789241514057/en/
. Fortunately,Despite the emergence and spread of pyrethroid resistance, there is evidence showing that LLINs this resistance has only rarely been associated with decreased efficacy of LLINs, which continue to provide a substantial level of protection in most settings. This was evidenced in a large multi-country evaluation coordinated by WHO between 2011 and 2016, which found no evidence of association between insecticide resistance and malaria disease burden across study locations in 5 countries.
Nevertheless, the spread of insecticide resistance threatens the effectiveness of vector control interventions. New insecticides and other tools are needed to address the emerging threat. Rotational use of different existing classes of insecticides for in IRS is recommended as one approach to manage insecticide resistance.
However, malaria-endemic areas of sub-Saharan Africa and India are causing significant concern due to high levels of malaria transmission and widespread reports of insecticide resistance. The use of 2 different insecticides in a mosquito net offers an opportunity to mitigate the risk of the development and spread of insecticide resistance; developing these new nets is a priority. Several promising products for both IRS and nets are in the pipeline.
Detection Monitoring of insecticide resistance should be an essential component of all national malaria control efforts to ensure inform the selection of that the most effective vector control methods are being used. Countries are encouraged to develop national plans for insecticide resistance monitoring and management. A framework to support this process was released by WHO in 2017. The choice of insecticide for IRS should always be informed by recent, local data on the susceptibility of target vectors.
To ensure a timely and coordinated global response to the threat of insecticide resistance, WHO worked with a wide range of stakeholders to develop the "Global Plan for Insecticide Resistance Management in Malaria Vectors (GPIRM)", which was released in May 2012.
Diagnosis and treatment
Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to reducing malaria transmission. The best available treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT).
WHO recommends that all cases of suspected malaria be confirmed using parasite-based diagnostic testing (either microscopy or rapid diagnostic test) before administering treatment. Results of parasitological confirmation can be available in 30 minutes or less. Treatment, solely on the basis of symptoms should only be considered when a parasitological diagnosis is not possible. More detailed recommendations are available in the "WHO Guidelines for the treatment of malaria", third edition, published in April 2015.
Antimalarial drug resistance
Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1950s and 1960s, undermining malaria control efforts and reversing gains in child survival.
WHO recommends the routine monitoring of antimalarial drug resistance, and supports countries to strengthen their efforts in this important area of work.
An ACT contains both the drug artemisinin and a partner drug. In recent years, parasite resistance to artemisinin has been detected in 5 countries of the Greater Mekong subregion: Cambodia, Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam. Studies have confirmed that artemisinin resistance has emerged independently in many areas of this subregion.
In 2013, WHO launched the Emergency response to artemisinin resistance (ERAR) in the Greater Mekong Subregion (GMS), a high-level plan of attack to contain the spread of drug-resistant parasites and to provide life-saving tools for all populations at risk of malaria. But even as this work was under way, additional pockets of resistance emerged independently in new geographic areas of the subregion. In parallel, there were reports of increased resistance to ACT partner drugs in some settings. A new approach was needed to keep pace with the changing malaria landscape.
Consequently, WHO’s Malaria Policy Advisory Committee in September 2014 recommended adopting the goal of eliminating P. falciparum malaria in this subregion by 2030. WHO launched the Strategy for Malaria Elimination in the Greater Mekong Subregion (2015–2030) at the World Health Assembly in May 2015, which was endorsed by all the countries in the subregion. With technical guidance from WHO, all GMS countries have developed national malaria elimination plans. Together with partners, WHO is providing ongoing support for country elimination efforts through the Mekong Malaria Elimination programme, an initiative that evolved from the ERAR.
Surveillance
Surveillance entails tracking of the disease and programmatic responses, and taking action based on the data received. Currently, many countries with a high burden of malaria have weak surveillance systems and are not in a position to assess disease distribution and trends, making it difficult to optimize responses and respond to outbreaks.
Effective surveillance is required at all points on the path to malaria elimination and the Global Technical Strategy for Malaria 2016-2030 (GTS) recommends that countries transform surveillance into a core intervention. Strong malaria surveillance enables programmes to optimize their operations, by empowering programmes to:
- advocate for investment from domestic and international sources, commensurate with the malaria disease burden in a country or subnational area;
- allocate resources to populations most in need and to interventions that are most effective, in order to achieve the greatest possible public health impact;
- assess regularly whether plans are progressing as expected or whether adjustments in the scale or combination of interventions are required;
- account for the impact of funding received and enable the public, their elected representatives and donors to determine if they are obtaining value for money; and
- evaluate whether programme objectives have been met and learn what works so that more efficient and effective programmes can be designed.
In March 2018, WHO released a reference manual on malaria surveillance, monitoring and evaluation that provides guidance on global surveillance standards and guides countries in their efforts to strengthen surveillance systems and use their own data to make evidence-informed decisions.
Stronger malaria surveillance systems are urgently needed to enable a timely and effective malaria response in endemic regions, to prevent outbreaks and resurgences, to track progress, and to hold governments and the global malaria community accountable.
Elimination
Malaria elimination is defined as the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities. Continued measures are required to prevent re-establishment of transmission.
Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by human malaria parasites as a result of deliberate activities. Interventions are no longer required once eradication has been achieved.
Countries that have achieved at least 3 consecutive years of 0 local cases of malaria are eligible to apply for the WHO certification of malaria elimination. In recent years, 8 countries have been certified by the WHO Director-General as having eliminated malaria: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016), Kyrgyzstan (2016) and Paraguay (2018). The WHO Framework for Malaria Elimination (2017) provides a detailed set of tools and strategies for achieving and maintaining elimination.
Vaccines against malaria
RTS,S/AS01 (RTS,S) – also known as Mosquirix – is an injectable vaccine that provides partial protection against malaria in young children. The vaccine is being evaluated in sub-Saharan Africa as a complementary malaria control tool that potentially could be added to (and not replace) the core package of WHO-recommended preventive, diagnostic and treatment measures.
In July 2015, the vaccine received a positive opinion by the European Medicines Agency, a stringent medicines regulatory authority. In October 2015, two WHO advisory groups recommended pilot implementation of RTS, S/AS01 in a limited number of African countries. WHO adopted these recommendations and is strongly supportive of the need to proceed with the pilot programme as the next step for the world’s first malaria vaccine.
In November 2016, WHO announced that the RTS,S vaccine would be rolled out in pilot projects in selected areas in 3 countries in sub-Saharan Africa: Ghana, Kenya and Malawi. Funding has been secured for the initial phase of the programme and vaccinations are due to begin in early 2019. These pilot projects could pave the way for wider deployment of the vaccine if safety and effectiveness are considered acceptable.
WHO response
WHO Global Technical Strategy for Malaria 2016-2030
The WHO Global Technical Strategy for Malaria 2016-2030 – adopted by the World Health Assembly in May 2015 – provides a technical framework for all malaria-endemic countries. It is intended to guide and support regional and country programmes as they work towards malaria control and elimination.
The Strategy sets ambitious but achievable global targets, including:
- Reducing malaria case incidence by at least 90% by 2030.
- Reducing malaria mortality rates by at least 90% by 2030.
- Eliminating malaria in at least 35 countries by 2030.
- Preventing a resurgence of malaria in all countries that are malaria-free.
This Strategy was the result of an extensive consultative process that spanned 2 years and involved the participation of more than 400 technical experts from 70 Member States. It is based on 3 key pillars:
- ensuring universal access to malaria prevention, diagnosis and treatment;
- accelerating efforts towards elimination and attainment of malaria-free status; and
- transforming malaria surveillance into a core intervention.
The WHO Global Malaria Programme (GMP) coordinates WHO's global efforts to control and eliminate malaria by:
- setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies, and guidelines;
- keeping independent score of global progress;
- developing approaches for capacity building, systems strengthening, and surveillance; and
- identifying threats to malaria control and elimination as well as new areas for action.
GMP is supported and advised by the Malaria Policy Advisory Committee (MPAC), a group of 15 global malaria experts appointed following an open nomination process. The MPAC, which meets twice yearly, provides independent advice to WHO to develop policy recommendations for the control and elimination of malaria. The mandate of MPAC is to provide strategic advice and technical input, and extends to all aspects of malaria control and elimination, as part of a transparent, responsive and credible policy-setting process.
High burden high impact approach
At the World Health Assembly in May 2018, the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, called for an aggressive new approach to jump-start progress against malaria. A new country-driven response – “High burden to high impact” – was launched in Mozambique in November 2018.
The approach will be driven by the 11 countries that carry the highest burden of the disease (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania). Key elements include:
- Political will to reduce the toll of malaria;
- Strategic information to drive impact;
- Better guidance, policies and strategies; and
- A coordinated national malaria response.
Catalyzed by WHO and the RBM Partnership to End Malaria, “High burden to high impact” builds on the principle that no one should die from a disease that can be prevented and diagnosed, and that is entirely curable with available treatments. The support and engagement of all partners will be critically important to the success of this country-led approach. For more information, please refer to the “High burden high impact” response brochure .
Source: https://www.who.int/news-room/fact-sheets/detail/malaria
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